Abstract:

Objective

To evaluate the impact of modified radical mastectomy combined with latissimus dorsi muscle repositioning on postoperative drainage， flap perfusion， and tube removal time in breast cancer patients.

Methods

A retrospective analysis was conducted on the clinical data of 375 primary breast cancer patients who underwent modified radical mastectomy in the Fourth Hospital of Hebei Medical University between January 2021 and December 2022. Patients were divided into experimental group （modified radical mastectomy combined with intraoperative latissimus dorsi muscle repositioning） and control group （conventional modified radical mastectomy） based on whether latissimus dorsi muscle repositioning was performed during surgery. The blood flow， color and necrosis of the flap were observed and the postoperative drainage volume was measured daily after surgery. At 6 months after surgery， the patients were surveyed using the Quality of Life Questionnaire-Breast Cancer 23 （QLQ-BR23）. Postoperative drainage volume and QLQ-BR23 scores were continuous variables and expressed as ±s. Between-group comparisons were made using repeated measures ANOVA and t test. Flap perfusion and baseline clinical characteristics were count data expressed as frequency（percentage）， and compared between groups using chi-square test. Age and tube removal time， as nonnormally distributed data， were expressed as M （P₂₅， P₇₅） and compared using the Mann-Whitney U test.

Results

There was a statistically significant difference in postoperative drainage volume between the two groups from day 1 to day 4 （F＝20.510， P＜0.001）. Significant differences were also observed within the same group between different time points （F＝2451.157， P＜0.001）， and there was interaction between the surgical method and time （F＝7.437， P＝0.002）. For the drainage volume on each postoperative day （day 1 to day 4）and total drainage volume， the experimental group had significantly lower values compared with the control group （t＝－7.069， －10.714， －10.162， －4.197， 21.226， all P＜0.001）. The experimental group had 5 cases（2.6%） of flap perfusion complications， compared with 17 cases （9.2%） in the control group， suggesting a significant difference between groups （χ² ＝7.299， P ＝0.007）. The tube removal time was 6 （6， 7） d after operation in the control group and 4 （4， 5） d in the experimental group， with a statistically significant difference between groups （Z＝-11.229， P＜0.001）. Compared with the control group， the experimental group had significantly higher scores in body image of the QLQ-BR23 functional dimension （t ＝－4.556， P＜0.001）and lower scores in breast symptom of the QLQ-BR23 symptom dimension （t＝2.519，P＝0.012）.

Conclusions

The latissimus dorsi muscle repositioning during modified radical mastectomy can reduce postoperative complications and improve the quality of life in breast cancer patients. This technique is simple， effective， and worthy of clinical promotion.

Key words: Breast neoplasms, Mastectomy，modified radical, Latissimus dorsi