Neo‐adjuvant chemotherapy does not affect the immediate postoperative complication rate after breast reconstruction

Abstract

Neo-adjuvant chemotherapy (NAC) refers to systemic therapy for breast cancer (BC) prior to definitive surgical treatment and is proved safe and effective. The purpose of administering NAC is to downstage the tumor, allowing for less extensive surgery and improved cosmetic outcomes. [1][2][3][4] While originally intended for patients with locally advanced BC, for whom even a mastectomy may not be feasible, NAC is now frequently administered to patients with operable BC, in attempt to improve cosmetic outcomes or to limit the extent of axillary lymph node removal. 5 Surgical management of BC has evolved considerably over the past decades with a major shift occurring from mastectomies to breast-conserving therapy. Both surgeons and patients share concerns that NAC may increase the risk for infection after immediate breast reconstruction (IBR) due to its effect on the immune system and the relatively short duration between chemotherapy and surgery. While breast reconstruction plays an increasingly significant role in the treatment of BC, little has been written about the effect of NAC on postoperative complications after reconstruction. We identified 120 patients (154 breasts) who underwent surgery for BC with IBR between the years 2013-2016 at Kaplan Medical Center. The cohort was divided into patients who received NAC (n = 36) and those who did not (n = 84). All analyses were performed with the patient being the analytical unit. Data collected retrospectively from hospital records included: demographics, comorbidities, disease characteristics, neo-adjuvant treatment, indication for mastectomy, and immediate postoperative complications (30 days). 6The mean follow-up time was 19 months (2-44 months). Standard NAC at our institution is indicated for large tumors, lymph node involvement, and in cases where the tumor to breast size ratio might dictate a large excision with a poor aesthetic result. It consists of four cycles of adriamycin (60 mg/m²) and cyclophosphamide (600 mg/m²) given every other week followed by 12 cycles of weekly paclitaxel (80 mg/m²). Time to surgery after completion of NAC is not specified by protocol. For patients undergoing NAC, the mean interval from the last treatment until surgery was 37.2 days (SD ± 15.6, 21.6-52.8). Mastectomy was further classified into nipple sparing mastectomy (NSM) or skin sparing mastectomy (SSM). Reconstruction after mastectomy was implant based, tissue expander, or free flap. Patients who had a lumpectomy and oncoplastic reconstruction were also included. The primary outcome of interest was whether any complication occurred.We used SPSS software to analyze the data. The statistical significance was set in advance to be (P < 0.05). Univariate analyses and multivariate logistic regression model were used to analyze the data. First, we examined risk factors (diabetes, smoking, prior breast irradiation) for complication rates among our total study population and found that smoking was a significant predictor of any complication (P = 0.02). Next, we examined the surgical...

Impact of neoadjuvant chemotherapy on surgical complications in breast cancer: A systematic review and meta-analysis

“…A total of 134,191 patients (136,326 breasts) were included, of which 9,678 patients (10,571 breasts) were treated with NACT and 124,516 patients (125,696 breasts) were not treated with NACT and thus represented the control group. Three studies [20e22] only reported number of breasts while two studies [23,24] only reported number of patients. To increase the comparability of the studies, the complication rates based on breasts and patients were analysed individually.…”

Tumor-to-Nipple Distance in Selecting Patients for Nipple-sparing Mastectomy

“…The complication rate in this series (35%) may be partially explained by our high rate of smokers (20%), prior radiation treatment (XRT) (11%), and alloplastic reconstruction (70%). In a previous publication 27 based on an overlapping dataset, we found that alloplastic reconstruction had a higher complication rate compared with autologous reconstruction.…”

The effect of chemotherapy on the complication rates of implant and free flap breast reconstruction: A Systematic Review

“…The major complications identi ed were partial or total ap loss, venous congestion, infection, hematoma, seroma, fat necrosis, and wound dehiscence. Thirteen studies concluded there was no signi cant difference in the complication rates of patients who received NST and those who did not [3,5,12,13,21,22,24,26,31,35,43,44,46,49]. In the pooled analysis, when comparing BRS complications with and without NST, the overall NST patient complication rates were higher (10.61%), but not statistically signi cant (NST = 44.07 %, Control = 33.46%, P=0.21).…”

“…Eight of the studies were conducted in the United States of America [9,13,21,29,41,42,44,46]. One study was translated into English from Hebrew [22]. Fifteen studies had patients with ap reconstruction surgery [3,22,26,29,30,31,35,43,44,49], six studies had patients with both ap and implant reconstruction surgery [9,12,13,21,42,46] and two studies had patients with implant reconstruction surgery [5,24].…”

“…One study was translated into English from Hebrew [22]. Fifteen studies had patients with ap reconstruction surgery [3,22,26,29,30,31,35,43,44,49], six studies had patients with both ap and implant reconstruction surgery [9,12,13,21,42,46] and two studies had patients with implant reconstruction surgery [5,24]. From the available studies, a total of 671 patients were on implants following BRS and 48,416 with ap reconstruction.…”