title: Clinical outcomes of video-assisted skin-sparing partial mastectomy for breast cancer and immediate reconstruction with latissimus dorsi muscle flap as breast-conserving therapy.
abstract: BACKGROUND
  Skin-sparing partial mastectomy (SSPM) has yet to be investigated as a breast-conserving therapy for early-stage breast cancer. We report the clinical outcomes for video-assisted SSPM (VA-SSPM) with immediate breast reconstruction using autogenous tissue.
  
  
  METHODS
  VA-SSPM is indicated for early-stage breast cancer arising in the upper-outer or lower-outer quadrant without skin involvement. An incision is placed along the midaxillary line, and SSPM is performed under endoscopic guidance using subcutaneous tunneling and lifting methods. Through the same incision, a latissimus dorsi muscle flap is harvested for breast reconstruction. From January 2000 to October 2007, 168 patients (Tis, n = 24; T1, n = 37; T2, n = 107) underwent VA-SSPM, and morbidity, curability, and postoperative patient satisfaction were investigated.
  
  
  RESULTS
  Postoperative complications included skin necrosis (2.4%, n = 4) and muscle flap necrosis (0.6%, n = 1), but no severe complications were observed. After a mean follow-up of 58.6 months, eight patients (4.8%) experienced local recurrence. Sixty-month distant metastasis-free survival rates for Tis, T1, and T2 were 100%, 97%, and 83.3%, respectively, with an overall rate of 88.4%. Furthermore, overall survival rates for Tis, T1, and T2 were 100%, 94.1%, and 94.4%, respectively, with an overall survival rate of 95% for all patients. A patient satisfaction survey showed that 81.6% of patients evaluated the surgery as "good."
  
  
  CONCLUSIONS
  VA-SSPM for early-stage breast cancer improves cosmetic results and achieves high patient satisfaction without increasing local or distant organ recurrence. This method offers a useful local therapy for early-stage breast cancer.
authors.affiliation: Department of Endocrine, Breast Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamikyo-ku, Kyoto 602-8566, Japan. hiro@koto.kpu-m.ac.jp
authors.forename: Hiroo
authors.initials: H
authors.lastname: Nakajima
authors.forename: Ikuya
authors.initials: I
authors.lastname: Fujiwara
authors.forename: Naruhiko
authors.initials: N
authors.lastname: Mizuta
authors.forename: Koichi
authors.initials: K
authors.lastname: Sakaguchi
authors.forename: Mahiro
authors.initials: M
authors.lastname: Ohashi
authors.forename: Asako
authors.initials: A
authors.lastname: Nishiyama
authors.forename: Yoshimi
authors.initials: Y
authors.lastname: Umeda
authors.forename: Miho
authors.initials: M
authors.lastname: Ichida
authors.forename: Junji
authors.initials: J
authors.lastname: Magae
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000601:surgery*; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000379:methods; D015412:Mastectomy, Segmental / Q000379:methods*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D017060:Patient Satisfaction; D013524:Surgical Flaps; D016896:Treatment Outcome; D020535:Video-Assisted Surgery
references.citation: Plast Reconstr Surg. 1998 Jul;102(1):49-62
references.pmid: 9655407
references.citation: Cancer. 2006 Jan 1;106(1):35-41
references.pmid: 16333848
references.citation: Ann Surg. 2003 Jul;238(1):120-7
references.pmid: 12832974
references.citation: Int J Radiat Oncol Biol Phys. 1985 Mar;11(3):575-8
references.pmid: 3972667
references.citation: Ann Surg Oncol. 2003 Mar;10(2):95-7
references.pmid: 12620899
references.citation: Am J Surg. 2005 Dec;190(6):918-22
references.pmid: 16307946
references.citation: Biomed Pharmacother. 2002;56 Suppl 1:205s-208s
references.pmid: 12487283
references.citation: Cancer J. 2000 Sep-Oct;6(5):331-5
references.pmid: 11079173
references.citation: Eur J Surg Oncol. 2007 Mar;33(2):140-6
references.pmid: 17112698
references.citation: Eur J Surg Oncol. 2003 Mar;29(2):127-31
references.pmid: 12633554
references.citation: Br J Surg. 2007 Oct;94(10):1220-5
references.pmid: 17579346
references.citation: N Engl J Med. 2002 Oct 17;347(16):1227-32
references.pmid: 12393819
references.citation: Surg Laparosc Endosc. 1998 Aug;8(4):308-12
references.pmid: 9703608
references.citation: J Natl Cancer Inst. 2000 Jul 19;92(14):1143-50
references.pmid: 10904087
references.citation: Ann Surg Oncol. 2008 Apr;15(4):1081-91
references.pmid: 18224376
references.citation: Ann Oncol. 2005 Oct;16(10):1569-83
references.pmid: 16148022
references.citation: Surg Laparosc Endosc Percutan Tech. 2001 Dec;11(6):356-62
references.pmid: 11822858
references.citation: Int J Clin Oncol. 2006 Feb;11(1):51-4
references.pmid: 16508729
references.citation: Ann Surg Oncol. 1997 Jul-Aug;4(5):377-84
references.pmid: 9259963
references.citation: World J Surg. 2007 Oct;31(10):1934-40
references.pmid: 17674094
references.citation: N Engl J Med. 2002 Oct 17;347(16):1233-41
references.pmid: 12393820
references.citation: Ann Surg Oncol. 1999 Oct-Nov;6(7):676-81
references.pmid: 10560854
references.citation: J Am Coll Surg. 2006 Nov;203(5):704-14
references.pmid: 17084333
references.citation: Am J Surg. 2004 Jul;188(1):78-84
references.pmid: 15219490
references.citation: Am J Surg. 2007 Oct;194(4):438-43
references.pmid: 17826052
references.citation: N Engl J Med. 1995 Apr 6;332(14):907-11
references.pmid: 7877647
references.citation: Surg Oncol. 2008 Aug;17(2):97-105
references.pmid: 18093828
references.citation: Eur J Surg Oncol. 2008 Feb;34(2):143-8
references.pmid: 17709228
references.citation: Breast. 1999 Aug;8(4):162-8
references.pmid: 14731434
references.citation: Ann Surg Oncol. 2002 Jun;9(5):462-6
references.pmid: 12052757