Department of Plastic Surgery and Burns Treatment, Copenhagen University Hospital, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Denmark.
Department of Plastic Surgery and Burns Treatment, Copenhagen University Hospital, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Denmark.
J Plast Reconstr Aesthet Surg. 2023 Dec;87:17-23. doi: 10.1016/j.bjps.2023.09.048. Epub 2023 Sep 17.
The impact of neoadjuvant chemotherapy (NACT) on the complication rate after implant-based and autologous breast reconstruction remains unclear. The aim of this study was to systematically review and perform a meta-analysis of previously published studies on immediate breast reconstruction (IBR) in breast cancer patients treated with NACT compared with controls.
PubMed and EMBASE were searched to identify studies assessing the impact of NACT on major and minor complications after IBR. The primary effect measures were relative risk (RR), 95% confidence interval (95% CI), and p-value.
Eight studies comprising 51,731 patients were included in the meta-analysis. Of these, 5161 patients received NACT and 46,570 patients did not receive NACT. In regard to major complications, NACT did not statistically significant increase the rate of reconstructive failure (RR = 1.35, 95% CI = 0.96-1.91, p = 0.09), the rate of mastectomy skin-flap necrosis (RR = 1.39, 95% CI = 0.61-3.17, p = 0.44), or the rate of reoperation (RR = 1.09, 95% CI = 0.87-1.37, p = 0.45). Regarding minor complications, NACT did not significantly increase the rate of wound complications (RR = 1.05, 95% CI = 0.87-1.28, p = 0.62). In a subgroup analysis of implant-based breast reconstruction following NACT, single-stage direct-to-implant (DTI) had a significantly lower implant failure rate compared with two-staged tissue expander/implant (TE/I) (RR = 0.43, 95% CI = 0.26-0.71, p = 0.0011).
NACT did not increase the major or minor complication rate after IBR with either autologous tissue or implants. Thus, NACT and IBR should be considered safe procedures. The review of studies describing patients undergoing implant-based breast reconstruction following NACT could indicate that single-stage DTI was a safer procedure than two-staged TE/I. However, the association requires further evaluation.
新辅助化疗（NACT）对接受基于植入物和自体乳房重建的乳腺癌患者的并发症发生率的影响尚不清楚。本研究的目的是系统地回顾和进行荟萃分析，以评估接受 NACT 治疗的乳腺癌患者与对照组相比，接受即刻乳房重建（IBR）的主要和次要并发症。
通过 PubMed 和 EMBASE 检索评估 NACT 对 IBR 后主要和次要并发症影响的研究。主要的效应测量是相对风险（RR）、95%置信区间（95%CI）和 p 值。
共有 8 项研究纳入了 51731 例患者的荟萃分析。其中，5161 例患者接受了 NACT，46570 例患者未接受 NACT。在主要并发症方面，NACT 并未显著增加重建失败率（RR=1.35，95%CI=0.96-1.91，p=0.09）、乳房皮瓣坏死率（RR=1.39，95%CI=0.61-3.17，p=0.44）或再次手术率（RR=1.09，95%CI=0.87-1.37，p=0.45）。在 NACT 后接受植入物乳房重建的亚组分析中，单阶段直接到植入物（DTI）与两阶段组织扩张器/植入物（TE/I）相比，植入物失败率显著降低（RR=0.43，95%CI=0.26-0.71，p=0.0011）。
NACT 并未增加 IBR 后自体组织或植入物的主要或次要并发症发生率。因此，NACT 和 IBR 应被视为安全的程序。对描述接受 NACT 后接受植入物乳房重建的患者的研究进行回顾，表明单阶段 DTI 比两阶段 TE/I 更安全，但这种关联需要进一步评估。
