Mastectomy versus breast conserving surgery: A single surgeon’s audit from a developing country
Mastectomy versus breast conserving surgery: A single surgeon’s audit from a developing country
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乳房切除术与保乳手术：来自发展中国家的单一外科医生的审核
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发表时间：
2019
期刊：
影响因子：
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通讯作者：
John Boyages Am
中科院分区：
文献类型：
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作者：
Ellen Tailby;John Boyages Am
目的：根据发展中国家现有的手术选择和资源，回顾乳腺癌的手术治疗。材料和方法：本次审查是在一所拥有三级护理设施的大学医院进行的。 2000 年至 2018 年期间诊断出的所有乳腺癌患者均纳入其中。人口统计数据和提供的手术选择是本次审查的重点。该综述将数据分为两组：乳房切除术和保乳手术（BCS）。结果：上述期间接受手术治疗的乳腺癌患者总数为602例。年龄在24-83岁之间，中位年龄为48岁。 312 名 (52%) 患者接受了乳房切除术，290 名 (48%) 患者接受了 BCS。早年乳房切除术比 BCS 更频繁地进行，然而，过去十年表明 BCS 正在慢慢成为更受欢迎的手术选择。结论：乳腺癌外科手术的采用基于多学科会诊和治疗资源的可用性。随着早期检测策略和肿瘤整形程序的出现，发展中国家推广和鼓励了更保守的方法。关键词： 乳房切除术；肿瘤切除术；乳腺癌简介 早在三千多年前，古埃及人就注意到了乳腺癌。有趣的是，它随后被描述为一种无法通过局部切除治疗的全身性疾病。直到公元二世纪，第一次报道的乳房切除术是由亚历山大的列奥尼德斯外科医生进行的。到了 1600 年代，北欧更多的乳房截肢手术是使用镊子、刀和烧灼器进行的，远早于防腐剂和麻醉的出现。约翰·亨特 (John Hunter)、阿斯特利·库珀 (Astley Cooper) 和约翰·沃伦 (John Warren) 由于能够执行快速而精确的手术而被称为“伟大的外科医生”[1]。 1846 年，麻醉的引入增强了外科手术的简便性，被誉为“外科医生的世纪”。德国的比尔罗斯、伦敦的汉德利和巴尔的摩的霍尔斯特德是杰出的大胆癌症外科医生，他们设计了切除肿瘤和区域淋巴结的手术。霍尔斯特德提倡根治性乳房切除术，这成为近一个世纪以来乳腺癌手术的基础。在 20 世纪 70 年代，随着基于佩吉特理论对乳腺癌的系统性有了更多的了解，随后采用了不太广泛的手术 [2]。与辅助化疗、放疗治疗的显着发展不同，手术治疗的基本原则
Aim: To review the surgical management of breast cancer based on the adoption of the available surgical options and resources in developing countries. Materials and methods: This review was undertaken at a university hospital with tertiary care facilities. All patients diagnosed with breast cancer between 2000-2018 were included. Demographic data and the offered surgical options were the focus of this review. The review categorized the data into two groups: mastectomy and Breast Conserving Surgery (BCS). Results: The total number of the surgically treated breast cancer during the above period were 602 patients. Age ranged between 24-83 with the median age of 48 years. Mastectomy was performed in 312 (52%) patients while BCS in 290 (48%) patients. In the early years Mastectomy was more frequently performed than BCS, however, the last decade have shown that BCS is slowly becoming the more adopted surgical option. Conclusion: The adoption of breast cancer surgical procedures is based on the multidisciplinary consults and the availability of treatment resources. With the emerging early detection strategies and oncoplastic procedures, more conservative approaches are propagated and encouraged in developing countries. Keys words: Mastectomy; lumpectomy; Breast cancer Introduction Breast cancer was noted as early as over three thousand years ago by the ancient Egyptians. Interestingly it was then described as a systemic disease that cannot be treated by local excisions. It wasn’t until the second century AD when the first reported mastectomy was performed by a surgeon named Leonides of Alexandria. By 1600s in northern Europe more breast amputations were performed using forceps, knives, and cauterizing irons long before antisepsis and anesthesia was introduced. John Hunter, Astley Cooper, and John Warren were labelled as “Great surgeons” due to their ability to perform swift and precise procedures [1]. In 1846 the introduction of anesthesia potentiated the ease of surgical procedures propagating the name “the century of the surgeon.”Bilroth in Germany, Handley in London, and Halsted in Baltimore stood out as prominent bold cancer surgeons who designed procedures to remove the tumors and regional the lymph nodes. Halsted advocated that radical mastectomy which became the basis of breast cancer surgery for almost a century. In the 1970s, with more understanding of the systemic nature of breast cancer based on Paget’s theory less extensive procedures were then adopted [2]. Unlike the remarkable evolution of adjuvant chemo\ radiotherapy treatments, the basic principles of surgical treatments