Department for Surgical Sciences, Uppsala University, Uppsala, Sweden.
Section for Breast Surgery, Department of Surgery, Akademiska University Hospital, Uppsala, Sweden.
Br J Surg. 2024 Oct 30;111(11). doi: 10.1093/bjs/znae266.
Chest wall perforator flaps are emerging in oncoplastic breast conservation, mostly as an alternative to mastectomy. However, standardization and consensus on patient selection, techniques, and outcomes have not yet been reached. The aim of this international multicentre collaborative study was to explore practice patterns and outcomes in high-volume centres from different countries.
Patients with both pre-invasive and invasive breast cancer treated at the Uppsala University Hospital in Uppsala, Sweden, the Royal Marsden Hospital in London, UK, and the Westmead Breast Cancer Institute in Sydney, Australia, were included in this study. The rationale for offering chest wall perforator flaps and surgical outcomes were prospectively documented.
In total, 603 patients were analysed median age of 54 (interquartile range (i.q.r.) 48-63) years, median BMI of 25.0 (i.q.r. 22.5-28.1) kg/m2, median tumour extent of 30 (IQR 19-45) mm, median breast volume of 280 (i.q.r. 216-430) ml, and median calculated resection ratio of 16% (i.q.r. 9%-28%). In 67.7%, the treating surgeon had offered chest wall perforator flaps to avoid mastectomy. The procedure was performed as day surgery in 69.5% of patients, with an overall complication rate of 8.6% and the majority of complications being classified as Clavien-Dindo grade I (5.3% of patients). The re-excision rate was 15.9%, with only 1.5% of patients converting to a mastectomy. There were no flap losses. At a median follow-up of 22 (range 12 to 98) months, rates of local recurrence, distant recurrence, and breast cancer-related mortality were 1.9%, 4.9%, and 1.7% respectively.
Chest wall perforator flaps are a useful option to allow more women to avoid mastectomy. In experienced hands, the procedure is safe and should be offered to suitable patients.
胸壁穿支皮瓣在肿瘤整形保乳术中越来越多地应用，主要作为乳房切除术的替代方法。然而，患者选择、技术和结果的标准化和共识尚未达成。本国际多中心合作研究的目的是探讨来自不同国家的高容量中心的实践模式和结果。
本研究纳入了在瑞典乌普萨拉大学医院、英国伦敦皇家马斯登医院和澳大利亚韦斯特米德乳腺癌研究所接受治疗的患有浸润性和非浸润性乳腺癌的患者。前瞻性记录提供胸壁穿支皮瓣的理由和手术结果。
共分析了 603 例患者，中位年龄为 54 岁（四分位距 48-63 岁），中位 BMI 为 25.0（四分位距 22.5-28.1）kg/m2，中位肿瘤范围为 30（四分位距 19-45）mm，中位乳房体积为 280（四分位距 216-430）ml，中位计算切除率为 16%（四分位距 9%-28%）。67.7%的治疗医生为避免乳房切除术而提供了胸壁穿支皮瓣。该手术有 69.5%的患者作为日间手术进行，总体并发症发生率为 8.6%，大多数并发症为 Clavien-Dindo Ⅰ级（5.3%的患者）。再次切除率为 15.9%，仅有 1.5%的患者转为乳房切除术。没有皮瓣丢失。在中位随访 22（范围 12 至 98）个月时，局部复发、远处复发和乳腺癌相关死亡率分别为 1.9%、4.9%和 1.7%。
胸壁穿支皮瓣是允许更多女性避免乳房切除术的一种有用选择。在有经验的医生手中，该手术是安全的，应提供给合适的患者。
