目的 探讨乳腔镜辅助下早期乳腺癌保乳治疗的优越性。方法 乳腔镜辅助下行保乳术37例，术后均行乳腺和病灶区放射治疗，并按病理及受体情况给予相应的辅助化疗及内分泌治疗。结果 乳腔镜辅助下保乳术成功35例，2例术中因腋窝出血量多而转开放性手术。患者无明显手术并发症, 且美容效果良好。术后随访时间最长27个月, 中位随访时间为18 个月,无一例局部复发、远处转移和死亡。术后乳腺美容效果评估： 优、良者术后6个月为68.2%，术后1年为83.4%。结论 乳腔镜辅助下早期乳腺癌保乳术以不降低生存率、不增加复发率为原则，联合多学科有机配合及综合治疗为保证，具有创伤小、并发症少、外形美观、生存质量高等优点。
ObjectiveTo investigate the effect of breast conservation therapy (BCT) and mastectomy (Mast) on the prognosis of early luminal breast cancer (ELBC).MethodsBy retrieving the PubMed, Embase, Web of Science, CNKI, Wanfang data, and VIP databases, the meta-analysis was performed on the documents that met the inclusion criteria. The Review Manager 5.3 and Stata 12.0 were used for statistical analysis.ResultsA total of 25 articles were included, involving 13 032 patients with ELBC, of which 8 419 underwent the BCT and 4 613 underwent the Mast. The results of meta-analysis showed that there was no significant difference in the postoperative local regional relapse (LRR) between the BCT and the Mast in the treatment of all patients with ELBC [OR=0.84, 95% CI (0.43, 1.64), P=0.61]. For treating with BCT, the local relapse (LR), distant metastasis rate (DMR), disease-free survival (DFS), and overall survival (OS) in the patients with luminal A ELBC were better than those in the patients with luminal B ELBC (P<0.05); Using the same method, the DMR and DFS in the patients with luminal A/B ELBC were better than those in the patients with luminal-HER2 ELBC (P<0.05). For treating with Mast, the LRR, LR, DMR, and OS in the patients with luminal A ELBC were better than those in the patients with luminal B ELBC (P<0.05); Using the same method, the LRR in the patients with luminal A/B ELBC was better than that in the patients with luminal-HER2 ELBC (P<0.05).ConclusionsFor patients with ELBC, similar LRR can be obtained by BCT and Mast treatment. Regardless of the surgical strategy, patients with luminal A ELBC are more likely to obtain relatively ideal clinical prognosis. Luminal-HER2 ELBC has the worst prognosis after BCT treatment.
ObjectiveTo discuss the feasibility and security of breast conserving surgery (BCS) in patients with multifocal/multicentric breast cancer (MMBC).MethodThe clinical trials about BCS in patients with MMBC at home and abroad in recent years were searched and reviewed.ResultsThe results of most retrospective clinical trials showed that BCS in patients with MMBC could achieve similar or at least as good results as mastectomy. However, for there were some inevitable bias in retrospective studies, the conclusion should be analyzed modestly. Two prospective multicenter randomized controlled trials, the MIAMI UK trial and the ACOSOG Z11102 trial, were still ongoing, of which results were expected to confirm these conclusions further. ConclusionsUnder the premise of mastering the indications, BCS would be a reasonable option for MMBC when incisal margin is negative and cosmetic result is satisfactory. In addition, the lack of standard classification and definition for multifocality and multicentricity increases the difficulty of the research, and the distance of the cancer foci and the ratio of tumor to breast volume in patients with MMBC might be the key factors affecting the efficacy of BCS. Therefore, more rational-designed prospective studies and accurate subgroup analysis are expected to provide impelling evidence for application of BCS in patients with MMBC.