Fox Chase Cancer Center/Temple University Division of Plastic and Reconstructive Surgery, Philadelphia, PA, USA.
Biomedical and Research Services, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA.
Breast Cancer Res Treat. 2022 Jun;193(2):241-251. doi: 10.1007/s10549-022-06558-8. Epub 2022 Mar 14.
Perioperative tamoxifen remains a valuable therapeutic modality for breast cancer patients. Studies in the existing literature have suggested a potential increased risk of thrombotic complications in autologous breast free flap reconstruction patients exposed to tamoxifen perioperatively. However, several recent publications have questioned the validity of these associations. Therefore, we aim to perform a systematic appraisal of the existing literature to determine if perioperative tamoxifen exposure increases the risk of flap complications in autologous breast-free flap reconstruction patients.
A systematic literature search was performed using: PubMed, EMBASE, Cochrane Central, Web of Science, EBSCOHost, ClinicalTrials.gov, and TRIP databases from their inception up to April 2021. Articles analyzing the impact of perioperative tamoxifen in autologous breast free flap patients were included. The outcomes assessed were total flap loss, overall flap complications, thrombotic flap complications, which was defined as the sum of arterial and venous flap thrombi, and systemic venous thromboembolism (VTE). Pooled estimates and relative risk were calculated using a random effects model.
9294 Articles were screened and 7 were selected for analysis, which included 3669 flaps in 2759 patients. Compared to patients who did not receive tamoxifen perioperatively, those who received tamoxifen did not have an increased risk of thrombotic flap complications (pooled RR 1.06; 95% CI 0.61-1.84), total flap loss (pooled RR 2.17; 95% CI 0.79-5.95), overall flap complications (pooled RR 1.04; 95% CI 0.76-1.41), or systemic VTE (pooled RR 1.93; 95% CI 0.72-5.13). The heterogeneity of the studies was not significant for any of the outcomes.
The purpose of this study was to update the current understanding of the impact of perioperative tamoxifen on autologous breast free flap reconstruction outcomes. The existing literature supports that the perioperative continuation of tamoxifen in breast free flap patients is not associated with an increased risk of thrombotic flap complications, total flap loss, overall flap complications, or systemic VTE.
围手术期他莫昔芬仍然是乳腺癌患者的一种有价值的治疗方法。现有文献中的研究表明，接受他莫昔芬围手术期治疗的自体乳房游离皮瓣重建患者有潜在的血栓并发症风险增加。然而，最近的几项研究对这些关联的有效性提出了质疑。因此，我们旨在对现有文献进行系统评价，以确定围手术期他莫昔芬暴露是否会增加自体乳房游离皮瓣重建患者皮瓣并发症的风险。
使用 PubMed、EMBASE、Cochrane Central、Web of Science、EBSCOHost、ClinicalTrials.gov 和 TRIP 数据库进行系统文献检索，检索时间从数据库建立到 2021 年 4 月。纳入分析围手术期他莫昔芬对自体乳房游离皮瓣患者影响的文章。评估的结果包括总皮瓣失活、整体皮瓣并发症、血栓性皮瓣并发症，定义为动脉和静脉皮瓣血栓的总和，以及系统性静脉血栓栓塞症（VTE）。使用随机效应模型计算汇总估计值和相对风险。
筛选出 9294 篇文章，其中 7 篇被纳入分析，共涉及 2759 例患者的 3669 个皮瓣。与未接受围手术期他莫昔芬治疗的患者相比，接受他莫昔芬治疗的患者血栓性皮瓣并发症的风险没有增加（汇总 RR 1.06；95%CI 0.61-1.84），总皮瓣失活（汇总 RR 2.17；95%CI 0.79-5.95），整体皮瓣并发症（汇总 RR 1.04；95%CI 0.76-1.41）或系统性 VTE（汇总 RR 1.93；95%CI 0.72-5.13）。对于任何结果，研究的异质性都不显著。
本研究旨在更新围手术期他莫昔芬对自体乳房游离皮瓣重建结果影响的现有认识。现有文献支持，在接受游离皮瓣重建的乳腺癌患者中，围手术期继续使用他莫昔芬与血栓性皮瓣并发症、总皮瓣失活、整体皮瓣并发症或系统性 VTE 的风险增加无关。
