The impact of immediate breast reconstruction on the time to delivery of adjuvant therapy: the iBRA-2 study
The impact of immediate breast reconstruction on the time to delivery of adjuvant therapy: the iBRA-2 study
复制标题
DOI：
10.1038/s41416-019-0438-1
复制
发表时间：
2019-04-30
影响因子：
8.8
通讯作者：
Balata, Safa Ahmed
中科院分区：
文献类型：
--
作者：
O'Connell, Rachel L.;Rattay, Tim;Balata, Safa Ahmed
背景：即时乳房重建术(IBR)通常用于改善需要切除乳房的女性的生活质量，但也有人担心，更复杂的手术可能会推迟辅助肿瘤治疗，并影响长期结果。缺乏高质量的证据。IBRA-2研究旨在调查IBR对辅助治疗时间的影响。方法：纳入2016年7月至12月连续接受乳腺癌切除+/-IBR的女性。收集了患者的人口统计学、手术、肿瘤学和并发症数据。结果：从76个中心招募了2540名患者；1008名(39.7%)患者接受了IBR(仅植入675例，26.6%)；带蒂皮瓣[105例，4.1%]和游离皮瓣[228例，8.9%]。需要再次入院或再次手术的并发症在接受IBR的患者中明显比接受乳房切除术的患者更常见。1235例(48.6%)患者需要辅助化疗或放疗。两组患者辅助治疗的时间在临床上没有显著差异，但无论是否接受手术，主要并发症都与治疗延迟显著相关。结论：IBR不会导致辅助治疗的临床显著延迟，但术后并发症与治疗延迟有关。需要采取减少并发症的策略，包括仔细选择患者，以改善患者的预后。
BACKGROUND: Immediate breast reconstruction (IBR) is routinely offered to improve quality-of-life for women requiring mastectomy, but there are concerns that more complex surgery may delay adjuvant oncological treatments and compromise long-term outcomes. High-quality evidence is lacking. The iBRA-2 study aimed to investigate the impact of IBR on time to adjuvant therapy.METHODS: Consecutive women undergoing mastectomy +/- IBR for breast cancer July-December, 2016 were included. Patient demographics, operative, oncological and complication data were collected. Time from last definitive cancer surgery to first adjuvant treatment for patients undergoing mastectomy +/- IBR were compared and risk factors associated with delays explored.RESULTS: A total of 2540 patients were recruited from 76 centres; 1008 (39.7%) underwent IBR (implant-only [n = 675, 26.6%]; pedicled flaps [n = 105,4.1%] and free-flaps [n = 228, 8.9%]). Complications requiring re-admission or re-operation were significantly more common in patients undergoing IBR than those receiving mastectomy. Adjuvant chemotherapy or radiotherapy was required by 1235 (48.6%) patients. No clinically significant differences were seen in time to adjuvant therapy between patient groups but major complications irrespective of surgery received were significantly associated with treatment delays.CONCLUSIONS: IBR does not result in clinically significant delays to adjuvant therapy, but post-operative complications are associated with treatment delays. Strategies to minimise complications, including careful patient selection, are required to improve outcomes for patients.