肿胀麻醉与锐性解剖对比电灼解剖在即刻假体乳房重建的微创保乳全切除术中的手术及肿瘤学结果：一项真实世界回顾性队列研究

Surgical and Oncologic Outcomes of Tumescence and Sharp Dissection Versus Electrocautery Dissection in Minimal-Access Nipple-Sparing Mastectomy with Immediate Prosthesis Breast Reconstruction: A Real-World Retrospective Cohort Study.

作者信息

Ou Xinyu, Liu Zhihan, Liu Caigang, Wang Kun, Zhang Pusheng, Meng Xuli, Wei Wei, Shi Yuan, Liu Shu, Li Taolang, Xu Tai, Tang Wei, Liu Chenlu, Li Jiangtao, Li Zixuan, Zhao Jianli, Nie Yan, Chen GuangLei, Lv Zhenye, Liu Xiaoling, Yao Yandan, Lu Yiwen, Su Shicheng

机构信息

Breast Tumor Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China.

Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China.

出版信息

Ann Surg Oncol. 2025 Jun 25. doi: 10.1245/s10434-025-17680-4.

DOI:10.1245/s10434-025-17680-4

PMID:40563030

Abstract

BACKGROUND

Minimal-access nipple-sparing mastectomy (NSM) with immediate prosthesis breast reconstruction results in better cosmetic outcomes than conventional operation. However, the impact of skin flap development techniques on postoperative complications and long-term oncologic safety is largely unknown. This report describes the surgical and oncologic outcomes of tumescence and sharp dissection compared with electrocautery dissection.

METHODS

In this real-world retrospective cohort study, 5436 individuals undergoing NSM from 12 centers in China were identified. After exclusions and propensity score-matching, the study included 1252 patients who underwent minimal-access NSM with immediate prosthesis breast reconstruction between January 2016 and December 2022. Perioperative parameters, postsurgical complications, and long-term survival were analyzed.

RESULTS

Of the 1252 patients, 313 (25 %) underwent tumescence and sharp dissection, and 939 (75 %) underwent electrocautery dissection. The patients in the tumescence and sharp dissection group had significantly lower rates of necrotic complications (5.8 % vs 13.0 %; p = 0.001), infection (2.6 % vs 5.6 %; p = 0.041), and implant loss (0.3 % vs 2.2 %; p = 0.025) than those receiving electrocautery dissection, with a significantly shorter operation time (median, 177 min; interquartile range [IQR], 132-219 min vs 201 min; IQR, 143-249 min; p < 0.001). The two groups did not differ significantly in 5-year overall survival (p = 0.938) or disease-free survival (p = 0.893).

CONCLUSION

Tumescence and sharp dissection was associated with fewer postoperative complications and a shorter operation time than electrocautery dissection for breast cancer patients receiving minimal-access NSM with immediate prosthesis breast reconstruction, and showed no significant difference in long-term survival.

摘要

背景

与传统手术相比，采用即刻假体乳房重建的微创保乳手术（NSM）能带来更好的美容效果。然而，皮瓣制作技术对术后并发症和长期肿瘤学安全性的影响在很大程度上尚不清楚。本报告描述了肿胀麻醉锐性剥离与电刀剥离相比的手术及肿瘤学结果。

方法

在这项真实世界的回顾性队列研究中，确定了来自中国12个中心的5436例行NSM的患者。经过排除和倾向评分匹配后，该研究纳入了2016年1月至2022年12月期间行微创NSM并即刻假体乳房重建的1252例患者。分析围手术期参数、术后并发症和长期生存率。

结果

在1252例患者中，313例（25%）采用肿胀麻醉锐性剥离，939例（75%）采用电刀剥离。与接受电刀剥离的患者相比，肿胀麻醉锐性剥离组患者的坏死并发症发生率（5.8%对13.0%；p = 0.001）、感染发生率（2.6%对5.6%；p = 0.041）和植入物丢失率（0.3%对2.2%；p = 0.025）显著更低，手术时间显著更短（中位数，177分钟；四分位间距[IQR]，132 - 219分钟对201分钟；IQR，143 - 249分钟；p < 0.001）。两组在5年总生存率（p = 0.938）或无病生存率（p = 0.893）方面无显著差异。