Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts; Master of Medical Sciences in Clinical Investigations Program, Harvard Medical School, Boston, Massachusetts.
Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts; Charles E. Schmidt College of Medicine, Boca Raton, Florida.
Int J Radiat Oncol Biol Phys. 2020 Mar 1;106(3):514-524. doi: 10.1016/j.ijrobp.2019.11.008. Epub 2019 Nov 19.
To compare single-stage direct-to-implant (DTI) immediate reconstruction to the commonly used 2-stages expander and implant (TE/I) or autologous reconstruction with focus on postmastectomy radiation therapy (PMRT) setting.
We reviewed the charts of 1,286 patients who underwent 1,814 breast reconstructions at our institution with and without PMRT from 1997 to 2017. Patients were divided into 6 groups according to type of reconstruction and PMRT status. Primary objective was reconstruction complications defined solely on surgical reintervention operative notes such as infection, skin necrosis, and fat necrosis across all groups. Implant-related complications such as capsular contracture, implant rupture or exposure, or implant failure were compared between TE/I and DTI. Kaplan-Meier estimates were used to calculate 5-year cumulative incidence of complications. The secondary objective was to compare the 3 reconstruction types in settings of immediate reconstruction followed by PMRT on multivariable analysis.
Median follow-up was 5.8 years. Among 1286 patients, 41.1% (N = 529/1286) received PMRT. Among 1814 reconstructed breasts, autologous, single-stage, and TE/I represented 18.7%, 34.8%, and 46.2%, respectively. With no PMRT, the 5-year cumulative incidence of any reconstruction complication was 11.1%, 12.6%, and 19.5% for autologous, DTI, and TE/I reconstructions, respectively. The addition of PMRT resulted in 5-year cumulative incidence of 15.1%, 18.2%, and 36.8%, respectively. The multivariable analysis showed that DTI was associated with lesser complications compared with TE/I, whereas no significant difference was noted between DTI and autologous.
Single-stage DTI reconstruction had significantly lower complication rates than TE/I with and without PMRT. Single-stage complication rates were not significantly different from autologous complication rates in PMRT settings. Single-stage reconstruction may offer a valuable option for patients receiving PMRT.
比较单阶段直接种植（DTI）即刻重建与常用的 2 阶段扩张器和种植体（TE/I）或自体重建，重点关注乳房切除术放疗（PMRT）环境。
我们回顾了 1997 年至 2017 年在我们机构接受 1814 例乳房重建且有或无 PMRT 的 1286 例患者的图表。患者根据重建类型和 PMRT 状态分为 6 组。主要目标是根据所有组别的手术再干预手术记录（如感染、皮肤坏死和脂肪坏死）定义重建并发症，不包括与植入物相关的并发症，如包膜挛缩、植入物破裂或暴露或植入物失败。在 TE/I 和 DTI 之间比较了植入物相关并发症。Kaplan-Meier 估计用于计算 5 年累积并发症发生率。次要目标是在多变量分析中比较 PMRT 后即刻重建的 3 种重建类型。
中位随访时间为 5.8 年。在 1286 例患者中，41.1%（N=529/1286）接受了 PMRT。在 1814 例重建乳房中，自体、单阶段和 TE/I 分别占 18.7%、34.8%和 46.2%。无 PMRT 时，自体、DTI 和 TE/I 重建的 5 年累积任何重建并发症发生率分别为 11.1%、12.6%和 19.5%。添加 PMRT 后，5 年累积发生率分别为 15.1%、18.2%和 36.8%。多变量分析显示，与 TE/I 相比，DTI 与较少的并发症相关，而在 PMRT 环境中，DTI 与自体之间没有显著差异。
与 TE/I 相比，单阶段 DTI 重建具有更低的并发症发生率，无论是否有 PMRT。在 PMRT 环境中，单阶段重建的并发症发生率与自体重建的并发症发生率无显著差异。单阶段重建可能为接受 PMRT 的患者提供有价值的选择。
