The relationship between post-surgery infection and breast cancer recurrence

Abstract

Breast cancer is the second most prevalent form of cancer in women worldwide, with surgery remaining the standard treatment. The adverse impact of the surgery remains controversial. It has been suggested that systemic factors during the postoperative period may increase the risk of recurrence, specifically surgical site infection (SSI). The aim of this review was to critically appraise current published literature regarding the influence of SSIs, after primary breast cancer surgery, on breast cancer recurrence, and to delve into potential links between these. This systematic review adopted two approaches: to identify the incidence rates and risk factors related to SSI after primary breast cancer surgery; and, secondly, to examine breast cancer recurrence following SSI occurrence. Ninety-nine studies with 484,605 patients were eligible in the SSI-focused searches, and 53 studies with 17,569 patients for recurrence-focused. There was a 13.07% mean incidence of SSI. Six-hundred and thirty-eight Gram-positive and 442 Gram-negative isolates were identified, with methicillin-susceptible Staphylococcus aureus and Escherichia coli most commonly identified. There were 2077 cases of recurrence (11.8%), with 563 cases of local recurrence, 1186 cases of distant and 25 cases which recurred both locally and distantly. Five studies investigated the association between SSI and breast cancer recurrence with three concluding that an association did exist. In conclusion, there is association between SSI and adverse cancer outcomes, but the cellular link between them remains elusive. Confounding factors of retrospective study design, surgery type and SSI definition make results challenging to compare and interpret. A standardized prospective study with appropriate statistical power is justified.

Safety and donor site morbidity of the transverse musculocutaneous gracilis (TMG) flap in autologous breast reconstruction—A systematic review and meta‐analysis

“…Surgical site infections might be associated with adverse cancer outcomes, and surgical complications may result in diminished patient quality of life and increase the costs of the health care system 37,38 . Our review confirms that the incidence of surgical site complications on the TMG donor site compares to that of other popular donor sites for breast reconstruction.…”

The Use of Closed Incision Negative Pressure Therapy on the Medial Thigh Donor Site in Transverse Musculocutaneous Gracilis Flap Breast Reconstruction

“…Surgical site complications regularly require medical or surgical intervention, extend the in-hospital stay, delay the recovery process, and raise healthcare costs substantially. In addition to this, surgical site complications reduce patients’ health-related quality of life and some studies even suggest associations with adverse cancer outcomes [ 27 , 28 , 29 ]. Therefore, uneventful and quick wound healing is of utmost importance for women undergoing breast reconstruction who survived the physical and emotional burden associated with mastectomy and adjuvant breast cancer therapy.…”

Prospective Evaluation of Complications and Associated Risk Factors in Breast Cancer Surgery

“…In a review by O'Connor et al, based on 99 studies and almost 500 000 patients, the mean incidence for postoperative SSI was 13.1%. The most common causative bacteria were S. aureus, E. coli, and P. aeruginosa [5]. Known factors that influence the rate of SSI are high age, obesity, diabetes, current or recent smoking, previous chest irradiation, and recent chemotherapy.…”