Department of Plastic and Reconstructive Surgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Box 186, Hills Road, Cambridge CB2 0QQ, UK; Department of Plastic & Reconstructive Surgery, 401 Military Hospital of Athens, Greece.
Department of Plastic and Reconstructive Surgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Box 186, Hills Road, Cambridge CB2 0QQ, UK; School of Clinical Medicine, University of Cambridge, UK.
J Plast Reconstr Aesthet Surg. 2021 May;74(5):957-965. doi: 10.1016/j.bjps.2020.10.053. Epub 2020 Nov 2.
Hormonal therapy with tamoxifen and aromatase inhibitors reduces breast cancer recurrence and mortality but represents a risk factor for thromboembolic events. Therefore, most surgeons discontinue hormonal agents before microvascular surgery and for a variable period thereafter. There are no guidelines regarding when therapy should be stopped (preoperatively) or when it should be resumed (post-operatively). We, therefore, audited our hospital practice with the objective of making recommendations for microvascular breast reconstruction patients.
A review was performed of all free flap breast reconstructions between 2014 and 2019. Patients were classified according to hormone medication status at operation. Timings of drug cessation and recommencement were recorded. Thrombotic events, namely flap microvascular thrombosis, deep vein thrombosis, superficial vein thrombosis and pulmonary embolism, were compared.
A total of 240 patients had 275 free flaps over five years with 36 receiving hormone therapy within one month prior to surgery, which was discontinued 8.5 days (range: 0-28 days) before surgery. Intraoperative microvascular thromboses (HT 2.0%, NHT 0%, and p = 0.869) and post-operative microvascular complications/flap re-explorations (HT 6.6%, NHT 0%, and p = 0.234) were comparable between the two groups. Systemic venous thromboembolic events were also similar (HT 8.3%, NHT 6.1%, and p = 0.893). Age, BMI, smoking status and preoperative chemotherapy did not influence the incidence of thrombotic complications.
Hormone therapy did not significantly increase the risk of thromboembolic events. Despite the widespread practice of withholding it for 2 weeks prior to reconstructive surgery, this study does not support such practice being beneficial in terms of thromboembolic events and flap viability. Large-scale trials are needed to establish definitive protocols.
他莫昔芬和芳香化酶抑制剂的激素治疗可降低乳腺癌复发和死亡率，但却是血栓栓塞事件的危险因素。因此，大多数外科医生在微血管手术前和之后的一段时间内停止使用激素药物。目前尚无关于何时停止（术前）或何时恢复（术后）治疗的指南。因此，我们审查了我们医院的实践，目的是为微血管乳房重建患者提出建议。
对 2014 年至 2019 年间所有游离皮瓣乳房重建进行了回顾。根据手术时激素药物的状态对患者进行分类。记录药物停药和重新开始的时间。比较了血栓事件，即皮瓣微血管血栓形成、深静脉血栓形成、浅静脉血栓形成和肺栓塞。
五年内共 240 例患者行 275 例游离皮瓣，其中 36 例在术前 1 个月内接受激素治疗，术前 8.5 天（0-28 天）停药。两组术中微血管血栓形成（HT 2.0%，NHT 0%，p=0.869）和术后微血管并发症/皮瓣再次探查（HT 6.6%，NHT 0%，p=0.234）无差异。全身性静脉血栓栓塞事件也相似（HT 8.3%，NHT 6.1%，p=0.893）。年龄、BMI、吸烟状况和术前化疗均未影响血栓并发症的发生率。
激素治疗并未显著增加血栓栓塞事件的风险。尽管在重建手术前 2 周内广泛应用该治疗方法，但本研究不支持在血栓栓塞事件和皮瓣存活方面有益。需要进行大规模试验以确定明确的方案。
