Comparative Analysis Of The Short-term Therapeutic Effect In Breast Cancer Between Breast Conserving Reconstruction With Thoracodorsal Artery Perforator Flap And Whole Breast Reconstruction With Latissimus Dorsi Myocutaneous Flap

Objective:Breast conserving surgery and mastectomy are the main surgical methods for early stage breast cancer.The use of flaps can improve patients’cosmetic outcome and quality of life.Our study compared the clinicopathological factors,surgical conditions,postoperative recovery indicators,complications,quality of life and cosmetic outcome in breast cancer patients underwent breast conserving surgery+thoracodorsal artry perforator flap(BCS+TDAP)immediate reconstruction and skin sparing mastectomy+latissimus dorsi myocutaneous flap(SSM+LDMF)immediate reconstruction,to evaluate the therapeutic effect and applicable scope of two surgical methods in early stage breast cancer.Method:From January 2018 to December 2020,98 patients who underwent breast cancer surgery and immediate breast reconstruction by dorsal flaps in the second department of gastrointestinal surgery of the first affiliated hospital of Guangxi Medical University were collected.According to the surgical method,the patients were divided into BCS+TDAP group(n=48)and SSM+LDMF group(n=48).Collected the following information from the patients:Clinicopathological factors(age,BMI,marriage status,educational level,tumor size,tumor location,pathological type,molecular classification,axillary lymph node status,TNM stage);Operative situation(operative time,intraoperative blood loss);Postoperative rehabilitative indicators(incision pain score,postoperative drainage volume,postoperative hospital stay,recovery time of the shoulder function);Postoperative complications(hematoma,seroma,wound infection,wound dehiscence,poor wound healing,fat liquefaction,flap necrosis,nipple necrosis)and their grade;Adjuvant therapy(chemotherapy,radiotherapy,targeted therapy and endocrine therapy);Quality of life score(QLQ-BR23);Cosmetic score(postoperative photos and physical examination).The data were statistically analyzed by SPSS 23.0 software.Result:1.Clinicopathological factors:There was no statistically significant difference in age,marriage status,educational level,tumor size,pathological type,molecular classification,axillary lymph node status,pTNM stage between BCS+TDAP group and SSM+LDMF group(P>0.05).The BMI of BCS+TDAP group was higher than SSM+LDMF group(23.80±2.97 kg/m~2vs 21.81±2.29kg/m~2,P<0.001).In terms of the tumor location,97.9%of tumors in BCS+TDAP group were distributed in the external breast quadrant,which was significantly higher than that in SSM+LDMF group(58.3%),with statistically significant differences(P<0.001).2.Operative situation and postoperative rehabilitative indicators:The operative time in BCS+TDAP group was similar to that in SSM+LDMF group(234.9±42.2min vs 234.9±44.1min,P>0.05),but the intraoperative blood loss was less than SSM+LDMF group(104.8±25.3ml vs 128.8±26.5ml,P<0.001).Compared with the SSM+LDMF group,the BCS+TDAP group result in a lower pain score on the first day after surgery(1.6±0.8 points vs 2.1±1.2 points,P<0.05),less volume of postoperative drainage on the first three days(207.5±85.7ml vs 322.6±137.0ml,126.7±56.9ml vs 226.3±70.3ml,83.3±36.5ml vs 157.0±69.4ml,P<0.001),and faster recovery of the shoulder(2.7±1.7months vs 4.3±2.5months,P<0.05).There was no statistically significant differences in pain score(second day and third day after surgery)and postoperative hospital stay between this two groups(P>0.05).3.Postoperative complications:No statistically significant differences in hematoma,wound infection,wound dehiscence,poor wound healing,flap necrosis and nipple necrosis were found between this two groups(P>0.05).The BCS+TDAP group result in lower rates on seroma(2.1%vs 29.2%,P<0.001),fat liquefaction(2.1%vs 14.6%,P<0.05)and overall incidence of complications(25%vs 58.3%,P<0.05).The Clavien-Dindo classifications had no statistically significant differences between this two groups,which were mostly classed as gradeⅠ.4.Adjuvant therapy:The rate of radiotherapy in BCS+TDAP group was higher than that in SSM+LDMF group.No statistically significant differences in chemotherapy,targeted therapy and endocrine therapy were found between this two groups(P>0.05).5.Quality of life:According to the QLQ-BR23 score,body image belonging to functional area(80.0±16.3 points vs 63.7±21.0 points,P<0.001)and symptoms of arms belonging to symptomatic area(13.2±9.4 points vs18.9±12.5 points,P<0.05)in BCS+TDAP group were better than that in SSM+LDMF group.No statistically significant differences in sexual functioning,sexual enjoyment,future perspective,side effects from treatment,symptoms of breast and worry of hair loss were found between this two groups(P>0.05).6.Cosmetic outcome:The cosmetic score of patients underwent BCS+TDAP reconstruction was better than that in SSM+LDMF reconstruction(10.08±1.60 points vs 8.33±2.50 points,P<0.001),with higher rate of excellent and good cosmetic score(87.5%vs 54.2%,P<0.001).Conclusion:The application of dorsal flap technique in BCS and SSM for early breast cancer can not only ensure the safety of surgery,but also improve the patient’s quality of life and cosmetic outcome.Compared with BCS+TDAP and SSM+LDMF reconstruction,the BCS+TDAP reconstruction has the advantages of faster recovery after surgery,lower complication rate,better quality of life and better cosmetic outcome.We prefer BCS+TDAP reconstruction when the tumor located in the lateral breast.SSM+LDMF reconstruction can also be a great choice for patients who have concerns in radiotherapy.