Safety of immediate transverse rectus abdominis myocutaneous breast reconstruction for patients with locally advanced disease
Safety of immediate transverse rectus abdominis myocutaneous breast reconstruction for patients with locally advanced disease
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DOI：
10.1001/archsurg.140.2.196
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发表时间：
2005-02-01
影响因子：
--
通讯作者：
Anthony, JP
中科院分区：
文献类型：
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作者：
Foster, RD;Hansen, SL;Anthony, JP
研究假设：乳腺癌术后即刻横行腹直肌肌皮瓣再造联合放射治疗是安全有效的。设计：回顾性病例系列。地点：大学附属教学医院。患者：1996年1月1日至2003年12月31日，252例患者接受乳房切除术后立即横行腹直肌肌皮瓣重建术。其中35例接受术后放射治疗(I期1例，II期17例，III期15例，IV期2例)。年龄29~72岁，平均49.5岁。术后随访1~8年，平均48个月。主要观察指标：皮瓣丢失、脂肪坏死、皮瓣体积丢失、辅助治疗延迟、需再次手术等。中位手术时间5.5小时。平均住院时间为5.2天。脂肪坏死3例，体积减少2例(6%)。术后辅助治疗没有明显延迟(中位间隔32天)。中位随访48个月，局部保乳成功1例(3%)，远处转移4例(11%)。结论：即时横行腹直肌肌皮瓣再造加放射治疗是安全的，并发症少，组织体积无明显变化。并发症往往很小，不会延误辅助治疗。乳房切除后应考虑立即乳房重建，尽管术后需要放射治疗。
Hypothesis: Immediate transverse rectus abdominis myocutaneous breast reconstruction combined with postoperative radiation therapy after mastectomy is safe and effective.Design: Retrospective case series.Setting: University-based teaching hospital.Patients: From January 1, 1996, through December 31, 2003, 252 patients underwent mastectomy and immediate transverse rectus abdominis myocutaneous flap reconstruction. Of those, 35 patients received postoperative radiation therapy (stage I, n = 1; II = 17; III = 15; IV, n = 2). Age range was 29 to 72 years (mean, 49.5 years). Follow-up was 1 to 8 years (mean, 48 months).Main Outcome Measures: Flap loss, fat necrosis, flap volume loss, adjuvant treatment delay, and need for additional surgery.Results: The rate of flap survival was 100%. Median operative time was 5.5 hours. Average hospital stay was 5.2 days. Fat necrosis occurred in 3 patients, with volume loss requiring additional surgery in 2 patients (6%). Postoperative adjuvant therapy was not significantly delayed (median interval, 32 days). With a median follow-up of 48 months, local recurrence was present in only 1 patient (3%), who underwent successful local salvage, and distant metastasis occurred in 4 patients (11%)Conclusions: Immediate transverse rectus abdominis myocutaneous breast reconstruction followed by radiation therapy is safe, with minimal morbidity and no significant change in tissue volume. Complications tend to be minor, not delaying adjuvant therapy. Immediate breast reconstruction should be considered after mastectomy, despite the need for postoperative radiation therapy.