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Tíðni og árangur tafarlausra brjóstauppbygginga á Landspítala 2008-2010

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Authors
Katrín Jónsdóttir
Svanheiður Lóa Rafnsdóttir
Þórdís Kjartansdóttir
Höskuldur Kristvinsson,
Þorvaldur Jónsson
Kristján Skúli Ásgeirsson
Issue Date
2012-09

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Other Titles
Results of immediate breast reconstructions at Landspítali-The National University Hospital of Iceland, in 2008-2010
Citation
Læknablaðið 2012, 98(9):459-63
Abstract
In late 2007, the availability of immediate breast reconstructions increased as a result of the establishment of an oncoplastic breast surgical service at Landspítali-The National University Hospital The aim of this study was to look at the rates and early complications of immediate breast reconstructions in our hospital in 2008-2010 and compare with the results from the UK National Mastectomy and Breast Reconstruction Audit (NMBRA). This is a retrospective population-based study, including all women who had immediate breast reconstruction at Landspítali in 2008-2010. 319 mastectomies and 157 breast reconstructions were performed. Of these, 98 (62%) were immediate, (mean age 49, 29-69). The immediate breast reconstruction rate was therefore 31%, with a respective 55% for patients 50 years old or younger. In comparison, the rate was 5% in 2000-2005. Immediate reconstructions with an extended autologous latissimus dorsi flap were performed in 25 (26%) cases and implant based reconstructions in the remaining (n=73, 74%). Inpatient complications occurred in 12 (12%) patients and 5 needed reoperation (3 post-operative bleeding, 1 skin necrosis, 1 imminent LD-flap failure). Readmission due to complications after discharge occurred in 14 (14%), while 37 (38%) developed mild complications not requiring readmission. The results were comparable to NMBRA, although the rates of autologous flap reconstructions were significantly higher than in this study (63% vs. 26%). As a result of the establishment of an oncoplastic breast surgical service at Landspítali, the rates of immediate breast reconstruction have increased significantly (from 5% to 31%). The complication rates are low and similar to NMBRA.
Inngangur: Möguleikar íslenskra brjóstakrabbameinssjúklinga til að gangast undir tafarlausa brjóstauppbyggingu hafa aukist verulega á undanförnum árum, einkum frá lokum árs 2007. Markmið þessarar rannsóknar var að kanna tíðni og snemmkomna fylgikvilla tafarlausra brjóstauppbygginga á Landspítala á árunum 2008-2010 og bera niðurstöðurnar saman við einu birtu rannsókn á þessu efni sem nær til heillar þjóðar og er frá Bretlandi (NMBRA). Efniviður og aðferðir: Rannsóknin er afturskyggn þýðisrannsókn á öllum konum sem gengust undir tafarlausa brjóstauppbyggingu á Landspítala á árunum 2008-2010. Niðurstöður: Heildarfjöldi brjóstnáma á tímabilinu var 319 en brjóstauppbyggingar voru 157 og af þeim voru 98 (62%) tafarlausar. Tafarlausar uppbyggingar voru því gerðar hjá 31% allra sem gengust undir brjóstnám en 55% hjá 50 ára og yngri. Til samanburðar var heildarhlutfallið 5% á árunum 2000-2005. Meðalaldur kvenna sem gengust undir tafarlausa uppbyggingu á rannsóknartímabilinu var 49 ár (29-69). Tafarlausar vöðvaflipauppbyggingar voru 25 (26%) en aðrar uppbyggingar voru gerðar með ígræði. Fylgikvillar í legu í kjölfar aðgerðar urðu eftir 12 (12%) tafarlausar uppbyggingar, þar af þurftu 5 sjúklingar enduraðgerð (þrír vegna blæðinga, einn vegna húðdreps og annar vegna yfirvofandi vöðvaflipadreps). Þörf var á endurinnlögn eftir útskrift í 14 (14%) tilfellum. Eftir útskrift urðu vægir fylgikvillar sem ekki kröfðust endurinnlagnar í 37 (38%) tilfellum. Almennt voru fylgikvillar sambærilegir og í NMBRA en flipauppbyggingar voru mun algengari í þeirri rannsókn (63% á móti 26%). Ályktun: Veruleg aukning hefur orðið á tafarlausum brjóstauppbyggingum á Landspítala (frá 5% í 31%). Almennt eru þessar aðgerðir áhættulitlar og tíðni fylgikvilla svipuð og í NMBRA.
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