Choice of reconstructive procedures in the surgical treatment of breast cancer

Karcinom dojke predstavlja heterogenu bolest sa različitim morfološkim i molekularnim karakteristikama, biološkim ponašanjem i reagovanjem na terapiju, predstavljajući najrasprostranjeniji maligni tumor kod žena. U savremenoj hirurgiji, rekonstrukcija dojke predstavlja integralni aspekt u lečenju karcinoma, čime se bezbedno i efikasno, u bilo koje vreme, kao jednostepeni ili dvofazni postupak, restauracijom dojke uspostavlja telesni integritet i smanjuje postoperativni komorbiditet. PACIJENTI I METOD. Istraživanje predstavlja kliničku studiju prospektivno-retrospektivnog tipa, kojom su obuhvaćene 124 pacijentkinje, u periodu od januara 2005. do januara 2010.godine. Pacijentkinje su svrstane u kontrolnu grupu (40) kod kojih je izvedena izolovana mastektomija i eksperimentalnu (84) u kojoj su pacijentkinje sa izvedenom mastektomijom i rekonstrukcijom dojke, prosečne starosti 53,5god. za kontrolnu i 43god. za eksperimentalnu grupu. REZULTATI. Naši rezultati pokazuju da nema značajne razlike u učestalosti komplikacija kod izolovanih mastektomija i mestektomija sa rekonstrukcijom, kao i da je nivo komplikacija kod neposrednih rekonstrukcija niži u odnosu na odložene.Stopa učestalosti komplikacija kod neposrednih rekonstrukcija implantatima iznosi 26,92% od čega su u 19,23% identifikovane kao minor a u 7,69% kao major komplikacije. Pojavu hematoma beležimo u 3,85%, duboku infekciju u 4,76%, serom u 19,23%. Kapsularnu kontrakturu beležimo u 3,85%.Utvrdili smo postojanje značajne veze između veličine tumora i stadijuma tumorske bolesti i učestalosti komplikacija.Takođe smo našli postojanje pozitivne korelacije između indeksa telesne mase i pojave komplikacija. Naši rezultati pokazuju i postojanje značajne veze između hroničnih oboljenja, hemio i zračne terapije i pušenja sa pojavom komplikacija.Sa prosečnom cenom koštanja od 83.544,50 din. neposredna rekonstrukcija implantatima predstavnja ekonomski najprihvatljiviju opciju u rekonstrukciji dojke.Tokom istraživanja, posebno su nas interesovali stav i saznanja ispitanica o telesnom izgledu, psihološkom statusu, očuvanoj seksualnosti i samopoštovanju. Anketa je formirana samo za ovu priliku, nije univerzalna i visoko specifična. Predstavlja autorski koncept formiran na osnovu sličnih istraživanja sprovedenih u svetu i na osnovu preporuka Svetske zdravstvene organizacije (World Health Organization) o posmatranju fizičkog, emocionalnog i socijalnog statusa kod žena operisanih od karcinoma dojke. Mi smo pri konstrukciji pitanja kao polaznu osnovu imali strukturu i dizajn HRQoL, Health Survey SF-36, Body Image Questionnaire European Organization for Research and Treatment of Cancer (E.O.R.T.C.Quality of life).Analizirali smo srednje vrednosti skorova, na skali od 0 do 10. Najviše vrednosti skorova (9) vezane za pitanja o telesnom izgledu, samopuzdanju, seksualnosti, ženstvenosti i samopoštovanju, imamo kod neposrednih rekonstrukcija, kod kojih je zbeležen i najniži nivo psihičkih tegoba (9,09%).ZAKLjUČAK.Ustanovili smo da neposredna rekonstrukcija implantatima predstavlja metodu izbora u lečenju operabilnih karcinoma dojke. Kod ovih pacijentkinja je sveukupno zadovoljstvo najizraženije,sa najoptimalnijim 137 psiho-socijalnim efektima, zadovoljavajućim kvalitetom seksualnog života i opšte životnim aktivnostima.Neposredne rekonstrukcije implantatima,predstavljaju bezbednu opciju sa niskom stopom postoperativnih komplikacija i ekonomski su najprihvatljivije.Breast cancer is a heterogeneous disease with different morphological and molecular characteristics, biological behavior and response to therapy, representing the most widespread malignant tumor in women. In modern surgery, breast reconstruction is an integral aspect in the treatment of cancer, which is safe and effective, at any time, as a singlestage or two-stage procedure, restoration of established breast physical integrity and reduces postoperative comorbidity. PATIENTS AND METHODS. The study is a prospectiveretrospective clinical study, which included 124 patients, from January 2005. by January 2010. Patients were divided into a control group (40) in which the mastectomy was performed isolated and experimental (84) in which patients were performed with the mastectomy and reconstruction, mean age 53.5 years. for control and 43 years for the experimental group. RESULTS. Our results show no significant differences in complication rates for isolated mastectomy with reconstruction and mastectomy, and that the level of complication in the immediate reconstruction of lower than delayed. Incidence of complications in the immediate implant reconstruction is 26.92%, of which 19,23% ware identified as minor and 7.69% as major complications. Hematoma recorded at 3.85%, deep infection of 4.76%, 19.23% in seroma. Capsular contracture recorded at 3.85%. Existence we found significant associations between tumor size and stage of disease and tumor incidence complications. We found a positive correlation between body mass index and the occurrence of complications. Our results show the existence of a significant link between chronic disease, chemotherapy and radiotherapy and smoking with the appearance of complications. With the average cost price of 83544.50 din immediate implant reconstruction is the most economically advantageous option for breast reconstruction. During the research, we are particularly interested in attitude and knowledge about the physical appearance of women, psychological status, sexuality and self-preserved. The survey was created for this purpose, it is not universal and highly specific. Author presents a concept formed the basis of similar studies conducted in the world and based on the recommendations of the World Health Organization (World Health Organization) on the observation of physical, emotional, and social status of women operated on for breast cancer. We are in the construction of questions as a starting point had the structure and design of HRQoL, Health Survey, SF-36, Body Image Questionnaire European Organization for Research and Treatment of Cancer (EORTC Quality of life). Analysis included the mean scores on a scale of 0 to 10. The highest mean scores (9) related to questions about body image, self-esteem, sexuality, femininity and selfesteem, we have the immediate reconstruction, in which the lowest level is and mental illnesses (9.09%).CONCLUSION. We found that immediate implant reconstruction the method of choice in the treatment of operable breast cancer. In these patients, the overall satisfaction with the most pronounced, with the most optimal psycho-social effects, satisfactory quality of sexual life and general life activities. Immediate reconstruction with implants a safe option with a low rate of postoperative complications, and economic considerations are the most appropriate