[Oncoplastic versus conventional breast conserving surgery. A comparison of clinicopathological findings, cosmetic results and quality of life in 60 cases].
[Oncoplastic versus conventional breast conserving surgery. A comparison of clinicopathological findings, cosmetic results and quality of life in 60 cases].
复制标题
[肿瘤整形术与传统保乳手术。
作者：
Z. Mátrai;G. Gulyás;E. Kovács;Zsuzsa Sándor;C. Polgár;A. Bartal;M. Kásler
肿瘤整形外科技术似乎是适合实现保留美容的目标后，根治性切除乳腺肿瘤。本研究的目的是提供一个传统的（BCS）和肿瘤整形（OPS）保乳手术的临床和病理比较，辅以主观评估的美容和患者的生活质量，第一次在匈牙利的样本。作者对60例晚期肿瘤整形和60例传统保乳手术病例的临床病理学数据进行了回顾性评估，在辅助放疗后，作者还调查了患者的美容结果和生活质量（EORTC BR 23）。通过统计学方法对结果进行比较。两组在年龄、肿瘤位置、乳房大小、腋窝手术类型（前哨淋巴结活检与腋窝淋巴结切除术）、肿瘤分级和受体状态方面无显著差异。OPS组的肿瘤大小显著更大（p=0.0009），象限切除率更高（p=0.0032），区域淋巴结转移（p=0.0043）和辅助化疗（p=0.0122）更常见。与BCS组相比，OPS组的手术持续时间更长（p<0.001），标本重量更大（p=0.0308），显微镜下手术切缘阳性导致的手术完成率显著更低（p=0.0306）。两组在并发症发生率和辅助治疗开始时间方面没有差异。OPS组的美容效果明显上级OPS组（p<0.001），OPS患者手臂、肩部（p=0.0399）和胸痛（患侧）（p=0.0304）较少，手术侧上肢运动也更好（p=0.006）。OPS组的随访期较短（BCS组和OPS组分别为平均32.2个月和8.7个月），无法对肿瘤学终点进行有意义的评估。与传统的保乳手术相比，肿瘤整形手术适用于显微镜下根治性肿瘤切除，即使是较大的病变和真正的象限切除术，手术时间较长，但并发症发生率较低，不会延迟辅助治疗，因此不会增加癌症风险。与BCS相比，OPS产生更好的美容效果和更高的患者满意度。对于OPS的局部肿瘤控制效果的评估，需要更多的经验和更长的随访时间。
Oncoplastic surgical techniques seem to be suitable for realizing the goal of retaining cosmesis following radical removal of breast tumors. The purpose of the present study is to provide a clinical and pathological comparison of conventional (BCS) and oncoplastic (OPS) breast-conserving surgeries, supplemented by a subjective assessment of cosmesis and quality of life of patients, the first time on a Hungarian sample. The authors performed a retrospective assessment of clinicopathological data of 60 advanced oncoplastic and 60 conventional breast-conserving surgery cases, and following adjuvant radiotherapy, the authors also surveyed patients for cosmetic results and quality of life (EORTC BR23). Comparison of the results was performed by statistical methods. The two groups did not differ substantially in age, tumor location, breast size, type of axillary surgery (sentinel node biopsy vs. axillary lymphadenectomy), tumor grade and receptor status. Tumor size was significantly greater (p=0.0009), the rate of quadranectomies was higher (p=0.0032), metastases in the regional lymph nodes (p=0.0043) and the administration of adjuvant chemotherapy (p=0.0122) were more frequent in the OPS group. The duration of surgeries was longer (p<0.001), the weight of the specimens was greater (p=0.0308), the rate of completion surgeries due to microscopically positive surgical margins was significantly smaller (p=0.0306) in the OPS than in the BCS group. There was no difference between the two groups in the rate of complications and the time elapsed to the start of adjuvant treatment. The cosmetic outcome was clearly superior in the OPS group (p<0.001), and OPS patients had fewer arm, shoulder (p=0.0399), and chest pain (of the affected side) (p=0.0304), upper limb movements of the operated side were also better (p=0.006). The short follow-up period of the OPS group (mean 32.2 vs. 8.7 months in BCS and OPS, respectively) did not allow a meaningful assessment of oncologic endpoints. When compared to conventional breast conserving surgery, oncoplastic surgery is suitable for microscopically radical tumor removal even in case of larger lesions and true quadranectomy with longer surgical time but lower rate of complications without delaying the adjuvant treatments and thus not increasing the cancer risk. OPS yields better cosmetic results and higher patient satisfaction compared to BCS. More experience and longer follow-up is needed for the assessment of local tumor control achieved by OPS.