Determinants of short and long term outcomes in patients undergoing immediate breast reconstruction following neoadjuvant chemotherapy

Wengler, Craig; Valente, Stephanie A.; Al‐Hilli, Zahraa; Woody, N.M.; Muntean, Julia H.; Abraham, Jame; Tendulkar, Rahul D.; Djohan, Risal; O’Rourke, Colin; Crowe, Joseph P.; Grobmyer, Stephen R.

doi:10.1002/jso.24741

Cited by 30 publications

(23 citation statements)

References 32 publications

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“…To analyze control variables, the relationships between NACT, surgery, and physical condition were compared using multivariate variance analysis, and continuous variables were evaluated using the T test. According to the literature [ 13 , 14 ], we analyzed known confounding factors, including age, BMI, smoking history, menopausal status, etc. In addition, stage and grade were investigated based on clinical experience, and this analysis allows for a more accurate comparison.…”

Section: Methodsmentioning

confidence: 99%

Latissimus dorsi myocutaneous flap repair is effective after neoadjuvant chemotherapy for locally advanced breast cancer

Yang

et al. 2022

World J Surg Onc

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Objective To describe the clinical outcome and physical condition of patients with locally advanced breast cancer (LABC) who received neoadjuvant chemotherapy followed by mastectomy and latissimus dorsi myocutaneous flap repair. Methods A retrospective review of 142 patients with locally advanced breast cancer was selected from 1156 breast cancer patients in the South and North areas of The Affiliated Calmette Hospital of Kunming Medical University between May 2008 and December 2018. Results All participants (n = 142) were women aged 40–55 years (average age 47.35 ± 0.43 years) who received neoadjuvant chemotherapy followed by mastectomy and latissimus dorsi flap repair. The median follow-up period was 16 months (range 12–24 months). For stage of disease, there were 19 cases (13%) in stage IIB, 31 cases (22%) in stage IIIA, 39 cases (28%) in stage IIIB, and 53 cases (37%) in stage IIIC, which were statistically significant with the physical condition of patients (≤ 0.001). Neoadjuvant chemotherapy was administered to shrink the tumors, and an average tumor size decrease from 10.05 ± 1.59 cm × (8.07 ± 1.54) cm to 6.11 ± 1.72 cm × (3.91 ± 1.52) cm (P < 0.001) was considered statistically significant. A t test was used for the ECOG score statistics, and the results showed that the scores were statistically significant (≤ 0.001) before and after neoadjuvant chemotherapy and after surgery. Conclusions Neoadjuvant chemotherapy is an accepted treatment option for patients with locally advanced breast cancer, and the use of a latissimus dorsi musculocutaneous flap for post-mastectomy reconstruction may improve the patients’ physical condition. Our results indicated that this strategy was safe and feasible.

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Section: Methodsmentioning

confidence: 99%

Latissimus dorsi myocutaneous flap repair is effective after neoadjuvant chemotherapy for locally advanced breast cancer

Yang

et al. 2022

World J Surg Onc

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“…Furthermore, assessment of nipple margin during surgery is mandatory (17). Several studies have reported on the feasibility of this approach in patients who receive NACT, and the LRR rates ranged between 3.2% and 10.3% (18)(19)(20)(21)(22). However, the majority of the studies involved a relatively small sample size and short follow-up durations.…”

Section: Discussionmentioning

confidence: 99%

Factors Predicting Locoregional Recurrence After Neoadjuvant Chemotherapy and Nipple-Sparing/Skin-Sparing Mastectomy With Immediate Breast Reconstruction

Kim

Lee

et al. 2021

Front. Oncol.

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BackgroundFew data are available on the risk factors of locoregional recurrence (LRR) after neoadjuvant chemotherapy (NACT) and immediate breast reconstruction (IBR) in breast cancer. Herein, we evaluated the factors predicting LRR in a large series of patients who underwent either nipple- (NSM) or skin-sparing mastectomy (SSM) with IBR after NACT.MethodsWe retrospectively analyzed 609 breast cancer patients who underwent NACT and NSM/SSM with IBR between February 2010 and June 2017. Factors associated with an increased risk of LRR were analyzed by univariate (chi-square or Fisher’s exact test) and multivariate (Cox proportional hazard regression model) analyses.ResultsDuring a median follow-up of 63 months, LRR as the first event occurred in 73 patients, and the 5-year cumulative LRR rate was 10.8%. Multivariate analysis revealed post-NACT Ki67 ≥ 10% [hazard ratio (HR), 2.208; 95% confidence interval (CI), 1.295-3.765; P = 0.004], high tumor grade (HR, 1.738; 95% CI, 1.038-2.908; P = 0.035), and presence of lymphovascular invasion (LVI) (HR, 1.725; 95% CI, 1.039-2.864; P = 0.035) as independently associated with increased LRR risk. The 10-year LRR rate was 8.5% for patients with none of the three associated risk factors, 11.6% with one factor, 25.1% with two factors, and 33.7% with all three factors (P < 0.001).ConclusionsPost-NACT Ki67 ≥ 10%, high tumor grade, and presence of LVI are independently associated with an increased risk of developing LRR after NACT and NSM/SSM with IBR. Future prospective trials are warranted to decrease the risk of LRR in patients with associated risk factors.

