平衡乳腺浸润性小叶癌且BMI升高患者的手术并发症风险与切缘阳性情况：一项机构队列研究。
Balancing risks of surgical complications and positive margins for patients with invasive lobular carcinoma of the breast and elevated BMI: An institutional cohort study.
作者信息
Falade Israel, Switalla Kayla, Quirarte Astrid, Baxter Molly, Soroudi Daniel, Rothschild Harriet, Abe Shoko Emily, Goodwin Karen, Piper Merisa, Alvarado Michael, Julian Bao-Quynh, Ewing Cheryl, Wong Jasmine, Rose John, Esserman Laura, Foster Robert, Mukhtar Rita A
机构信息
University of California San Francisco, School of Medicine, San Francisco, CA, USA.
University of California San Francisco, Department of Surgery, San Francisco, CA, USA.
出版信息
Am J Surg. 2025 Mar;241:116073. doi: 10.1016/j.amjsurg.2024.116073. Epub 2024 Nov 6.
BACKGROUND
The risks of postoperative complications in breast cancer patients vary by patient and tumor characteristics. Elevated BMI and invasive lobular carcinoma (ILC) increase risks of surgical complications and positive margins, respectively.
METHODS
We retrospectively analyzed patients with BMI ≥30 kg/m from an institutional ILC database. The primary outcome was surgical complication rate by procedure type. The secondary outcome was positive margin rates by surgical approach, stratified by T stage.
RESULTS
Of 154 analyzed patients, standard BCS, lumpectomy with oncoplastic closure, and simple mastectomy had the lowest complication rates (18.2 %, 17.0 %, 11.8 %). Oncoplastic reduction mammoplasty and mastectomy with aesthetic closure had the highest rates (35.5 %, 33.3 %). The overall positive margin rate was 28.5 %, significantly higher in BCS vs. mastectomy (37.4 % vs. 15.0 %, p = 0.003). Oncoplastic surgery significantly reduced positive margin rates in BCS.
CONCLUSION
In this study, 23.4 % of patients experienced surgical complications, with higher rates in oncoplastic/reconstructive approaches. However, oncoplastic surgery reduced positive margins, highlighting the importance of balancing risks for optimal surgical planning.
背景
乳腺癌患者术后并发症的风险因患者和肿瘤特征而异。BMI升高和浸润性小叶癌（ILC）分别增加手术并发症和切缘阳性的风险。
方法
我们对一个机构性ILC数据库中BMI≥30 kg/m²的患者进行了回顾性分析。主要结局是按手术类型划分的手术并发症发生率。次要结局是按手术方式划分的切缘阳性率，并按T分期进行分层。
结果
在154例分析患者中，标准保乳手术（BCS）、肿瘤整形闭合的肿块切除术和单纯乳房切除术的并发症发生率最低（分别为18.2%、17.0%、11.8%）。肿瘤整形缩乳术和美容闭合的乳房切除术发生率最高（分别为35.5%、33.3%）。总体切缘阳性率为28.5%，BCS组显著高于乳房切除术组（37.4%对15.0%，p = 0.003）。肿瘤整形手术显著降低了BCS的切缘阳性率。
结论
在本研究中，23.4%的患者发生了手术并发症，肿瘤整形/重建手术方式的发生率更高。然而，肿瘤整形手术降低了切缘阳性率，突出了在优化手术规划时平衡风险的重要性。
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