Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
Department of Acute and Trauma Surgery, Karolinska University Hospital, Stockholm, Sweden.
BJS Open. 2024 Sep 3;8(5). doi: 10.1093/bjsopen/zrae095.
While immediate breast reconstruction rates in breast cancer are increasing, they remain low in women over 65 years old. The aim was to investigate surgical outcomes in women older than 65 years receiving implant-based immediate breast reconstruction.
The population-based Stockholm Breast Reconstruction Database includes all adult women with breast cancer receiving an implant-based immediate breast reconstruction in Stockholm, Sweden, 2005-2015. Primary outcomes within 30 days from immediate breast reconstruction were: infection requiring antibiotics and reoperation on. Implant removal was a secondary outcome. Women more than 65 years were compared with younger age groups. Chi-square tests and multivariable logistic regression were applied for the primary outcomes, and Kaplan-Meier analysis for the secondary outcome.
Among 1749 cases of immediate breast reconstruction, 140 (8.0%) were in women more than 65 years. Median follow-up was 74 months (1-198). Postoperative infection was not more common in women older than 65 years old (22 of 140, 15.7%) than in women under 65 years old (303 of 1609, 18.8%; P = 0.221). Reoperation on was more frequent in women older than 65 years than in other age groups (more than 65: 8.6%; 50-64: 6.5%; 40-49: 3.5%; less than 40: 1.6%; P < 0.001), however, age older than 65 years was not an independent risk factor in the multivariable analysis (OR 1.00, 95% c.i. 0.44 to 2.28). Overall, 6-year probability of implant removal was 11.4%, (8.1% due to complications and 3.3% due to patient preference). There was no statistically significant difference between age groups for either reason (P = 0.085 and P = 0.794 respectively).
Older age alone was not associated with worse surgical outcomes after implant-based immediate breast reconstruction in highly selected patients older than 65 years when compared with their younger counterparts.
虽然乳腺癌即刻乳房重建的比例在不断增加，但在 65 岁以上的女性中仍较低。本研究旨在调查在瑞典斯德哥尔摩接受基于植入物的即刻乳房重建的 65 岁以上女性的手术结果。
基于人群的斯德哥尔摩乳房重建数据库纳入了 2005 年至 2015 年期间在瑞典斯德哥尔摩接受基于植入物的即刻乳房重建的所有成年乳腺癌女性。即刻乳房重建后 30 天内的主要结局为：需要抗生素治疗的感染和再次手术。假体取出为次要结局。将 65 岁以上的女性与年轻年龄组进行比较。主要结局采用卡方检验和多变量逻辑回归，次要结局采用 Kaplan-Meier 分析。
在 1749 例即刻乳房重建病例中，140 例（8.0%）为 65 岁以上的女性。中位随访时间为 74 个月（1-198）。65 岁以上的女性术后感染并不比 65 岁以下的女性更常见（140 例中的 22 例[15.7%]与 1609 例中的 303 例[18.8%]；P=0.221）。65 岁以上的女性再次手术的比例高于其他年龄组（65 岁以上：8.6%；50-64 岁：6.5%；40-49 岁：3.5%；<40 岁：1.6%；P<0.001），但在多变量分析中，年龄大于 65 岁并不是独立的危险因素（OR 1.00，95%CI 0.44 至 2.28）。总体而言，6 年假体取出率为 11.4%（8.1%因并发症，3.3%因患者偏好）。两组之间在任何原因方面均无统计学差异（分别为 P=0.085 和 P=0.794）。
在高度选择的 65 岁以上患者中，与年轻患者相比，单独年龄因素与基于植入物的即刻乳房重建后手术结果较差无关。
