肿瘤整形手术联合容积置换与植入式乳房重建的乳房切除术：乳腺癌患者的早期术后并发症

Oncoplastic Surgery with Volume Replacement versus Mastectomy with Implant-Based Breast Reconstruction: Early Postoperative Complications in Patients with Breast Cancer.

作者信息

Ku Gabriel De La Cruz, Desai Anshumi, Singhal Meera, Mallouh Michael, King Caroline, Rojas Alexis N, Persing Sarah, Homsy Christopher, Chatterjee Abhishek, Nardello Salvatore

机构信息

Universidad Cientifica del Sur, Lima, Peru.

Department of Surgery, University of Massachusetts Medical School, Worcester, Massachusetts.

出版信息

J Reconstr Microsurg. 2024 Dec 20. doi: 10.1055/a-2491-3110.

DOI:10.1055/a-2491-3110

PMID:39608763

Abstract

BACKGROUND

Two common surgical approaches for breast cancer are breast-conserving surgery and mastectomy with implant-based breast reconstruction (MIBR). However, for large tumors, an alternative to MIBR is oncoplastic surgery with volume replacement (OPSVR). We performed a comprehensive analysis comparing OPSVR with MIBR, with our aim to focus on the 30-day postoperative complications between these two techniques.

METHODS

We conducted a retrospective cohort study using the National Surgical Quality Improvement Program (NSQIP) database from 2005 to 2020. Only breast cancer patients were included and were divided according to the surgical technique: OPSVR and MIBR. Logistic regression analysis was used to assess independent risk factors for total, surgical, and wound complications.

RESULTS

A cohort of 8,403 breast cancer patients was analyzed. A total of 683 underwent OPSVR and 7,720 underwent MIBR. From 2005 to 2020, the adoption of OPSVR gradually increased over the years ( < 0.001), whereas MIBR decreased. OPSVR patients were older (57.04 vs. 51.89 years, < 0.001), exhibited a higher body mass index (31.73 vs. 26.93, < 0.001), had a greater prevalence of diabetes mellitus (11.0 vs. 5.0%, < 0.001). They also had a higher ASA classification (2.33 vs. 2.15, < 0.001), shorter operative time (173.39 vs. 216.20 minutes, < 0.001), and a higher proportion of outpatient procedures (83.7 vs. 39.5%, < 0.001). Outcome analysis demonstrated fewer total complications in the OPSVR patients (4.2 vs. 10.9%, < 0.001), including lower rates of surgical complications (2.2 vs. 8.0%, < 0.001) and wound complications (1.9 vs. 4.8%, = 0.005) compared with MIBR patients. Multivariate analysis identified OPSVR as an independent protective factor for total, surgical, and wound complications.

CONCLUSION

OPSVR has become a favorable technique for patients with breast cancer. Even in patients with higher comorbidities, OPSVR demonstrates safe and better outcomes when compared with MIBR. It should be considered a reasonable and safe breast surgical option in the appropriate patient.

摘要

背景

乳腺癌的两种常见手术方法是保乳手术和基于植入物的乳房重建乳房切除术（MIBR）。然而，对于大肿瘤，MIBR的一种替代方法是带容量置换的肿瘤整形手术（OPSVR）。我们进行了一项全面分析，比较OPSVR和MIBR，旨在关注这两种技术术后30天的并发症。

方法

我们使用2005年至2020年的国家外科质量改进计划（NSQIP）数据库进行了一项回顾性队列研究。仅纳入乳腺癌患者，并根据手术技术分为：OPSVR和MIBR。采用逻辑回归分析评估总体、手术和伤口并发症的独立危险因素。

结果

分析了一组8403例乳腺癌患者。共有683例接受了OPSVR，7720例接受了MIBR。从2005年到2020年，OPSVR的采用率逐年逐渐增加（<0.001），而MIBR则下降。OPSVR患者年龄较大（57.04岁对51.89岁，<0.001），体重指数较高（31.73对26.93，<0.001），糖尿病患病率更高（11.0%对5.0%，<0.001）。他们的美国麻醉医师协会（ASA）分级也更高（2.33对2.15，<0.001），手术时间更短（173.39分钟对216.20分钟，<0.001），门诊手术比例更高（83.7%对39.5%，<0.001）。结果分析表明，与MIBR患者相比，OPSVR患者的总体并发症更少（4.2%对10.9%，<0.001），包括手术并发症发生率更低（2.2%对8.0%，<0.001）和伤口并发症发生率更低（1.9%对4.8%，=0.005）。多变量分析确定OPSVR是总体、手术和伤口并发症的独立保护因素。