Prospective randomized study of surgical morbidity following primary systemic therapy for breast cancer

Abstract

The influence of primary systemic therapy in treating operable breast cancer on postmastectomy morbidity rates was investigated. The contribution of other risk factors was assessed by multiple logistic regression. Seventy-nine eligible patients were randomly allocated, 39 to undergo immediate modified radical mastectomy, and 40 to receive initial cytotoxic or endocrine treatment followed by mastectomy. Postoperative wound seroma, infection and necrosis were recorded prospectively. Fourteen minor and six major complications occurred in 17 patients treated conventionally, while 14 patients developed 11 minor and six major complications after systemic therapy (P > 0.4). Median hospital stay was 8 days for both groups. Age, smoking, immediate breast reconstruction and the type of primary systemic treatment given were not independent predictors of complication risk. Obesity emerged as a significant risk factor for postmastectomy complications (P = 0.015). Primary systemic therapy does not increase the rate of morbidity after mastectomy.

Impact of obesity on diagnosis and treatment of breast cancer

“…On the other hand, obesity seems to have an unfavourable effect on the recovery after breast cancer surgery, as obese women had more often prolonged hospital stay. High BMI has been identified as a significant and independent risk factor for complications after breast or axillary surgery, such as wound infections or lymphoedema [44][45][46][47]. In addition, obese women may need more time to recover after surgery due to complications linked to the higher prevalence of comorbid conditions, which may impact on breast cancer outcome by consequently postponing subsequent radiotherapy and adjuvant treatments.…”

Impact of different type of cancer treatment on the effectiveness of breast reconstruction

“…The available options include tamoxifen, aromatase inhibitors, and fulvestrant (11)(12)(13)(14)(15)(16). A prospective randomized trial performed in 1995, comparing modified radical mastectomy to hormone therapy followed by modified radical mastectomy found that there was no significant difference in the risk of complications and that immediate breast reconstruction was not an independent predictor of complications (17). This opinion has been maintained by a study from 2016, even though it has been observed, that the group of patients who received adjuvant hormonal therapy after mastectomy, were initially presenting more advanced stage of the disease, were more likely to receive post mastectomy radiation therapy and had a greater risk of axillary lymph node dissection (11).…”

Breast reconstruction following prophylactic or therapeutic mastectomy for breast cancer: Recommendations from an evidence-based provincial guideline

“…Data suggest that immediate reconstruction can be safely integrated with chemotherapy without a significant impact on complications. A prospective randomized trial comparing modified radical mastectomy to neoadjuvant chemotherapy or hormone therapy followed by modified radical mastectomy (72) found that there was no significant difference in the risk of complications and that immediate breast reconstruction was not an independent predictor of complications. The American College of Surgeons National Surgical Quality Improvement Program's reported wound complication rate among breast cancer patients receiving neoadjuvant chemotherapy followed by surgery was low (3.1%), with a nonsignificant trend toward increased complications in those who underwent immediate reconstruction (OR 1.58 [95% CI 0.98 to 2.58]) (73).…”