Billon Raphaëlle, Bosc Romain, Belkacemi Yazid, Assaf Elias, SidAhmed-Mezi Mounia, Hersant Barbara, Meningaud Jean-Paul
Department of Plastic, Reconstructive, Aesthetic and Maxillo-Facial Surgery, Henri Mondor University Hospital, UPEC, University Paris-Est Créteil, Créteil, France.
Department of Plastic, Reconstructive, Aesthetic and Maxillo-Facial Surgery, Henri Mondor University Hospital, UPEC, University Paris-Est Créteil, Créteil, France; Centre Sein Henri Mondor, Henri Mondor University Hospital, Créteil, France.
J Plast Reconstr Aesthet Surg. 2017 Nov;70(11):1495-1504. doi: 10.1016/j.bjps.2017.05.046. Epub 2017 Jun 3.
Hormone (anti-estrogen) therapy (HT) plays a major role in hormone receptor-positive breast cancer management. The latest guidelines propose to extend the duration of adjuvant treatment from 5 to 10 years. The association between HT and thromboembolic or microvascular complications during breast reconstruction has been investigated. However, while estrogens play a crucial role in wound healing, no study has assessed the impact of tamoxifen or aromatase inhibitors on other postoperative complications, including wound healing complications. This study aimed to assess the impact of HT on surgical outcomes after breast reconstruction.
All patients who underwent breast reconstruction between January 2012 and December 2013 were reviewed. Rates of wound healing complications, prosthesis complications, microvascular thrombosis, flap failures, and venous thromboembolism were retrospectively compared between patients treated and not treated with HT at the time of surgery.
A total of 233 operations were performed: 78 free flaps, 12 autologous latissimus dorsi flaps, 47 implants, 42 lipofilling, and 54 secondary symmetrization. At the time of surgery, 38% of patients were treated with HT. Those who received HT experienced significantly more wound healing complications (61% versus 28%; p < 0.001), including fat necrosis (26% versus 8.3%; p < 0.001), infections (15% versus 2.8%; p < 0.001), delayed wound healing (49% versus 13%; p < 0.001), and grade III/IV capsular contracture (55% versus 9.1%; p = 0.001). No significant difference was observed in the occurrence of microvascular thrombosis and venous thromboembolism.
HT seems to be associated with an increased risk of wound healing complications. Currently, there is no guideline on perioperative HT discontinuation. Further investigations are required.
激素（抗雌激素）治疗（HT）在激素受体阳性乳腺癌的治疗中起着重要作用。最新指南建议将辅助治疗的持续时间从5年延长至10年。HT与乳房重建期间血栓栓塞或微血管并发症之间的关联已得到研究。然而，虽然雌激素在伤口愈合中起关键作用，但尚无研究评估他莫昔芬或芳香化酶抑制剂对包括伤口愈合并发症在内的其他术后并发症的影响。本研究旨在评估HT对乳房重建术后手术结果的影响。
回顾了2012年1月至2013年12月期间所有接受乳房重建的患者。对手术时接受和未接受HT治疗的患者的伤口愈合并发症、假体并发症、微血管血栓形成、皮瓣坏死和静脉血栓栓塞发生率进行了回顾性比较。
共进行了233例手术：78例游离皮瓣、12例背阔肌自体皮瓣、47例植入物、42例脂肪填充和54例二次对称手术。手术时，38%的患者接受了HT治疗。接受HT治疗的患者出现的伤口愈合并发症明显更多（61%对28%；p<0.001），包括脂肪坏死（26%对8.3%；p<0.001）、感染（15%对2.8%；p<0.001）、伤口愈合延迟（49%对13%；p<0.001）和III/IV级包膜挛缩（55%对9.1%；p=0.001）。微血管血栓形成和静脉血栓栓塞的发生率未观察到显著差异。
HT似乎与伤口愈合并发症风险增加有关。目前，尚无围手术期停用HT的指南。需要进一步研究。
