Departments of Plastic and Reconstructive Surgery.
Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
Int J Surg. 2023 Oct 1;109(10):2896-2905. doi: 10.1097/JS9.0000000000000063.
Breast cancer is the most common treatment-related second malignancy among women with previous chest radiotherapy for Hodgkin lymphoma (HL). Little is known about the effects of this kind of radiotherapy on the outcomes of postmastectomy breast reconstruction (BR). This study compared adverse outcomes of BR after HL-related chest radiotherapy to matched controls.
The authors conducted a retrospective, matched cohort study in two expert cancer centres in the Netherlands. BRs after therapeutic or prophylactic mastectomy in HL survivors who received chest radiotherapy were matched with BRs in nonirradiated patients without HL on age at mastectomy date, date of BR, and type of BR. The primary outcome was complication-related BR failure or conversion and secondary outcomes were complication-related re-operation, capsular contracture, major donor-site complications, and complication-related ICU admission. The authors analyzed all outcomes univariably using Fisher's exact tests and the authors assessed reconstruction failure, complication-related re-operation, and capsular contracture with multivariable Cox regression analysis adjusting for confounding and data clustering.
Seventy BRs in 41 patients who received chest radiotherapy for HL were matched to 121 BRs in 110 nonirradiated patients. Reconstruction failure did not differ between HL survivors (12.9%) and controls (12.4%). The comparison groups showed no differences in number of reoperations, major donor-site complications, or capsular contractures. BR in HL survivors more often let to ICU admission due to complications compared with controls ( P =0.048).
We observed no increased risk of adverse outcomes following BR after previous chest radiotherapy for HL. This is important information for counselling these patients and may improve shared decision-making.
乳腺癌是霍奇金淋巴瘤（HL）既往胸部放疗后女性中最常见的治疗相关第二恶性肿瘤。对于这种放疗对乳房切除术后重建（BR）结局的影响知之甚少。本研究比较了 HL 相关胸部放疗后 BR 的不良结局与匹配对照组。
作者在荷兰的两个专家癌症中心进行了回顾性匹配队列研究。在接受胸部放疗的 HL 幸存者中，对接受保乳或预防性乳房切除术的 BR 进行了治疗，并与未接受 HL 治疗且无 HL 的患者在乳房切除术日期、BR 日期和 BR 类型上进行了匹配。主要结局是与并发症相关的 BR 失败或转换，次要结局是与并发症相关的再次手术、包膜挛缩、主要供区并发症和与并发症相关的 ICU 入院。作者使用 Fisher 精确检验对所有结局进行了单变量分析，并使用多变量 Cox 回归分析评估了重建失败、与并发症相关的再次手术和包膜挛缩，调整了混杂因素和数据聚类。
41 例接受 HL 胸部放疗的患者中有 70 例 BR 与 110 例未接受放疗的患者中有 121 例 BR 相匹配。HL 幸存者（12.9%）和对照组（12.4%）的重建失败率无差异。两组间再次手术、主要供区并发症或包膜挛缩的数量无差异。与对照组相比，HL 幸存者的 BR 因并发症更常导致 ICU 入院（P =0.048）。
我们没有观察到 HL 既往胸部放疗后 BR 后不良结局的风险增加。这对于咨询这些患者非常重要信息，可能会改善共同决策。
