Surgical trends in breast cancer: a rise in novel operative treatment options over a 12year analysis

被引:159
作者
Jonczyk, Michael M. [1 ,3 ]
Jean, Jolie [4 ]
Graham, Roger [1 ]
Chatterjee, Abhishek [2 ]
机构
[1] Tufts Med Ctr, Dept Surg, 800 Washington St,South Bldg,4th Floor, Boston, MA 02111 USA
[2] Tufts Med Ctr, Dept Plast Surg, 800 Washington St,South Bldg,4th Floor, Boston, MA 02111 USA
[3] Tufts Univ, Clin Translat Sci Program, Sackler Grad Sch, 136 Harrison Ave 813, Boston, MA 02111 USA
[4] Tufts Univ, Sch Med, 145 Harrison Ave, Boston, MA 02111 USA
基金
美国国家卫生研究院;
关键词
Breast conservation surgery; Mastectomy; Breast reconstruction; Trend analysis; Surgical incidence; CONSERVING SURGERY; SINGLE-INSTITUTION; RECONSTRUCTION; MASTECTOMY; CONSERVATION; COMPLICATIONS; OUTCOMES;
D O I
10.1007/s10549-018-5018-1
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
PurposeBreast cancer surgical techniques are evolving. Few studies have analyzed national trends for the multitude of surgical options that include partial mastectomy (PM), mastectomy without reconstruction (M), mastectomy with reconstruction (M+R), and PM with oncoplastic reconstruction (OS). We hypothesize that the use of M is declining and likely correlates with the rise of surgery with reconstructive options (M+R, OS).MethodsA retrospective cohort analysis was conducted using the ACS-NSQIP database from 2005 to 2016 and ICD codes for IBC and DCIS. Patients were then grouped together based on current procedural terminology (CPT) codes for PM, M, M+R, and OS. In each group, categories were sorted again based on additional reconstructive procedures. Data analysis was conducted via Pearson's chi-squared test for demographics, linear regression, and a non-parametric Mann- Kendall test to assess a temporal trend.ResultsThe patient cohort consisted of 256,398 patients from the NSQIP data base; 197,387 meet inclusion criteria diagnosed with IBC or DCIS. Annual breast surgery trends changed as follows: PM 46.3-46.1% (p=0.21), M 35.8-26.4% (p=0.001), M+R 15.9-23.0% (p=0.03), and OS 1.8-4.42% (p=0.001). Analyzing the patient cohort who underwent breast conservation, categorical analysis showed a decreased use of PM alone (96-91%) with an increased use of OS (4-9%). For the patient cohort undergoing mastectomy, M alone decreased (69-53%); M+R with muscular flap decreased (9-2%); and M+R with implant placement increased (20-40%)all three trends p<0.0001.ConclusionThe modern era of breast surgery is identified by the increasing use of reconstruction for patients undergoing breast conservation (in the form of OS) and mastectomy (in the form of M+R). Our study provides data showing significant trends that will impact the future of both breast cancer surgery and breast training programs.
引用
收藏
页码:267 / 274
页数:8
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