RECONSTRUCTIVE PLASTIC SURGERY IN PATIENTS WITH BREAST CANCER STAGES T1-3N1-3M0

Tokaev Valerij Kazbekovich, Zikiryahodzhaev Aziz Dil'shodovich, Troshenkov Evgenij Alekseevich, Rasskazova Elena Aleksandrovna, Polyak Marianna Aleksandrovna, Nikitina Ekaterina Andreevna, Malik Denis Sergeevich

Breast cancer is a significant social and medical problem. An integrated approach to the management of women seems to be relevant, with the leading stage being surgical treatment. Reconstructive plastic surgery is one of the most promising methods of surgical treatment, especially in the group of women of reproductive age. The purpose of the study was to analyze the results of performing reconstructive plastic surgery in patients with breast cancer with stages T1-3N1-3M0. Materials and methods. A prospective and retrospective clinical study was carried out. Case histories and outpatient records of patients who received treatment in 2017 in the scope of one-stage breast reconstruction in terms of complex treatment (n=69) were analyzed. The frequency of development of early and late complications after reconstructive plastic surgery in patients with locally advanced breast cancer was assessed, 3 and 5-year overall and relapse-free survival were analyzed. Statistical processing of the obtained data was carried out using the programs STATISTICA v.10.0, MS Excel 7.0. Results. The average age of the patients was 45±1.7 years, the most common stage was T2N1M0 - 30.43%, T1N1M0 - 26.09% and T2N2M0 - 14.49%). Most patients were diagnosed with infiltrative ductal carcinoma - 76.81%. Almost all patients in the study underwent complex treatment - 97.10%. In 37.68% of cases at the 1st stage, patients received NAPCT, in 62.32% APCT was performed, radiation therapy was performed in 95.65%, hormonal therapy was prescribed in 66.67%, targeted therapy was prescribed for non-2-3+ in 63.77 %. Conclusions. 1. NAPCT in 72.46% of patients led to partial regression of the tumor node (PR), in 14.49% - complete regression of the tumor node (CR), in 2.90% - to no response (NR). 2. The frequency of complications was 31.88%. The most common complications were capsular contracture III-II degree according to J.L. Baker and seroma - 7.25% of patients each. 3. The presence of elderly and senile age did not affect the development of complications. The presence of overweight and obesity was associated with a higher risk of complications during simultaneous breast reconstruction - OR = 8.89 (95% CI 2.79-28.33). The use of neoadjuvant polychemotherapy/targeted therapy has not been associated with an increased risk of complications. 4. Local recurrence was detected in 4.35% of cases, progression of the disease - in 11.59%, death - in 10.14% of cases. The relapse-free five-year survival rate was 95.65%. The overall five-year survival rate was 89.86%.

Keywords:breast cancer, reconstructive plastic surgery, neoadjuvant chemotherapy, postoperative complications, overall survival, disease-free survival