The Impact of Timing of Delayed Autologous Breast Reconstruction following Postmastectomy Radiation Therapy on Postoperative Morbidity.

IF 2.2 3区医学 Q2 SURGERY Journal of reconstructive microsurgery Pub Date : 2024-05-01 Epub Date: 2023-09-26 DOI:10.1055/a-2182-1440

Humza N Mirza, Nicholas L Berlin, Kristoffer B Sugg, Jung-Shen Chen, Kevin C Chung, Adeyiza O Momoh

{"title":"The Impact of Timing of Delayed Autologous Breast Reconstruction following Postmastectomy Radiation Therapy on Postoperative Morbidity.","authors":"Humza N Mirza, Nicholas L Berlin, Kristoffer B Sugg, Jung-Shen Chen, Kevin C Chung, Adeyiza O Momoh","doi":"10.1055/a-2182-1440","DOIUrl":null,"url":null,"abstract":"Background: The ideal time to perform reconstruction after the completion of postmastectomy radiation therapy (PMRT) in patients with locally advanced breast cancer is currently unknown. We evaluate the association between the timing of delayed autologous breast reconstruction following PMRT and postoperative complications.Methods: Patients who underwent mastectomy, PMRT, and then delayed autologous breast reconstruction from 2009 to 2016 were identified from the Truven Health MarketScan Research Databases. Timing of reconstruction following PMRT was grouped 0-3, 3-6, 6-12, 12-24, and after 24 months. Multivariable models were used to assess associations between timing of reconstruction following PMRT and key measures of morbidity.Results: A total of 1,039 patients met inclusion criteria. The rate of any complications for the analytic cohort was 39.4%, including 13.3% of patients who experienced wound complications and 11.3% of patients requiring additional flaps. Unadjusted rates of complications increased from 23.4% between 0 and 3 months to 49.4% between 3 and 6 months and decreased thereafter. Need for additional flaps was highest within 3 to 6 months (14.0%). Multivariate analysis revealed higher rates of any complications when reconstruction was performed between 3 and 6 months (odds ratio [OR]: 3.04, p < 0.001), 6 and 12 months (OR: 2.66, p < 0.001), or 12 and 24 months (OR: 2.13, p = 0.001) after PMRT. No difference in complications were noted in reconstructions performed after 24 months compared with those performed before 3 months (p > 0.05). However, rates of wound complications were least likely in reconstructions after 24 months (OR: 0.34, p = 0.035).Conclusion: These findings suggest plastic surgeons may consider performing autologous breast reconstruction early for select patients, before 3 months following PMRT without increasing postoperative morbidity.","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":null,"pages":null},"PeriodicalIF":2.2000,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of reconstructive microsurgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1055/a-2182-1440","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2023/9/26 0:00:00","PubModel":"Epub","JCR":"Q2","JCRName":"SURGERY","Score":null,"Total":0}

引用次数: 0

Abstract

Background: The ideal time to perform reconstruction after the completion of postmastectomy radiation therapy (PMRT) in patients with locally advanced breast cancer is currently unknown. We evaluate the association between the timing of delayed autologous breast reconstruction following PMRT and postoperative complications.

Methods: Patients who underwent mastectomy, PMRT, and then delayed autologous breast reconstruction from 2009 to 2016 were identified from the Truven Health MarketScan Research Databases. Timing of reconstruction following PMRT was grouped 0-3, 3-6, 6-12, 12-24, and after 24 months. Multivariable models were used to assess associations between timing of reconstruction following PMRT and key measures of morbidity.

Results: A total of 1,039 patients met inclusion criteria. The rate of any complications for the analytic cohort was 39.4%, including 13.3% of patients who experienced wound complications and 11.3% of patients requiring additional flaps. Unadjusted rates of complications increased from 23.4% between 0 and 3 months to 49.4% between 3 and 6 months and decreased thereafter. Need for additional flaps was highest within 3 to 6 months (14.0%). Multivariate analysis revealed higher rates of any complications when reconstruction was performed between 3 and 6 months (odds ratio [OR]: 3.04, p < 0.001), 6 and 12 months (OR: 2.66, p < 0.001), or 12 and 24 months (OR: 2.13, p = 0.001) after PMRT. No difference in complications were noted in reconstructions performed after 24 months compared with those performed before 3 months (p > 0.05). However, rates of wound complications were least likely in reconstructions after 24 months (OR: 0.34, p = 0.035).

Conclusion: These findings suggest plastic surgeons may consider performing autologous breast reconstruction early for select patients, before 3 months following PMRT without increasing postoperative morbidity.

查看原文

微信好友朋友圈 QQ好友复制链接

本刊更多论文

乳房切除术后放射治疗延迟自体乳房重建时机对术后发病率的影响。

背景：目前尚不清楚局部晚期癌症患者在完成乳房切除术后放射治疗（PMRT）后进行重建的理想时间。我们评估了PMRT后延迟自体乳房重建的时间与术后并发症之间的关系。方法：从Truven Health MarketScan研究数据库中确定2009-2016年接受乳房切除术、PMRT，然后延迟自体乳房重建的患者。PMRT后重建的时间分为0-3、3-6、6-12、12-24和24个月后。多变量模型用于评估PMRT后重建时间与发病率关键指标之间的相关性。结果：1039例患者符合入选标准。分析队列的任何并发症发生率为39.4%，其中13.3%的患者出现伤口并发症，11.3%的患者需要额外的皮瓣。未经调整的并发症发生率从0-3个月的23.4%增加到3-6个月的49.4%，此后有所下降。在3-6个月内对额外皮瓣的需求最高（14.0%）。多因素分析显示，3-6个月间进行重建时，任何并发症的发生率都较高（OR 3.04，P0.05）。然而，24个月后重建的伤口并发症发生率最低（OR 0.34，P=0.035）。结论：这些发现表明，整形外科医生可以考虑在PMRT后三个月之前，对选定的患者尽早进行自体乳房重建，而不会增加术后发病率。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文去求助

来源期刊

Journal of reconstructive microsurgery 医学-外科

CiteScore

4.50

自引率

28.60%

发文量

审稿时长

1 months

期刊介绍： The Journal of Reconstructive Microsurgery is a peer-reviewed, indexed journal that provides an international forum for the publication of articles focusing on reconstructive microsurgery and complex reconstructive surgery. The journal was originally established in 1984 for the microsurgical community to publish and share academic papers. The Journal of Reconstructive Microsurgery provides the latest in original research spanning basic laboratory, translational, and clinical investigations. Review papers cover current topics in complex reconstruction and microsurgery. In addition, special sections discuss new technologies, innovations, materials, and significant problem cases. The journal welcomes controversial topics, editorial comments, book reviews, and letters to the Editor, in order to complete the balanced spectrum of information available in the Journal of Reconstructive Microsurgery. All articles undergo stringent peer review by international experts in the specialty.