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Effect of surgical complications on outcomes in breast cancer patients treated with mastectomy and immediate reconstruction

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Abstract

Background

Operative complications affect recurrence in non-breast malignancies. Rising rates of mastectomy with immediate reconstruction and their increased post-operative complications fuel concerns for poorer outcome in breast cancer (BC). We sought to determine the effect of complications on recurrence in BC patients.

Methods

A single-institution retrospective review was conducted of incident BC treated with mastectomy and immediate reconstruction. Overall survival and recurrence were compared between patients with complications to those without.

Results

Of 201 patients (350 mastectomies, 86 nipple-sparing), 62 (30.8%) had a surgical complication. Patients with complications were older, but groups were similar for type of reconstruction, tobacco use, hormone receptor status, HER2, lymphovascular invasion, and pathologic stage (all p > 0.05). Twenty-two complications (10.9%) were infection, 5 (2.5%) dehiscence, 14 flap necrosis (7%), 21 hematomas (10.4%), and 8 nipple necroses (9%). Recurrence occurred in 18 (8.9%) patients: 4 local, 2 regional, and 12 distant. After 8.9 years of median follow-up, patients with complications trended towards higher recurrence (hazard ratio (HR) 2.23, log-rank p = 0.08, Cox regression p = 0.05), particularly with nipple necrosis (HR 3.28, log-rank p = 0.09, regression p = 0.06). Patients with other complications had similar recurrence-free survival to those without (all p > 0.05). Higher stage (HR 13.66, log-rank p = 0.03) and adjuvant radiation (HR 2.78, log-rank p = 0.04) cases were more likely to recur. Patients with complications had similar overall survival to those without (log-rank p > 0.05).

Conclusion

BC patients with surgical complications do not have lower overall survival. This finding may be due to the improved prognosis compared to non-breast malignancies.

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Data availability

Available to all authors.

Abbreviations

BC:

Breast cancer

OS:

Overall survival

DFS:

Disease-free survival

HR:

Hazard ratio

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Funding

This research was supported by the institution without outside funding.

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Authors and Affiliations

  1. Department of Breast Oncology, H. Lee Moffitt Cancer Center, 10920 McKinley Dr, Tampa, FL, 33612, USA

    Emily L. Siegel, Junmin Whiting, Younchul Kim, Weihong Sun, Christine Laronga & M. Catherine Lee

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  1. Emily L. Siegel
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  2. Junmin Whiting
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  3. Younchul Kim
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  4. Weihong Sun
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  5. Christine Laronga
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  6. M. Catherine Lee
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Correspondence to M. Catherine Lee.

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Siegel, E.L., Whiting, J., Kim, Y. et al. Effect of surgical complications on outcomes in breast cancer patients treated with mastectomy and immediate reconstruction. Breast Cancer Res Treat 188, 641–648 (2021). https://doi.org/10.1007/s10549-021-06241-4

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  • DOI: https://doi.org/10.1007/s10549-021-06241-4

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