Background

In breast cancer surgery, IBR (immediate breast reconstruction) is widely proposed to patients without indications of adjuvant treatments and without risk factors of surgical complications. New INCa's guidelines (2022) allow the expansion of IBR indications.

Objective

A retrospective, unicentric and safety study: post-operative complication rate after IBR in comparison with simple mastectomy (SM, reference treatment).

Materiel and method

This retrospective study has included all major patients who have received mastectomy for breast cancer between 2016 and 2020 before application of new guidelines, in Hôpital de la Croix-Rousse, Lyon (France). They were distributed in two groups according to their surgery : IBR and SM. Usual risk factors of post-operative complications were collected (tabacco, obesity…). The primary endpoint was the occurrence of an early post-operative complication (within 3 months after surgery). Two secondary analysis focused on the impact of preoperative risk factors on complications, and the proportion of patients eligibled for an IBR among SM based on new INCA's guidelines.

Results

The study included 185 mastectomies: 153 SM, 32 mastectomies IBR. IBR's patients presented less risk factors, and few indications of adjuvant treatments. The rate of major complications was identical in the two groups (14 % in SM group, 12 % in IBR group), and there were more minor complications in the SM group than in the IBR group (p 0,01). According to our study, the raw proportion of initially possible IBR was 68 % (36 % of breast reconstruction in this study).

Conclusion

This analyse approve IBR in selected patients. In this context, INCa's guidelines (2022) can generalize IBR's proposal to patients. However, the analysis of pre-operative risk factors stay essential in medical care.

中文翻译：

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乳腺癌乳房切除术：对 210 名患者进行单中心系列研究，比较简单乳房切除术后或立即乳房重建术后的围手术期发病率

背景

在乳腺癌手术中，IBR（即刻乳房重建）被广泛推荐给无辅助治疗指征且无手术并发症危险因素的患者。新 INCa 指南 (2022) 允许扩大 IBR 适应症。

客观的

一项回顾性、单中心和安全性研究：与单纯乳房切除术（SM，参考治疗）相比，IBR 术后并发症发生率。

材料和方法

这项回顾性研究纳入了 2016 年至 2020 年应用新指南之前在法国里昂红十字医院接受乳腺癌乳房切除术的所有主要患者。根据手术情况将他们分为两组：IBR 组和 SM 组。收集术后并发症的常见危险因素（烟草、肥胖……）。主要终点是术后早期并发症（术后 3 个月内）的发生情况。两项二次分析侧重于术前危险因素对并发症的影响，以及根据新 INCA 指南，SM 中符合 IBR 条件的患者比例。

结果

该研究包括 185 例乳房切除术：153 例 SM，32 例 IBR 乳房切除术。IBR 患者的危险因素较少，辅助治疗的指征也很少。两组主要并发症发生率相同（SM 组为 14%，IBR 组为 12%），并且 SM 组的次要并发症多于 IBR 组 (p < 0,01)。根据我们的研究，最初可能的 IBR 的原始比例为 68%（本研究中乳房重建的比例为 36%）。

结论

该分析批准了选定患者的 IBR。在此背景下，INCa 指南 (2022) 可以将 IBR 的建议推广给患者。然而，术前危险因素的分析在医疗护理中仍然至关重要。