Verbat Miroslava, Zinner Gauthier, Dong Edward T C, Oranges Carlo M
From the First Faculty of Medicine, Charles University, Prague, Czech Republic.
Department of Plastic, Reconstructive, and Aesthetic Surgery, Geneva University Hospitals and University of Geneva, Geneva, Switzerland.
Plast Reconstr Surg Glob Open. 2025 Jun 18;13(6):e6868. doi: 10.1097/GOX.0000000000006868. eCollection 2025 Jun.
Hormonal therapy (HT) is pivotal in managing hormone receptor-positive breast cancer. However, in autologous microvascular breast reconstructions (AMBRs), HT raises concerns, particularly regarding venous thromboembolic (VTE) risk and its potential impact on flap viability. This systematic review and meta-analysis aimed to evaluate the impact of HT on complications of AMBR.
We performed a systematic review and meta-analysis of all comparative studies reporting postoperative complications of AMBR in patients receiving HT in comparison with a control group. All types of free flaps were included. Complications were categorized and compared. Odds ratios and 95% confidence intervals were calculated using a random-effects model.
Eight studies, encompassing 4776 flaps performed on 3796 patients undergoing AMBR with or without HT, were included. Patients undergoing HT were treated with either selective estrogen receptor modulators (SERMs) or aromatase inhibitors. Five studies compared both treatments to a control group, whereas 3 studies focused on tamoxifen. Only studies with retrospective design could be included. There was no statistically significant difference between the 2 groups in terms of overall flap complication rates, partial and total flap loss, flap fat necrosis, flap pedicle arterial and/or venous thrombosis, or systemic VTE. Subgroup analysis revealed a significantly higher risk of systemic VTE in the SERMs group compared with controls, while other complications were not significant.
Our results show that HT does not increase the risk of flap complications in the context of AMBR, whereas SERMs increase the risk of systemic VTE. Further research with prospective studies is warranted to confirm these findings.
激素疗法（HT）在激素受体阳性乳腺癌的治疗中起着关键作用。然而，在自体微血管乳房重建术（AMBR）中，HT引发了一些担忧，尤其是关于静脉血栓栓塞（VTE）风险及其对皮瓣存活的潜在影响。本系统评价和荟萃分析旨在评估HT对AMBR并发症的影响。
我们对所有比较研究进行了系统评价和荟萃分析，这些研究报告了接受HT的患者与对照组相比AMBR术后并发症的情况。纳入了所有类型的游离皮瓣。对并发症进行分类并比较。使用随机效应模型计算比值比和95%置信区间。
纳入了8项研究，共涉及3796例接受或未接受HT的AMBR患者所进行的4776例皮瓣手术。接受HT的患者接受选择性雌激素受体调节剂（SERM）或芳香化酶抑制剂治疗。5项研究将两种治疗方法与对照组进行了比较，而3项研究聚焦于他莫昔芬。仅纳入了回顾性设计的研究。两组在总体皮瓣并发症发生率、部分和完全皮瓣丢失、皮瓣脂肪坏死、皮瓣蒂部动脉和/或静脉血栓形成或全身性VTE方面无统计学显著差异。亚组分析显示，与对照组相比，SERM组全身性VTE风险显著更高，而其他并发症无显著差异。
我们的结果表明，在AMBR背景下，HT不会增加皮瓣并发症的风险，而SERM会增加全身性VTE的风险。有必要进行前瞻性研究以进一步证实这些发现。
