Outcomes in Patients Receiving Neoadjuvant Chemotherapy Undergoing Immediate Breast Reconstruction: Effect of Timing and Postoperative Complications
Christopher J. Venutolo, B.A., Min-Jeong Cho, M.D., Austin Hembd, M.D., Savannah Hampton, B.S.A., Avinash P. Jayaraman, B.A., Nicholas T. Haddock, M.D., Sumeet S. Teotia, M.D..
Department of Plastic Surgery, UT Southwestern Medical Center, Dallas, TX, USA.
PURPOSE: The impact of neoadjuvant chemotherapy on postoperative complications is important in breast cancer patients undergoing immediate breast reconstruction since it has the potential to delay adjuvant radiation therapy. This study was conducted to examine the effect of time from last dose of neoadjuvant chemotherapy to immediate breast reconstruction on postoperative complications and to assess if postoperative complications cause any delay in commencement of radiation treatment.
METHODS: A retrospective review was performed on patients who underwent neoadjuvant chemotherapy with immediate breast reconstruction using tissue expanders from November 2011 to May 2017 in a NCI designated academic cancer center. The time interval from the last dose of chemotherapy to surgery was calculated for all patients. Patients who underwent radiation treatment had the time interval from surgery to commencement of radiation treatment calculated. Postoperative surgical complications were categorized as either major or minor complications depending on whether patients required hospitalization or reoperation. Independent sample t-tests were used to compare means for both time to surgery from first dose of chemotherapy therapy and time to commencement of radiation between patients with major complications and minor complications versus those with no complications. Descriptive statistics were used to summarize patient demographics and characteristics.
RESULTS: A total of 128 patients were identified. Mean time to surgery from last dose of chemotherapy was 31.81 days with a range of 12-89 days. Of the 128 patients, 25 (19.5%) experienced a major complication necessitating hospitalization or return to the O.R., and 50 (39.1%) experienced any minor complication. Out of the 128 patients, 54 patients completed radiation therapy at our institution. The mean time to commencement of radiation from surgery was 70.74 days with a range of 24-178 days. The difference in time to commencement of radiation between patients with major complications and no complications was statistically significant (p=0.018), and the difference in time to commencement of radiation between patients with minor complications and no complications was also statistically significant (p=0.027). For patients who experienced any major complication, there was no statistical significance (p = 0.835) for time to surgery from last chemotherapy dose when compared with patients with no major complications. In addition, there was no statistical significance (p=0.710) for time to surgery from last dose of chemotherapy when comparing patients with minor complications and no minor complications.
CONCLUSION: Postoperative major and minor complications delay the commencement of radiation in patients who undergo neoadjuvant chemotherapy with immediate breast reconstruction compared to patients with no complications. However, the time period from last dose of chemotherapy to immediate breast reconstruction surgery does not appear to contribute to postoperative major or minor complications. These findings are important when counseling patients who desire immediate breast reconstruction with tissue expanders.
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