Retrospective Study In Ultra-quadrantectomy Combined With Latissimus Dorsi Flap Breast Reconstruction Surgery

Objective : The study retrospectively analyzed the short and long term efficacy of applying ultra-quadrantectomy combined with latissimus dorsi flap(LDF) breast reconstruction surgery and applying the conventional breast-conserving surgery in early-stage breast cancer. The purpose is to evaluate the cosmetic outcome and feasibility of the ultra-quadrantectomy combined with LDF breast reconstruction surgery without postoperative radiotherapy.Method: By comparatively analyzing the data of matched cases from two groups, the study reviewed the data of 22 patients(Group A) who received the ultra-quadrantectomy combined with LDF breast reconstruction surgery without postoperative radiotherapy in Surgical Oncology of Affiliated Hospital of HBU from May, 2009 to Feb. 2013, and selected 44 patients(Group B) who underwent conventional breast-conserving surgery to match with Group A based on the four variables of breast cancer TNM stage, axillary lymph node status, estrogen receptor status, and Her-2 status. The complete clinical and follow-up data of two groups were recorded. All data were analyzed by using SPSS17.0 software: the χ2 test was used to compare data, the Kaplan-Meier was used to calculate survival rate, and draw survival curve, and the log-rank test was used to compare survival curve difference. The difference when α = 0.05, P <0.05 was considered statistically significant. The postoperative complications, disease free survival, overall survival and postoperative breast cosmetic results were compared.Result: The survey of subjective satisfaction towards breast cosmetic results showed that the breast aesthetic satisfaction rate of Group A was 81.8%(18/22) while Group B was 86.4%(38/44). There was no significant difference between them(P>0.05). Higher incidence of seroma appeared in Group A than in Group B(P <0.05). The follow-up time of Group A was 9-62 months, and the median follow-up time was 42 months. There was one case of local recurrence, two cases of distant metastases, and both were lung metastases, one case of death due to the transfer. The follow-up time of Group B was 6-62 months, and the median follow-up time was 38.5 months. There were four cases of local recurrence, three cases of distant metastasis, one case of lung metastasis, two cases of liver metastases, two patients died due to the transfer. No significant difference was found in disease free survival and overall survival of the two groups(P> 0.05).Conclusion: We apply ultra-quadrantectomy and axillary lymph node dissection in early-stage breast cancer. Since the residual lumen closure may affect breast shape, we reconstruct breast with latissimus dorsi flap(LDF) in the surgery. Although without radiotherapy, the survival and recurrence rate has no significant difference compared to taking traditional breast-conserving surgery and the cosmetic effect is satisfactory.