The impact of delayed wound healing on patient-reported outcomes after breast cancer surgery

Zehnpfennig, Lea; Ritter, Mathilde; Montagna, Giacomo; Handschin, Tristan M; Wettstein-Ling, Barbara; Oberhauser, Ida; Lévy, Jérémy; Schaefer, Kristin M.; Maggi, Nadia; Soysal, Savas D.; López, Liliana Castrezana; Müller, Mathias D.; Schwab, Fabienne D.; Haug, Martin; Weber, Walter; Kurzeder, Christian; Kappos, Elisabeth A.

doi:10.1016/j.bjps.2022.06.106

Cited by 7 publications

(7 citation statements)

References 25 publications

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“…35 However, when DWH in OBS is compared to conventional breast surgery, there is no difference in patient-reported outcomes. 36 The harmful effects on cancer outcomes when the timely administration of adjuvant therapies is delayed are well documented. 24,37,38 In fact, an interval between extirpative breast surgery and initiation of adjuvant XRT of greater than 9 weeks is associated with an increased likelihood of recurrence and mortality.…”

Section: Discussionmentioning

confidence: 99%

Closed Incision Negative Pressure Therapy in Oncoplastic Surgery Prevents Delays to Adjuvant Therapy

Ockerman

Bryan

Wiesemann

et al. 2023

Plastic and Reconstructive Surgery - Global Open

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Background: Breast reductions, including oncoplastic breast surgery (OBS), have high postoperative wound healing complication (WHC) rates, ranging from 17% to 63%, thus posing a potential delay in the onset of adjuvant therapy. Incision management with closed incision negative pressure therapy (ciNPT) effectively reduces postoperative complications in other indications. This retrospective analysis compares postoperative outcomes and delays in adjuvant therapy in patients who received ciNPT on the cancer breast versus standard of care (SOC) after oncoplastic breast reduction and mastopexy post lumpectomy. Methods: Patient demographics, ciNPT use, postoperative complication rates, and time to adjuvant therapy were analyzed from the records of 150 patients (ciNPT = 29, SOC = 121). Propensity score matching was used to match patients based on age, body mass index, diabetes, tobacco use, and prior breast surgery. Results: In the matched cohort, the overall complication rate of ciNPT-treated cancerous breasts was 10.3% (3/29) compared with 31% (9/29) in SOC-treated cancerous breasts (P = 0.096). Compared with the SOC-treated cancerous breasts, the ciNPT breasts had lower skin necrosis rates [1/29 (3.4%) versus 6/29 (20.7%); P = 0.091] and dehiscence rates [0/29 (0%) versus 8/29 (27.6%); P = 0.004]. In the unmatched cohort, the total number of ciNPT patients who had a delay in adjuvant therapy was lower compared to the SOC group (0% versus 22.5%, respectively; P = 0.007). Conclusion: Use of ciNPT following oncoplastic breast reduction effectively lowered postoperative wound healing complication rates and, most importantly, decreased delays to adjuvant therapy.

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Section: Discussionmentioning

confidence: 99%

Closed Incision Negative Pressure Therapy in Oncoplastic Surgery Prevents Delays to Adjuvant Therapy

Ockerman

Bryan

Wiesemann

et al. 2023

Plastic and Reconstructive Surgery - Global Open

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“…Surgical techniques were divided into oncoplastic tumorectomy (including round block mammoplasty, V-Mammoplasty, B-Mammoplasty, Hemibatwing technique, and Reduction mammoplasty), conventional mastectomy, nipple/skin-sparing surgery (NSM/SSM) with immediate implant based reconstruction (including pre and sub pectoral placement) or immediate autologous reconstruction (including DIEP, TMG PAP ap and latissimus dorsi ap reconstruction). 13,14 Exclusion criteria were a loss of follow up or breast cancer stage 0 and a follow up of less then three months.…”

Section: Study Design and Patientsmentioning

confidence: 99%

“…Instead of a conventional mastectomy, breast-conserving oncoplastic techniques are increasingly performed and becoming the gold standard, combining oncological safety with aesthetically pleasing results. [11][12][13] To be able to best counsel the patient, it is important to understand the impact of NST on today's often more complex surgical therapy and its postoperative course. Consequently several studies have compared postoperative complications in patients with and without NST with contradictive outcomes.…”

Section: Introductionmentioning

confidence: 99%

The Impact of Neoadjuvant Systemic Treatment on Postoperative Complications in Breast Cancer Surgery

