Surgical Outcomes for Mastectomy Patients Receiving Neoadjuvant Chemotherapy

Abstract

Objective:To evaluate the risk of neoadjuvant chemotherapy for surgical morbidity after mastectomy with or without reconstruction using 1:1 matching.Background:Postoperative surgical complications remain a potentially preventable event for breast cancer patients undergoing mastectomy. Neoadjuvant chemotherapy is among variables identified as contributory to risk, but it has not been rigorously evaluated as a principal causal influence.Methods:Data from American College of Surgeons National Surgical Quality Improvement Program (2006–2012) were used to identify females with invasive breast cancer undergoing planned mastectomy. Surgical cases categorized as clean and undergoing no secondary procedures unrelated to mastectomy were included. A 1:1 matched propensity analysis was performed using neoadjuvant chemotherapy within 30 days of surgery as treatment. A total of 12 preoperative variables were used with additional procedure matching: bilateral mastectomy, nodal surgery, tissue, and/or implant. Outcomes examined were 4 wound occurrences, sepsis, and unplanned return to the operating room.Results:We identified 31,130 patient procedures with 2488 (7.5%) receiving chemotherapy. We matched 2411 cases, with probability of treatment being 0.005 to 0.470 in both cohorts. Superficial wound complication was the most common wound event, 2.24% in neoadjuvant-treated versus 2.45% in those that were not (P = 0.627). The rate of return to the operating room was 5.7% in the neoadjuvant group versus 5.2% in those that were not (P = 0.445). The rate of sepsis was 0.37% in the neoadjuvant group versus 0.46% in those that were not (P = 0.654).Conclusions:This large, matched cohort study, controlled for preoperative risk factors and most importantly for the surgical procedure performed, demonstrates that breast cancer patients receiving neoadjuvant chemotherapy have no increased risk for surgical morbidity.

A population-based audit of surgical practice and outcomes of oncoplastic breast conservations in Scotland – An analysis of 589 patients

“…This can be explained by the multi-centre nature of our series with initially less experience in OBC techniques. Interestingly, we found a significantly lower overall complication rate after neo-adjuvant chemotherapy (15.9%) despite others reporting no difference in complication rates after neo-adjuvant chemotherapy followed by OBC or mastectomy 4,39 .…”

Complications of mastectomy for breast cancer in a tertiary care centre in South-west Nigeria

“…The overall complication rate in the present study was higher than that observed in Ibadan by Ogundiran et al, [2] and Bowen et al [10] in which complications were limited to 30 days postoperative period so did not include late complications such as recurrence andupper limb oedema but similar to the report of N"guessam et al [5] As at the time of this report, 41.6% of the patients were alive having been followed up for at least six months, while 39% were lost to follow-up care and 19.4% were dead. This pattern is similar to the experience of others.…”

“…chemotherapy had been associated with postoperative wound complications of mastectomy in the past but recent studies showed no increase in postoperative morbidity. [9,10] In the present study, 31% had neoadjuvant chemotherapy and half of them had a postoperative complication.…”

Does response to neo-adjuvant chemotherapy impact breast reconstruction?

“…The rates of short‐term complications in our patients were similar to those reported in this study. Other reports have similarly shown acceptable complication rates of immediate breast reconstruction after NAC, even when radiation therapy is also utilized . In terms of oncologic outcomes, Prabhu et al showed that IR may delay time to post‐mastectomy radiation in patients treated with neo‐adjuvant chemotherapy, but that there were no differences in locoregional control, disease‐specific survival, and overall survival when compared to a cohort of patients who did not have breast reconstruction .…”