Wing Sam E, Liu Yuki, Zheng Feibi, Hamm Naomi C, Dekhne Nayana S, Selber Jesse C
Intuitive Surgical, Health Economics and Outcomes Research, 1020 Kifer Rd, Sunnyvale, CA, 94086, USA.
Michael DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA.
Breast Cancer Res Treat. 2025 Jun 3. doi: 10.1007/s10549-025-07735-1.
~ 14-25% of patients who undergo a primary lumpectomy for the treatment of breast cancer require a reoperation due to adverse outcomes like positive surgical margins or early cancer recurrence, adding burden to the patients, providers, and payors. We analyze the economic impact of patients who require repeat breast tissue resection as part of their treatment following initial resection.
We utilized the Merative™ MarketScan Research Database to identify a cohort of women in the United States who received an index lumpectomy between 2016 and 2021 and identified their healthcare encounters one year postoperatively, including any repeat lumpectomies or mastectomies, as well as the use of any intraoperative adjuncts (e.g. localization methods or frozen sections).
Among 8,869 patients with a primary lumpectomy, 25% (n = 2197) underwent a second surgery, of which 75% (n = 1644) was a repeat lumpectomy and 25% (n = 553) was a mastectomy. Median healthcare expenditure for primary lumpectomy plus one year follow up was $55,985 USD ($2,500 out-of-pocket). Among patients with secondary procedures, median healthcare expenditure from primary lumpectomy plus one year follow up was $63,416 ($3,005 out-of-pocket) for repeat lumpectomy and $87,961 ($3,100 out-of-pocket) for subsequent mastectomy patients. Repeat procedures were more common among patients who did not receive an intraoperative adjunct for lesion localization or margin assessment.
While lumpectomy is the most common surgery for early-stage breast cancer, it often is not definitive, which can result in large added financial and operational burdens. Patient risk stratification and intraoperative adjuncts are needed to minimize risk of reoperation.
因手术切缘阳性或早期癌症复发等不良后果，约14% - 25%接受乳腺癌初次保乳手术的患者需要再次手术，这给患者、医疗服务提供者和支付方都带来了负担。我们分析了初次切除术后需要再次切除乳腺组织作为治疗一部分的患者的经济影响。
我们利用默克医疗保健公司（Merative™）的市场扫描研究数据库，确定了2016年至2021年间在美国接受初次保乳手术的一组女性，并确定了她们术后一年的医疗接触情况，包括任何再次保乳手术或乳房切除术，以及任何术中辅助手段（如定位方法或冰冻切片）的使用情况。
在8869例接受初次保乳手术的患者中，25%（n = 2197）接受了二次手术，其中75%（n = 1644）是再次保乳手术，25%（n = 553）是乳房切除术。初次保乳手术加一年随访的医疗费用中位数为55,985美元（自付2500美元）。在接受二次手术的患者中，再次保乳手术患者初次保乳手术加一年随访的医疗费用中位数为63,416美元（自付3005美元），后续乳房切除术患者为87,961美元（自付3100美元）。未接受术中病变定位或切缘评估辅助手段的患者再次手术更为常见。
虽然保乳手术是早期乳腺癌最常见的手术方式，但往往并非根治性手术，这可能导致巨大的额外财务和运营负担。需要对患者进行风险分层并使用术中辅助手段，以尽量降低再次手术的风险。
