Outcomes and Cost Analysis in High-Risk Patients Undergoing Simultaneous Free Flap Breast Reconstruction and Gynecologic Procedures

Corral, Gabriel A. Del; Wes, Ari M.; Fischer, John P.; Serletti, Joseph M.; Wu, Liza C.

doi:10.1097/sap.0000000000000156

Cited by 29 publications

(27 citation statements)

References 10 publications

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“…Patients who underwent gynecologic procedures alone also had more comorbidity, but were of similar age to patients who had coordinated surgery. Del Corral and colleagues studied patients with BRCA mutations who underwent bilateral free flap breast reconstruction and gynecologic procedures and compared postoperative outcomes with patients who had immediate reconstruction without gynecologic surgery. Specifically, there was no difference in DVT ( P = 1.0), arrhythmia ( P = 0.195), cardiac complications ( P = 0.088), gastrointestinal bleeding ( P = 0.119), or heart failure ( P = 0.251) between the two groups.…”

Section: Discussionmentioning

confidence: 99%

Postoperative complications in combined gynecologic, plastic, and breast surgery: An analysis from National Surgical Quality Improvement Program

Tevis¹,

Steiman

Neuman

et al. 2019

Breast J

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Patients undergoing the addition of a contralateral prophylactic mastectomy with unilateral breast cancer have an increased and potentially doubled post‐operative complication rate. One documented detriment from post‐operative complications is the potential delay in initiating adjuvant therapy. To determine if the addition of a gynecologic and/or plastic reconstructive procedure to breast surgery results in an increased risk of postoperative complications and re‐admissions, we evaluated outcomes in patients undergoing single vs multi‐site surgery in a large national surgical database. We utilized the National Surgery Quality Improvement Program (NSQIP) database to identify patients who underwent breast surgery between 2011 and 2015. We extracted patients who underwent prophylactic oophorectomy with or without hysterectomy as a comparison group. Chi square analysis was used to assess postoperative outcomes including complications, readmission, and reoperation. All statistics were performed in SPSS v. 24. During the study timeframe, 77 030 patients had a solitary or combined breast surgical procedure and a second cohort of 124 patients underwent gynecologic surgery. Breast cancer patients who did not have a simultaneous reconstruction or gynecologic procedure were older with more comorbidities. Patients undergoing coordinated procedures had a significantly longer length of stay, higher complication, readmission, and reoperation rates (P < 0.001 for all) as compared with patients who underwent single site surgery. Patients with surgery for breast cancer, either with a plastic or gynecologic procedure, have greater postoperative complications. Higher complication rates for those with coordinated operations may lead to delays in adjuvant therapy and discussions regarding the indications for simultaneous surgery are recommended.

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Section: Discussionmentioning

confidence: 99%

Postoperative complications in combined gynecologic, plastic, and breast surgery: An analysis from National Surgical Quality Improvement Program

Tevis¹,

Steiman

Neuman

et al. 2019

Breast J

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show abstract

“…The mean duration of hospital stay was 9.2 days (range, [8][9][10][11][12][13][14]. Mean follow-up was 7.1 months (range, [3][4][5][6][7][8][9][10][11][12][13][14][15][16]. Two patients were revised for hematoma and one for veinous thrombosis, twice.…”

Section: Resultsmentioning

confidence: 99%

“…Similarly, Spear et al performed double TRAM reconstruction and open laparotomy salpingo-oophorectomy [26,27]. More recently, Del Corral et al described a combined procedure with msTRAM, DIEP, SIEA or transverse upper gracilis (TUG) flaps but always performing an open laparotomy gynecological procedure [16]. Nevertheless, this would require for the team to stand ready during our procedure, and both teams would interfere negatively with each other during the microsurgical anastomosis.…”

Section: Figurementioning

confidence: 92%

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A new strategy for prophylactic surgery in BRCA women: Combined mastectomy and laparoscopic salpingo-oophorectomy with immediate reconstruction by double DIEP flap