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“…We also identified a significantly higher rate of reconstruction failure at 5 years with TE/I, compared to AR, for patients with overweight BMI (25.1‐30) and obese BMI (>30), but not for patients with normal BMI (≤25). It is well established in the literature that patients with current or previous smoking history and BMI ≥ 30 have a significant higher risk of failure of reconstruction . Additionally, these factors also increase the risk of infection and data have demonstrated that the most common etiology of implant‐based reconstruction failure is infection .…”

Section: Discussionmentioning

confidence: 99%

“…It is well established in the literature that patients with current or previous smoking history and BMI ≥ 30 have a significant higher risk of failure of reconstruction. [16][17][18][19] Additionally, these factors also increase the risk of infection and data have demonstrated that the most common etiology of implant-based reconstruction failure is infection. 20 We have identified that infections account for a substantial proportion of reconstruction failures in our series.…”

Section: Discussionmentioning

confidence: 99%

Long‐term complications and reconstruction failures in previously radiated breast cancer patients receiving salvage mastectomy with autologous reconstruction or tissue expander/implant‐based reconstruction

et al. 2019

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Salvage mastectomy (SM) is the standard of care for patients with local recurrence (LR) after breast conservation therapy (BCT), often with immediate reconstruction. Complications of reconstruction are a concern for these patients, and long‐term data are limited. We sought to compare rates of complications requiring re‐operation (CRR) and reconstruction failure (RF) between autologous reconstruction (AR) and tissue expander/implant reconstruction (TE/I). Patients with locally recurrent breast cancer after BCT, treated with SM and immediate AR or TE/I between 2000 and 2008, were identified. CRR was defined as unplanned return to operating room for wound infection, dehiscence, necrosis (including flap, skin, or fat), hematoma, or hernia (for AR) and extrusion, leak, or capsular contracture (for TE/I). RF was defined as conversion to another reconstruction technique or to flat chest wall. This study included 103 patients with 107 reconstructions. Median follow‐up was 6.6 years. CRR and RF were significantly higher with TE/I (n = 34) compared to AR (n = 73) at 5 years (50.9% vs 25.5%; P = 0.02) and (42.1% vs 5.8%; P < 0.001). On univariate analysis (UVA), TE/I (HR = 2.14; P = 0.02) and diabetes (HR = 5.10; P = 0.007) were significant predictors for CRR. On UVA, TE/I (HR = 7.30; P < 0.001) and older age at reconstruction (HR = 1.03; P = 0.003) were significant predictors for RF. In this population of previously irradiated patients, TE/I was associated with significantly higher CRR and RF. Complications continue to occur up to 10 years after TE/I. AR should be considered in appropriately selected patients, though TE/I may remain a reasonable option in patients without high‐risk factors for surgical complications.

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Determinants of short and long term outcomes in patients undergoing immediate breast reconstruction following neoadjuvant chemotherapy

Abstract: Following NAC, risk factors for complications in patients undergoing SSM/NSM with IR are high BMI, smoking, and adjuvant XRT. SSM/NSM following NAC is associated with excellent local control. These data support expanding the indications for NSM/SSM to include patients receiving NAC.

Cited by 30 publications

References 32 publications

Latissimus dorsi myocutaneous flap repair is effective after neoadjuvant chemotherapy for locally advanced breast cancer

Latissimus dorsi myocutaneous flap repair is effective after neoadjuvant chemotherapy for locally advanced breast cancer

Factors Predicting Locoregional Recurrence After Neoadjuvant Chemotherapy and Nipple-Sparing/Skin-Sparing Mastectomy With Immediate Breast Reconstruction

Long‐term complications and reconstruction failures in previously radiated breast cancer patients receiving salvage mastectomy with autologous reconstruction or tissue expander/implant‐based reconstruction

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