ObjectiveTo compare the effectiveness of sequential method pure single-port lumpectomy-breast conserving surgery (SMPSL-BCS) in treating early-stage breast cancer patients with tumors in different quadrants. Methods A retrospective analysis was conducted on 200 early-stage breast cancer female patients admitted between January 2023 and December 2023. According to the quadrant where the tumor was located, the patients were allocated into the upper outer quadrant group (UO group), lower outer quadrant group (LO group), upper inner quadrant group (UI group), and lower inner quadrant group (LI group), with 50 cases in each group. There was no significant difference (P>0.05) in the baseline data, including age, body mass index, smoking history, marital status, comorbidities, affected breast side, maximum tumor diameter on ultrasound, maximum pathological tumor diameter, clinical tumor stage, molecular subtype, and disease duration. The operation time, intraoperative blood loss, postoperative drainage volume, and extubation time were recorded and compared between groups. Additionally, the occurrence of early-stage complications (1-3 months after operation; including subcutaneous fluid accumulation, incision infection, superficial skin burns) and late-stage complications (>3 months after operation; including pectoralis major muscle adhesion, changes in breast appearance and shape, sensory discomfort) were assessed. At 6 months after operation, the cosmetic outcome of breast-conserving surgery was rated for all groups. Results The UO group had the shortest operation time, followed by the UI group, LO group, and LI group, showing significant differences between groups (P<0.05). The UO group had the least intraoperative blood loss, followed by the LO group, UI group, and LI group; except for the difference between UO group and LO group, which was not significant (P>0.05), the differences between the other groups were significant (P<0.05). The UO group had the least postoperative drainage volume, followed by the LO group, UI group, and LI group; except for the difference between LO group and UI group, which was not significant (P>0.05), the differences between the other groups were significant (P<0.05). The extubation time of the LI group was significantly longer than that of the other groups (P<0.05). All patients were followed up 4-12 months, with an average of 8 months. And 193 patients were followed up more than 6 months, including 48 patients in UO group, 47 in LO group, 49 in UI group, and 49 in LI group. In the early-stage period, the LI group had a higher incidence of subcutaneous fluid accumulation after tube removal compared to the UO group and LO group (P<0.05), while there was no significant difference in the incidences of other early complications between groups (P>0.05). In the late-stage period, the LI group had significantly higher incidences of pectoralis major muscle adhesion and changes in breast appearance and shape than UO group and LO group (P<0.05), and a significantly higher incidence of sensory discomfort than UO group (P<0.05). There was no significant difference in the incidences of other late-stage complications between groups (P>0.05). At 6 months after operation, the cosmetic outcomes of breast-conserving surgery were significantly better in UO group, LO group, and UI group than in LI group (P<0.05); there was no significant difference between the other groups (P>0.05). Conclusion In the treatment of early-stage breast cancer using SMPSL-BCS, patients with tumors located in the upper outer quadrant show the best effectiveness. The effectivenesses are similar for patients with tumors in the lower outer and upper inner quadrants. However, patients with tumors in the lower inner quadrant do not experience significant advantages. Therefore, it is recommended that SMPSL-BCS should not be the first-choice surgical method for patients with tumors in the lower inner quadrant.
ObjectiveTo investigate the safety of day surgery service model for one-stage prosthetic reconstruction after radical lumpectomy for breast cancer. MethodsThe breast cancer patients who underwent luminal prosthesis reconstruction at The First Affiliated Hospital of Air Force Military Medical University from January 2021 to December 2023 were retrospectively collected. The patients were assigned into an ambulatory group (ambulatory surgical service model) and an inpatient unit group (inpatient unit surgical service model) according to their surgical service modalities. The baseline data, surgical safety, tumor safety-related indexes, and postoperative quality of life indicators by Breast-Q 2.0 score of the two groups were compared. ResultsThere were 239 patients who met the selection criteria were included, including 146 in the ambulatory group and 93 in the inpatient unit group. Except for the age and menopausal status of the patients of two groups (P<0.05), there were no statistically significant differences in body mass index, chronic medical history, previous surgical history, molecular typing, tumor length, neoadjuvant chemotherapy, and radiotherapy between the the patients of two groups (P>0.05). In the surgery-related safety indexes, except for the total hospitalization time and postoperative drainage in the ambulatory group, which were significantly lower than those in the inpatient unit group (P<0.05), the differences between the two groups in terms of operation time, intraoperative bleeding, prosthesis size, postoperative dietary recovery time, postoperative pain score, and axillary lymph node dissection rate were not statistically significant (P>0.05). No significant difference was seen in the incidence of nipple-areola complex ischemia, flap ischemia, infection, implant loss, and the incidence of pericardial contracture among the early postoperative complications. The average follow-up time in the ambulatory group and inpatient unit group was (13.31±7.29) months and (13.41±9.02) months, respectively. All patients survived, among them, one patient (0.68%) in the ambulatory group and two patients (2.15%) in the inpatient unit group experienced local recurrence, and there was no significant difference in the rate of local recurrence between the two groups (P>0.05). In the Breast-Q 2.0 score, the information satisfaction of the patients in the inpatient unit group was significantly higher than that of in the inpatient unit group, and there were no statistical significances in the breast satisfaction, social satisfaction, and physician satisfaction. ConclusionsFrom the results of this study, day surgery for one-stage prosthetic reconstruction after radical lumpectomy for breast cancer is safe can also improve the patient’s experience of care.