Nava Caterina M, Martineau Jérôme, Dong Edward T C, Zinner Gauthier, Oranges Carlo M
Department of Plastic, Reconstructive, and Aesthetic Surgery, Geneva University Hospitals, Geneva University, 1205 Geneva, Switzerland.
Cancers (Basel). 2025 Feb 4;17(3):512. doi: 10.3390/cancers17030512.
While radiotherapy (RT) and chemotherapy (CT) significantly improve breast cancer outcomes, they may affect breast reconstruction by causing vascular damage and delayed wound healing. This retrospective study evaluates how preoperative RT, CT, or the combination of both impacts intraoperative and postoperative outcomes in immediate or delayed deep inferior epigastric perforator (DIEP) flap breast reconstructions.
We conducted a single-center review of all patients undergoing autologous DIEP flap reconstruction after mastectomy between 2018 and 2024. Patients were divided into four groups: RT only, CT only, a combination of RT and CT, and a control group with no preoperative therapies. Intraoperative and postoperative outcomes were then compared among these groups, with statistical significance defined as < 0.05.
We included 114 patients representing 141 DIEP-flap breast reconstructions. Flap survival rate was 98.5%. In the univariate analysis, total microvascular recipient site complications were significantly higher in the RT + CT group (14.0%, = 0.021). Donor-site complication rates differed significantly among the four groups ( = 0.025), with the highest rate observed in the RT + CT group (44.7%). In the logistic regression analysis, ischemia time was found as an independent risk factor for total recipient site complications, but not for microvascular complications (OR = 1.019, 95%-CI = 1.004-1.035, = 0.014).
Combined RT + CT significantly increased microsurgical complications. Ischemia time correlated with higher odds of total recipient site complications. Individualized patient management and diminished ischemia time are likely to improve flap survival.
虽然放疗（RT）和化疗（CT）能显著改善乳腺癌的治疗效果，但它们可能会因导致血管损伤和伤口愈合延迟而影响乳房重建。这项回顾性研究评估了术前放疗、化疗或两者联合对即刻或延迟腹直肌下动脉穿支（DIEP）皮瓣乳房重建术中及术后结果的影响。
我们对2018年至2024年间所有接受乳房切除术后自体DIEP皮瓣重建的患者进行了单中心回顾性研究。患者分为四组：单纯放疗组、单纯化疗组、放疗联合化疗组和未接受术前治疗的对照组。然后比较这些组的术中和术后结果，统计学显著性定义为P<0.05。
我们纳入了114例患者，共进行了141例DIEP皮瓣乳房重建。皮瓣存活率为98.5%。在单因素分析中，放疗+化疗组的总微血管受区并发症显著更高（14.0%，P=0.021）。四组供区并发症发生率差异有统计学意义（P=0.025），放疗+化疗组发生率最高（44.7%）。在逻辑回归分析中，发现缺血时间是总受区并发症的独立危险因素，但不是微血管并发症的独立危险因素（OR=1.019，95%CI=1.004-1.035，P=0.014）。
放疗联合化疗显著增加了显微手术并发症。缺血时间与总受区并发症的较高发生率相关。个体化的患者管理和缩短缺血时间可能会提高皮瓣存活率。
