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

Abstract

Purpose This study investigated the impact of chemotherapy on complication rates of implant and free flap breast reconstruction. The effect of timing and dosage of chemotherapy in minimizing the breast reconstruction surgery (BRS) complications were also investigated. Methods PRISMA guidelines were used to search relevant studies published from January 2009 to September 2021. Quality of selected studies were assessed using GRADE assessment and risk of bias was performed using Cochrane Collaboration’s tool and ROBINS-I. Rates of major and minor complications of neoadjuvant systemic therapy (NST) and adjuvant systemic therapy (AST) were compared by t-test using GraphPad Prism v.9.3.0 and P value <0.05 was considered statistically significant. Results A total of 19 studies comprising 49,217 patients were included. The GRADE assessment showed low risk of bias and good quality across studies. Three-hundred and twenty patients had implant reconstruction, 3,172 had flap reconstruction and 46,062 had both flap and implant reconstruction surgery. There was no significant difference in complication rates of patients between flap reconstruction surgery and implants. (P=0.4) In all studies, total complication rates for post-chemotherapy BRS patients was 46.03% compared to 32.49% without chemotherapy (P=0.09). Overall major complications rate was 14.5% (P=0.61) with NST and 21.1% (P=0.69) with AST. Minor complications rate was 28.8% (P=0.97) with NST and 39.5% (P=0.59) with AST. Complication rate of NST was lower than AST, but not statistically significant (P=0.64). No significant correlation was found between timing/duration of chemotherapy and rates of BRS complications (P=0.76). Conclusion No significant difference in BRS complications with and without chemotherapy was established. Despite these results suggesting little difference between NST and AST or chemotherapy in BRS complications, prospective control studies are currently limited, and more are necessary to better inform surgeons and their patients.

Employing Large Language Models for Surgical Education: An In-depth Analysis of ChatGPT-4

“…Nevertheless, it is important to acknowledge that BARD is the only model to make a preliminary diagnosis of necrotising fasciitis based on haemodynamic instability and provide relevant risk factors to aid junior doctors in formulating differential diagnoses. This capability may indicate BARD's potential as a valuable complementary diagnostic aid (10). Despite these strengths, the performance of BingAI and BARD in providing management advice for handling postoperative emergencies is markedly inferior to that of ChatGPT-4.…”

“…ChatGPT-3.5 has demonstrated performance near the passing threshold of 60% accuracy in the USMLE Steps 1, 2 CK, and 3 exams, comparable to a first-year postgraduate doctor seeking licensure as an unsupervised physician in the United States of America (USA) (5). Following the March 2023 release of ChatGPT-4, it has been claimed that the updated version of this LLM has enhanced clinical reasoning and test-answering capabilities compared to previous iterations (9,10). This has been further demonstrated with ChatGPT-4 significantly outperforming ChatGPT-3.5 on American neurosurgical written board examinations (8).…”

“…This has triggered concerns regarding the potential long-term effects of medical training. However, the pandemic has also spurred innovations in medical education, particularly in virtual simulation and telehealth (5,10,11). While most universities resume face-to-face training, the growing prevalence of AI and LLMs cannot be ignored, as they have emerged as possible tools to aid informed diagnosis and make safer treatment plans.…”