Maggi

Nussbaumer

Castrezana

et al. 2022

Preprint

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Purpose: The aim of the study was to analyse the impact of neoadjuvant systemic treatment (NST) on postoperative complications and the beginning of adjuvant treatment. Methods: This study includes data from a prospectively maintained database including patients with breast cancer (BC) stage I-IV with or without NST undergoing breast cancer surgery between January 2010 and September 2021. Results: Out of 517 enrolled patients, 77 received NST, 440 had primary breast surgery. After NST patients underwent surgery after a meantime of 34 days (26.5 – 40 days). No statistical significance could be found comparing the complication grading according to the Clavien Dindo classification. The complications were most frequently rated as grade 3b. There were no complications with grade 4 or higher. When differentiating into short and long-term, the overall rate of short-term complications was 20.3% with no significant difference between the two groups (20.8% vs. 20.2%). Regarding long-term complications, there was more impairment of shoulder mobility (26.0% vs. 9.5%, p = < 0.001) and chronic pain (42.9% vs. 28.6%, p = < 0.016) for patients with NST. The beginning of the administration of the adjuvant treatment was comparable in both groups (46.3 days vs. 50.5 days). Conclusion: In our cohort, complications between both groups were comparable according to Clavien Dindo. This study shows that NST has no negative impact on postoperative short-term complications and most importantly did not lead to a delay of the beginning of adjuvant treatment. Therefore, NST can be safely admitted, even when followed by extensive breast reconstruction surgery.

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“…As a result, efforts regarding aesthetic results and quality of life became an essential cornerstone in the treatment of BC. Instead of a conventional mastectomy, breast-conserving oncoplastic techniques are increasingly performed and becoming the gold standard, combining oncological safety with aesthetically pleasing results [11][12][13].…”

Section: Introductionmentioning

confidence: 99%

“…Surgical techniques were divided into oncoplastic tumorectomy (including round block mammoplasty, V-Mammoplasty, B-Mammoplasty, Hemibatwing technique, and Reduction mammoplasty), conventional mastectomy, nipple/skin-sparing surgery (NSM/SSM) with immediate implant based reconstruction (including pre and sub pectoral placement) or immediate autologous reconstruction (including DIEP, TMG PAP flap and latissimus dorsi flap reconstruction) [ 13 , 14 ]. Exclusion criteria were a loss of follow up or breast cancer stage 0 and a follow up of less than three months.…”

Section: Introductionmentioning

confidence: 99%

The impact of neoadjuvant systemic treatment on postoperative complications in breast cancer surgery

Nussbaumer

Maggi

Castrezana

et al. 2022

Breast Cancer Res Treat

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Purpose The aim of the study was to analyze the impact of neoadjuvant systemic treatment (NST) on postoperative complications and the beginning of adjuvant treatment. Methods This study includes data from a prospectively maintained database including patients with breast cancer (BC) stage I–IV with or without NST undergoing breast cancer surgery between January 2010 and September 2021. Results Out of 517 enrolled patients, 77 received NST, 440 had primary breast surgery. After NST patients underwent surgery after a meantime of 34 days (26.5–40 days). No statistical significance could be found comparing the complication grading according to the Clavien Dindo classification. The complications were most frequently rated as grade 3b. There were no complications with grade 4 or higher. When differentiating into short and long-term, the overall rate of short-term complications was 20.3% with no significant difference between the two groups (20.8% vs. 20.2%). Regarding long-term complications, there was more impairment of shoulder mobility (26.0% vs. 9.5%, p ≤ 0.001) and chronic pain (42.9% vs. 28.6%, p ≤ 0.016) for patients with NST. The beginning of the administration of the adjuvant treatment was comparable in both groups (46.3 days vs. 50.5 days). Conclusion In our cohort, complications between both groups were comparable according to Clavien Dindo. This study shows that NST has no negative impact on postoperative short-term complications and most importantly did not lead to a delay of the beginning of adjuvant treatment. Therefore, NST can be safely admitted, even when followed by extensive breast reconstruction surgery.

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The impact of delayed wound healing on patient-reported outcomes after breast cancer surgery

Cited by 7 publications

References 25 publications

Closed Incision Negative Pressure Therapy in Oncoplastic Surgery Prevents Delays to Adjuvant Therapy

Closed Incision Negative Pressure Therapy in Oncoplastic Surgery Prevents Delays to Adjuvant Therapy

The Impact of Neoadjuvant Systemic Treatment on Postoperative Complications in Breast Cancer Surgery

The impact of neoadjuvant systemic treatment on postoperative complications in breast cancer surgery

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