乳腺癌根治术后放疗时机对自体游离皮瓣乳房再造整体效果的影响。

The impact of post-mastectomy radiation timing on overall outcomes of autologous free-flap breast reconstruction.

机构信息

Division of Plastic and Reconstructive Surgery, University of California San Francisco, San Francisco, California, USA.

School of Medicine, University of California San Francisco, San Francisco, California, USA.

出版信息

Microsurgery. 2024 Jan;44(1):e31091. doi: 10.1002/micr.31091. Epub 2023 Jul 19.

DOI:10.1002/micr.31091

PMID:37469230

Abstract

BACKGROUND

The optimal timing of post-mastectomy radiation therapy (PMRT) in autologous breast reconstruction is controversial. Our study compares overall reconstructive outcomes in patients who received post-mastectomy radiation therapy either before or after the autologous flap.

METHODS

A single-center retrospective review was performed for patients who underwent free flap breast reconstruction and post-mastectomy radiation from January 2004 through January 2021. Demographic, intraoperative, and post-operative variables were recorded.

RESULTS

A total of 452 free flaps were identified, and 82 underwent PMRT. 59.8% were radiated with an expander prior to free flap surgery (PreFlap), and 40.2% flaps underwent PMRT (PostFlap). PostFlap patients were significantly younger (43.0 vs. 47.9 years, p = .016). There were no significant differences in free flap outcomes between the two cohorts including thrombosis, venous congestion, flap loss, takebacks, fat necrosis, seroma, or infection. Mastectomy skin flap necrosis was significantly higher in the PostFlap cohort (9.1% vs. 0%, p = .032), but nipple necrosis rates did not differ. There were no significant differences in number or need for revision surgeries, fat necrosis, or fat grafting between groups. However, there were significantly more total reconstructive complications, including infection and wound breakdown, experienced by the PreFlap cohort (46.9% vs. 24.2%, p = .038).

CONCLUSIONS

Timing of PMRT did not impact free flap outcomes, but those who had the expander radiated experienced significantly more complications overall. For the 34.7% of patients in the preFlap group who planned for autologous reconstruction form initial consultation, radiation after the flap may have improved their overall outcomes. As added complications cause delays in cancer therapy and final reconstruction, our results suggest that PMRT of the flap when possible may improve the overall experience for breast cancer patients.

摘要

背景

自体乳房重建术后放射治疗（PMRT）的最佳时机仍存在争议。我们的研究比较了接受 PMRT 的患者的整体重建结果，这些患者的 PMRT 是在自体皮瓣之前或之后进行的。

方法

对 2004 年 1 月至 2021 年 1 月期间行游离皮瓣乳房重建术和乳房切除术的患者进行了单中心回顾性研究。记录了人口统计学、术中及术后变量。

结果

共确定了 452 例游离皮瓣，其中 82 例接受了 PMRT。59.8%的患者在游离皮瓣手术前（PreFlap）接受了扩张器放射治疗，40.2%的皮瓣接受了 PMRT（PostFlap）。PostFlap 患者明显更年轻（43.0 岁比 47.9 岁，p=0.016）。两组游离皮瓣的结果无显著差异，包括血栓形成、静脉淤滞、皮瓣坏死、返修、脂肪坏死、血清肿或感染。PostFlap 组乳房皮瓣坏死发生率明显较高（9.1%比 0%，p=0.032），但乳头坏死率无差异。两组之间的手术次数或需要修复手术、脂肪坏死或脂肪移植无显著差异。然而，PreFlap 组的总重建并发症，包括感染和伤口破裂，明显更多（46.9%比 24.2%，p=0.038）。

结论

PMRT 的时机并不影响游离皮瓣的结果，但那些接受扩张器放射治疗的患者总体上经历了更多的并发症。对于初始咨询时即计划进行自体重建的 PreFlap 组的 34.7%患者，皮瓣后行放射治疗可能会改善他们的整体结果。由于增加的并发症会导致癌症治疗和最终重建的延迟，我们的结果表明，在可能的情况下对皮瓣进行 PMRT 可能会改善乳腺癌患者的整体体验。