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Reconstruction in Women with T4 Breast Cancer after Neoadjuvant Chemotherapy: When Is It Safe?
- Source :
-
Journal of the American College of Surgeons [J Am Coll Surg] 2021 Aug; Vol. 233 (2), pp. 285-293. Date of Electronic Publication: 2021 May 03. - Publication Year :
- 2021
-
Abstract
- Background: Despite limited evidence regarding its safety, immediate reconstruction (IR) is increasingly offered to women with T4 breast cancer. We compared outcomes after IR, delayed reconstruction (DR), and no reconstruction (NR) in patients treated with neoadjuvant chemotherapy (NAC) and postmastectomy radiation therapy (PMRT) for T4 disease.<br />Study Design: We retrospectively identified consecutive women with T4 tumors treated with trimodality therapy from January 2007 through December 2019. Clinicopathologic characteristics, complications requiring reoperation, time to PMRT, and recurrence patterns were compared. The cumulative incidence of local recurrence (LR) was estimated using Kaplan-Meier methods.<br />Results: Of the 269 women identified, the median (IQR) age was 52 (45-62) years; 164 women (61%) had T4d disease. Forty-five women (17%) had IR, 41 (15%) had DR, and 183 (68%) had NR. IR was independently associated with T4a-c disease (odds ratio [OR], 5.75; 95% CI, 2.57-12.87; p < 0.001) and younger age (OR 0.91; 95% CI, 0.86-0.94; p < 0.001). The risk of complications after IR was 22% overall and 46% in T4d patients (6/13), compared with 4.4% overall for NR and 7.3% for DR (p < 0.001). IR was associated with >8-week interval to PMRT (p < 0.001). At a median (range) follow-up of 4.2 (0.2-13) years, the median time to first recurrence was 18 months and was similar between groups (p = 0.13). The cumulative incidence of LR was 16% for T4d disease and 2.2% for T4a-c disease (p < 0.001).<br />Conclusions: After IR, women with T4 tumors, particularly T4d disease, experienced delayed initiation of adjuvant treatment and substantial morbidity, suggesting that an interval of >18 months between mastectomy and reconstruction is advisable.<br /> (Copyright © 2021 American College of Surgeons. Published by Elsevier Inc. All rights reserved.)
- Subjects :
- Adult
Breast pathology
Breast surgery
Breast Neoplasms diagnosis
Breast Neoplasms pathology
Chemotherapy, Adjuvant
Female
Follow-Up Studies
Humans
Incidence
Mammaplasty statistics & numerical data
Mastectomy adverse effects
Middle Aged
Neoadjuvant Therapy
Neoplasm Recurrence, Local prevention & control
Neoplasm Staging
Postoperative Complications etiology
Postoperative Complications surgery
Prospective Studies
Radiotherapy, Adjuvant statistics & numerical data
Reoperation statistics & numerical data
Retrospective Studies
Time Factors
Breast Neoplasms therapy
Mammaplasty adverse effects
Neoplasm Recurrence, Local epidemiology
Postoperative Complications epidemiology
Time-to-Treatment statistics & numerical data
Subjects
Details
- Language :
- English
- ISSN :
- 1879-1190
- Volume :
- 233
- Issue :
- 2
- Database :
- MEDLINE
- Journal :
- Journal of the American College of Surgeons
- Publication Type :
- Academic Journal
- Accession number :
- 33957258
- Full Text :
- https://doi.org/10.1016/j.jamcollsurg.2021.04.016