Hunsinger

Marchac

Derder

et al. 2016

Annales de Chirurgie Plastique Esthétique

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“…[16][17][18] Improved surgical techniques, including reconstruction, may have contributed to the 12 % per year increase in bilateral prophylactic mastectomy observed in the United States during the last decade. 19 Bilateral prophylactic mastectomy with reconstruction is a major surgical procedure, and although some have reported very low complication rates, 20 the bulk of available data suggest that 8-64 % of women will experience one or more complications [21][22][23][24] and that 52-71 % will require reoperation. [24][25][26] Prophylactic mastectomy also has a significant impact on body image and psychosocial function.…”

mentioning

confidence: 99%

Risk-Reducing Mastectomy for BRCA Gene Mutation Carriers

Euhus

2015

Ann Surg Oncol

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A family history of early-onset breast cancer in multiple relatives is an important breast cancer risk factor that should prompt efforts to define and manage cancer risk. Genetic testing is the most powerful tool we have for precisely determining who in these families is at increased risk and who is not. With the advent of massive parallel sequencing or next-generation sequencing and the commercialization of multigene panels, we have incrementally expanded the proportion of families that can be understood and managed from a genetic perspective. Nevertheless, BRCA1 and BRCA2 remain the most commonly identified genes affected by deleterious mutations. The next largest fraction includes PALB2, CHEK2, and ATM, but it is estimated that even with whole-genome sequencing, we are explaining only about 35 % of apparent inherited breast cancer predisposition. 1The first task after receiving a ''deleterious'' or ''likely deleterious'' genetic test result is to estimate cancer risks. This requires knowledge about the mutated gene, about the specific mutation, and about the extended cancer family history. It is common, but not accurate, to see a BRCA1 mutation and immediately assume that the lifetime breast cancer risk is 80 %. Slight differences in the way we code for other genes (polymorphisms) can influence the cancer probabilities associated with mutations in major predisposition genes. Different families have different risk profiles, even with the same mutation. This has been observed for BRCA1 for which lifetime breast cancer risk has been estimated at 26-87 % depending on the associated family history. It also is true for the newer ''modest penetrance'' genes such as ATM, for which the lifetime risk appears to be as high as 60 % in some families.2 Attention to the three-generation cancer family history during post-test counseling cannot be emphasized enough. Once cancer risks have been estimated, the focus shifts to developing a risk management strategy that considers the magnitude of the risk, the risks and effectiveness of possible interventions, and individual risk tolerance and preferences. The options to consider include lifestyle interventions, enhanced surveillance, chemoprevention, and risk-reducing surgery.The meta-analysis by De Felice and colleagues reported in this Annals of Surgical Oncology issue contributes to this discussion by attempting to quantify the breast cancer risk reduction afforded by bilateral risk-reducing mastectomy for BRCA gene mutation carriers. Their analysis included four prospective studies and estimated a 93 % reduction in breast cancer risk. Is this the number we should quote to our BRCA gene mutation carriers? A careful look at the studies included (or excluded) in this analysis will help to calibrate our confidence in the result.De Felice and colleagues were interested in prospective English-language studies describing bilateral prophylactic mastectomy in BRCA1 and BRCA2 mutation carriers with no diagnosis of breast cancer by the time of mastectomy.

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Outcomes and Cost Analysis in High-Risk Patients Undergoing Simultaneous Free Flap Breast Reconstruction and Gynecologic Procedures

Abstract: For the high-risk breast cancer patient, a combined mastectomy, free flap reconstruction, and gynecologic procedure represents an attractive and safe option.

Cited by 29 publications

References 10 publications

Postoperative complications in combined gynecologic, plastic, and breast surgery: An analysis from National Surgical Quality Improvement Program

Postoperative complications in combined gynecologic, plastic, and breast surgery: An analysis from National Surgical Quality Improvement Program

A new strategy for prophylactic surgery in BRCA women: Combined mastectomy and laparoscopic salpingo-oophorectomy with immediate reconstruction by double DIEP flap

Risk-Reducing Mastectomy for BRCA Gene Mutation Carriers

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