Eck Dustin L, McLaughlin Sarah A, Terkonda Sarvan P, Rawal Bhupendra, Perdikis Galen
From the Mayo Clinic Division of Plastic Surgery Jacksonville, FL.
Ann Plast Surg. 2015 Jun;74 Suppl 4:S201-3. doi: 10.1097/SAP.0000000000000446.
Recent studies have shown that patients undergoing immediate breast reconstruction after mastectomy have a higher rate of complications relative to patients undergoing mastectomy alone. Conflicting data exist on how these complications impact adjuvant treatment. We sought to quantify the additional risk associated with immediate breast reconstruction after mastectomy and determine how these risks influence adjuvant chemotherapy.
A retrospective review of women undergoing mastectomy for breast cancer and immediate breast reconstruction between January 2007 and December 2012 was conducted. We abstracted clinicopathological variables and stratified women according to the type of reconstruction and presence of surgical complications. Additionally, time to adjuvant chemotherapy was assessed.
Overall, 56 of 199 (28%) women suffered 70 complications, of which hematoma, skin necrosis, cellulitis, or seroma accounted for 53 (76%) of the complications. The start date of adjuvant therapy was known in 116 (58%) of the women with invasive cancer. Overall, patients that underwent immediate breast reconstruction did not have delay in adjuvant treatment when compared to patients with no reconstruction (41 days vs 42 days, P = 0.61). Women with a complication did have a significantly longer interval to adjuvant chemotherapy when compared to those with no complications (47 days vs 41 days, P = 0.027). When further stratified by type of reconstruction, although there were differences in time to adjuvant chemotherapy, none of these reached significance (tissue expanders: 45 days vs 41 days, P = 0.063; flap reconstruction: 72 days vs 49 days, P = 0.25).
Immediate reconstruction after mastectomy does not delay additional cancer treatment. Overall, when complications do occur, adjuvant therapy is significantly delayed, though the median delay was only 6 days.
近期研究表明，与仅接受乳房切除术的患者相比，乳房切除术后立即进行乳房重建的患者并发症发生率更高。关于这些并发症如何影响辅助治疗，存在相互矛盾的数据。我们试图量化乳房切除术后立即进行乳房重建相关的额外风险，并确定这些风险如何影响辅助化疗。
对2007年1月至2012年12月期间接受乳腺癌乳房切除术及立即乳房重建的女性进行回顾性研究。我们提取了临床病理变量，并根据重建类型和手术并发症的存在对女性进行分层。此外，评估了辅助化疗的时间。
总体而言，199名女性中有56名（28%）出现了70例并发症，其中血肿、皮肤坏死、蜂窝织炎或血清肿占并发症的53例（76%）。116名（58%）浸润性癌女性的辅助治疗开始日期已知。总体而言，与未进行重建的患者相比，立即进行乳房重建的患者在辅助治疗方面没有延迟（41天对42天，P = 0.61）。与无并发症的女性相比，有并发症的女性辅助化疗的间隔时间明显更长（47天对41天，P = 0.027）。当按重建类型进一步分层时，尽管辅助化疗的时间存在差异，但均未达到显著水平（组织扩张器：45天对41天，P = 0.063；皮瓣重建：72天对49天，P = 0.25）。
乳房切除术后立即重建不会延迟额外的癌症治疗。总体而言，当确实发生并发症时，辅助治疗会显著延迟，尽管中位延迟仅为6天。
