预防性乳房切除术及即刻游离皮瓣乳房重建术的代价——30天的结果

Prevention's Price-30-Day Outcomes of Risk-Reducing Mastectomy and Immediate Free Flap Breast Reconstruction.

作者信息

Knoedler Samuel, Diatta Fortunay, Hu Kevin, Klimitz Felix, Wirtz Julius M, Schaschinger Thomas, Perozzo Filippo A G, Sofo Giuseppe, Marena Francesco, Kim Bong-Sung, Pomahac Bohdan, Kauke-Navarro Martin

机构信息

Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT.

Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT; Department of Hand-, Plastic, and Reconstructive Surgery, Microsurgery, Burn Trauma Center. BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany.

出版信息

Clin Breast Cancer. 2025 Jul 10. doi: 10.1016/j.clbc.2025.07.003.

DOI:10.1016/j.clbc.2025.07.003

PMID:40754572

Abstract

BACKGROUND

Risk-reducing mastectomy (RRM) with free flap breast reconstruction (FFBR) is increasingly utilized for breast cancer prevention. While its oncological benefits are well-established, data on perioperative safety remain limited. To address this gap, we analyzed postoperative outcomes and risk factors for complications utilizing the American college of surgeons national surgical quality improvement program (ACS-NSQIP) database.

METHODS

The American college of surgeons national surgical quality improvement program (ACS-NSQIP) (2008-2022) database was queried to identify adult female patients who underwent RRM-FFBR. Primary outcomes included 30-day rates of reoperation, readmission, and surgical or medical complications. Confounder-adjusted multivariate logistic regression was used to identify factors associated with postoperative complications.

RESULTS

A total of 985 patients were included, with a mean age and BMI of 46 ± 9.4 years and 31 ± 5.7 kg/m², respectively. The most common comorbidities were obesity (n = 492; 50%) and hypertension (n = 170; 17%). Complications occurred in 171 (17%) cases, with 134 (14%) reoperations and 69 (7.0%) readmissions. 125 (13%) surgical complications were recorded, the majority of which were bleeding events (n = 105; 11%). Medical complications were rare (n = 33; 3.4%). Multivariable analyses revealed that higher hypertension (OR 1.8; 95% CI, 1.1-2.8; P = .017) and diabetes (OR 2.2.; 95% CI, 1.1-4.6; P = .031) were significantly associated with the occurrence of postoperative complications.

CONCLUSION

This multi-institutional study revealed 30-day complication and reoperation rates of 17% and 14%, respectively, following RRM-FFBR. Hypertension and diabetes were significant predictors of postoperative morbidity. Preoperative optimization of these modifiable risk factors may help improve surgical outcomes. These findings underscore the importance of individualized patient management and informed decision-making in RRM-FFBR.

摘要

背景

采用游离皮瓣乳房重建术（FFBR）的降低风险乳房切除术（RRM）越来越多地用于预防乳腺癌。虽然其肿瘤学益处已得到充分证实，但围手术期安全性的数据仍然有限。为了填补这一空白，我们利用美国外科医师学会国家外科质量改进计划（ACS-NSQIP）数据库分析了术后结果和并发症的风险因素。

方法

查询美国外科医师学会国家外科质量改进计划（ACS-NSQIP）（2008 - 2022年）数据库，以识别接受RRM-FFBR的成年女性患者。主要结局包括再次手术、再次入院以及手术或医疗并发症的30天发生率。采用混杂因素调整的多变量逻辑回归分析来确定与术后并发症相关的因素。

结果

共纳入985例患者，平均年龄和体重指数分别为46±9.4岁和31±5.7kg/m²。最常见的合并症是肥胖（n = 492；50%）和高血压（n = 170；17%）。171例（17%）发生并发症，其中134例（14%）再次手术，69例（7.0%）再次入院。记录到125例（13%）手术并发症，其中大多数是出血事件（n = 105；11%）。医疗并发症很少见（n = 33；3.4%）。多变量分析显示，高血压（OR 1.8；95%CI，1.1 - 2.8；P = 0.017）和糖尿病（OR 2.2；95%CI，1.1 - 4.6；P = 0.031）与术后并发症的发生显著相关。