Chest wall perforator flaps are safe and can decrease mastectomy rates in breast cancer surgery: multicentre cohort study.

IF 8.6 1区 医学 Q1 SURGERY British Journal of Surgery Pub Date : 2024-10-30 DOI:10.1093/bjs/znae266
Andreas Karakatsanis, Farid Meybodi, Eirini Pantiora, Elisabeth Elder, Faustine Cabel, Jeremy Hsu, James French, Iliana Aristokleous, Olivia Sjökvist, Daniel Önefäldt, Jaime Navia, Rachel L O'Connell, Jennifer E Rusby, Peter A Barry
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Abstract

Background: Chest wall perforator flaps are emerging in oncoplastic breast conservation, mostly as an alternative to mastectomy. However, standardization and consensus on patient selection, techniques, and outcomes have not yet been reached. The aim of this international multicentre collaborative study was to explore practice patterns and outcomes in high-volume centres from different countries.

Methods: Patients with both pre-invasive and invasive breast cancer treated at the Uppsala University Hospital in Uppsala, Sweden, the Royal Marsden Hospital in London, UK, and the Westmead Breast Cancer Institute in Sydney, Australia, were included in this study. The rationale for offering chest wall perforator flaps and surgical outcomes were prospectively documented.

Results: In total, 603 patients were analysed median age of 54 (interquartile range (i.q.r.) 48-63) years, median BMI of 25.0 (i.q.r. 22.5-28.1) kg/m2, median tumour extent of 30 (IQR 19-45) mm, median breast volume of 280 (i.q.r. 216-430) ml, and median calculated resection ratio of 16% (i.q.r. 9%-28%). In 67.7%, the treating surgeon had offered chest wall perforator flaps to avoid mastectomy. The procedure was performed as day surgery in 69.5% of patients, with an overall complication rate of 8.6% and the majority of complications being classified as Clavien-Dindo grade I (5.3% of patients). The re-excision rate was 15.9%, with only 1.5% of patients converting to a mastectomy. There were no flap losses. At a median follow-up of 22 (range 12 to 98) months, rates of local recurrence, distant recurrence, and breast cancer-related mortality were 1.9%, 4.9%, and 1.7% respectively.

Conclusion: Chest wall perforator flaps are a useful option to allow more women to avoid mastectomy. In experienced hands, the procedure is safe and should be offered to suitable patients.

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胸壁穿孔器皮瓣安全并能降低乳腺癌手术中的乳房切除率:多中心队列研究。
背景:胸壁穿孔器皮瓣正在肿瘤整形保乳术中兴起,主要是作为乳房切除术的替代方法。然而,关于患者选择、技术和结果的标准化和共识尚未达成。这项国际多中心合作研究旨在探索不同国家高容量中心的实践模式和结果:研究对象包括在瑞典乌普萨拉大学医院、英国伦敦皇家马斯登医院和澳大利亚悉尼韦斯特米德乳腺癌研究所接受治疗的浸润前乳腺癌和浸润性乳腺癌患者。对提供胸壁穿孔器皮瓣的理由和手术结果进行了前瞻性记录:共对 603 名患者进行了分析,中位年龄为 54(四分位数间距为 48-63)岁,中位体重指数为 25.0(四分位数间距为 22.5-28.1)千克/平方米,中位肿瘤范围为 30(四分位数间距为 19-45)毫米,中位乳房体积为 280(四分位数间距为 216-430)毫升,中位计算切除率为 16%(四分位数间距为 9%-28%)。67.7%的患者的主治医生提供了胸壁穿孔器皮瓣以避免乳房切除术。69.5%的患者在日间进行手术,总并发症发生率为8.6%,大部分并发症属于克拉维恩-丁多(Clavien-Dindo)I级(5.3%的患者)。再次切除率为15.9%,只有1.5%的患者转为乳房切除术。没有皮瓣脱落。中位随访时间为22个月(12至98个月),局部复发率、远处复发率和乳腺癌相关死亡率分别为1.9%、4.9%和1.7%:结论:胸壁穿孔器皮瓣是一种有效的选择,可以让更多女性避免乳房切除术。结论:胸壁穿孔器皮瓣是让更多女性避免乳房切除术的有效选择,在经验丰富的医生手中,该手术是安全的,应提供给合适的患者。
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来源期刊
CiteScore
12.70
自引率
7.30%
发文量
1102
审稿时长
1.5 months
期刊介绍: The British Journal of Surgery (BJS), incorporating the European Journal of Surgery, stands as Europe's leading peer-reviewed surgical journal. It serves as an invaluable platform for presenting high-quality clinical and laboratory-based research across a wide range of surgical topics. In addition to providing a comprehensive coverage of traditional surgical practices, BJS also showcases emerging areas in the field, such as minimally invasive therapy and interventional radiology. While the journal appeals to general surgeons, it also holds relevance for specialty surgeons and professionals working in closely related fields. By presenting cutting-edge research and advancements, BJS aims to revolutionize the way surgical knowledge is shared and contribute to the ongoing progress of the surgical community.
期刊最新文献
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