Risk of recurrence and death in breast cancer patients after delayed deep inferior epigastric perforator flap reconstruction

Adam, H.; Skogh, A.C. Docherty; Nord, Anette; Schultz, Inkeri; Gahm, Jessica; Hall, Per; Frisell, Jan; Halle, Martin; Boniface, Jana de

doi:10.1016/s0959-8049(18)30428-3

Cited by 2 publications

(6 citation statements)

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“…Previously, we mentioned there is no statistical difference in major complications between both procedures. Therefore, this particular factor will not be important in decision-making [13]. In summary, both procedures have their advantages and limitations.…”

Section: Discussionmentioning

confidence: 99%

“…Two Swedish studies described no difference in breast cancer recurrence between delayed DIEP flap reconstruction groups and mastectomy alone. A major limitation of these studies is that they included a relatively small number of DIEP flap reconstruction patients in a long period of time, 250 patients in a 14 year time period, and 225 patients in 9 years respectively [13,14]. A study by Geers et al assessed the effect of an (immediate or delayed) autologous breast reconstruction as compared to mastectomy alone, on distant relapse.…”

Section: Discussionmentioning

confidence: 99%

“…The extensive and prolonged autologous breast reconstructive surgery may be considered a major tissue trauma suggesting autologous breast reconstruction increases the breast cancer recurrence risk. However, studies have shown different results [12][13][14][15], probably owing to inclusion of heterogenous breast reconstructive surgery and lack of homogeneous study populations.…”

Section: Introductionmentioning

confidence: 99%

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The difference in local, regional and distant breast cancer recurrence between the immediate and delayed DIEP flap procedure; a retrospective cohort study

Joosen

Schop

Reinhoudt

et al. 2021

Breast Cancer Res Treat

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Purpose It has been hypothesized that autologous breast reconstruction can cause reactivation of dormant micro metastases by its extensive tissue trauma, influencing the risk of breast cancer recurrence. However, about the specific effect of timing on breast cancer recurrence in the deep inferior epigastric perforator (DIEP) flap reconstruction is not much known. In this study the rate of local, regional and distant recurrence between patients undergoing an immediate and delayed autologous DIEP flap breast reconstruction were evaluated. Methods In this retrospective cohort study, breast cancer patients undergoing a DIEP flap breast reconstruction between 2010 and 2018 in three hospitals in the Netherlands were evaluated. Cox proportional hazards regression analyses were performed to assess the impact of different factors on breast cancer recurrence. The primary endpoint was local breast cancer recurrence. Secondary endpoints were regional and distant recurrence. Results A total of 919 DIEP-flap reconstructions were done in 862 women of which 347 were immediate- and 572 were delayed DIEP flap reconstructions. After a median follow-up of 46 months and 86 months respectively (p < 0.001), local breast cancer recurrence occurred in 1.5% and in 1.7% of the patients resulting in an adjusted hazard ratio of 2.890 (p = 0.001, 95% CI 1.536, 5437). Conclusion This study suggests an increased risk for breast cancer recurrence in women receiving a delayed DIEP flap reconstruction as compared to women receiving an immediate DIEP flap reconstruction. However, these data should be interpreted carefully as a result of selection bias.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The difference in local, regional and distant breast cancer recurrence between the immediate and delayed DIEP flap procedure; a retrospective cohort study

Joosen

Schop

Reinhoudt

et al. 2021

Breast Cancer Res Treat

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“…However, to date, no randomized controlled data on the differences in the oncologic safety between mastectomy with breast reconstruction and without breast reconstruction or the oncologic outcomes of different reconstruction methods is available due to ethical concerns. Most existing studies based on retrospective data have documented that both IBR and AFR did not increase the risk of breast cancer recurrence [8][9][10][11][12]. However, con icting results have indicated that postmastectomy AFR has an increased risk of cancer recurrence compared with mastectomy alone [25].…”

Section: Discussionmentioning

confidence: 99%

“…Meanwhile, postmastectomy reconstruction options mainly include implant-based reconstruction (IBR) and autologous ap reconstruction (AFR) in the current clinical practice. Previous studies have demonstrated that breast reconstruction using either implants or autologous tissue does not increase the risk of breast cancer recurrence compared to conventional mastectomy without reconstruction [8][9][10][11][12]. However, few studies have compared breast cancer outcomes between the IBR and AFR [13].…”

Section: Introductionmentioning

confidence: 99%

Breast Cancer Outcomes Following Immediate Breast Reconstruction with Implants Versus Autologous Flaps: A Propensity Score-Matched Study

Han

Kim

et al. 2021

Preprint

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Purpose A large proportion of patients with breast cancer who had mastectomy had undergone breast reconstruction with implants or autologous flaps. However, only a few studies have compared the breast cancer outcomes between the implant-based reconstruction (IBR) and autologous flap reconstruction (AFR). In this study, we retrospectively compared the local recurrence rates, distant metastasis rates, and survival outcomes between immediate IBR and AFR. Methods A total of 1530 patients with primary breast cancer who underwent IBR or AFR with nipple-/skin-sparing mastectomy were included. Patients who underwent neoadjuvant systemic therapy were excluded from the study. After propensity score matching by age at diagnosis, T stage, N stage, molecular subtype, mastectomy type, adjuvant radiotherapy status, and follow-up period, 938 patients were 1:1 matched, comprising the well-balanced IBR and AFR groups. Locoregional recurrence-free survival (LRRFS), disease-free survival (DFS), distant metastasis-free survival (DMFS), and breast cancer-specific survival (BCSS) were compared between the matched groups. Results After matching, the median follow-up periods were 68 months and 71 months for the IBR and AFR groups, respectively. No significant differences were observed between the IBR and AFR groups regarding the local recurrence (7.2% vs. 5.1%; P = 0.175), regional recurrence (2.1% vs. 1.5%; P = 0.463), or distant metastasis (3.2% vs. 3.2%; P = 1.000) rates. Moreover, no significant difference was observed between the IBR and AFR groups in the LRRFS (hazard ratio, 0.691; 95% CI, 0.433–1.102; P = 0.118), DFS (hazard ratio, 0.709; 95% CI, 0.468–1.076; P = 0.104), DMFS (hazard ratio, 1.006; 95% CI, 0.491–2.059; P = 0.987), or BCSS (hazard ratio, 0.445; 95% CI, 0.111–1.786; P = 0.659). Conclusion In this propensity score-matched analysis of oncologic outcomes in patients with primary breast cancer who underwent immediate breast reconstruction with nipple-/skin-sparing mastectomy, no significant differences were observed between the IBR and AFR groups.

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Risk of recurrence and death in breast cancer patients after delayed deep inferior epigastric perforator flap reconstruction

Cited by 2 publications

References 0 publications

The difference in local, regional and distant breast cancer recurrence between the immediate and delayed DIEP flap procedure; a retrospective cohort study

The difference in local, regional and distant breast cancer recurrence between the immediate and delayed DIEP flap procedure; a retrospective cohort study

Breast Cancer Outcomes Following Immediate Breast Reconstruction with Implants Versus Autologous Flaps: A Propensity Score-Matched Study

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