Influence of complications following immediate breast reconstruction on breast cancer recurrence rates
Influence of complications following immediate breast reconstruction on breast cancer recurrence rates
复制标题
DOI：
10.1002/bjs.10068
复制
发表时间：
2016-03-01
影响因子：
9.6
通讯作者：
Kerin, M. J.
中科院分区：
文献类型：
--
作者：
Beecher, S. M.;O'Leary, D. P.;Kerin, M. J.
背景：即时乳房重建率正在上升。术后感染在接受重建术的患者中更为常见。对术后感染的炎症反应可以通过释放促炎介质来增加其他形式癌症的肿瘤复发风险。这项研究的目的是评估接受立即乳房再造的患者中并发症与乳腺癌复发之间的关系。方法：这是一个前瞻性维护的数据库，其中包括2004至2009年间在戈尔韦大学医院接受乳房再造的所有患者，戈尔韦大学医院是一家服务于爱尔兰西部的第三级乳腺癌转诊中心。所有患者至少随访5年。评估的结果包括伤口并发症的发展和乳腺癌复发。数据采用单因素和多变量COX回归分析。结果：共有229名患者接受即刻重建。总的5年无复发生存率为85.6%。53例(23.1%)出现伤口并发症，其中44例(19.2%)发生伤口感染。与无并发症的患者相比，发生术后伤口并发症的患者发生系统性复发的风险明显更大(风险比4.94，95%的C.I.2.72年至8.95年；P<；0.001)。在多变量分析中对诺丁汉预后指数组进行调整后，这一点仍然显著。有伤口并发症的患者的5年无复发生存率为%，而无并发症的患者的5年无复发生存率为89.2%(P<；0.001)。结论：本研究表明，立即乳房再造手术后的伤口并发症对乳腺癌患者具有重要意义。需要采取策略将乳腺癌患者术后伤口并发症的风险降至最低。
Background: The rate of immediate breast reconstruction is rising. Postoperative infections are more frequent in patients who undergo reconstruction. The inflammatory response to a postoperative infection can increase the risk of tumour recurrence in other forms of cancer through the release of proinflammatory mediators. The aim of this study was to assess the relationship between complications and breast cancer recurrence in patients undergoing immediate reconstruction.Methods: This was a review of a prospectively maintained database of all patients who had immediate breast reconstruction between 2004 and 2009 at Galway University Hospital, a tertiary breast cancer referral centre serving the west of Ireland. All patients had a minimum follow-up of 5 years. Outcomes assessed included the development of wound complications and breast cancer recurrence. The data were evaluated by univariable and multivariable Cox regression analysis.Results: A total of 229 patients who underwent immediate reconstruction were identified. The overall 5-year recurrence-free survival rate was 85.6 per cent. Fifty-three patients (23.1 per cent) had wound complications, of whom 44 (19.2 per cent) developed a wound infection. There was a significantly greater risk of developing systemic recurrence among patients who experienced a postoperative wound complication compared with those without a complication (hazard ratio 4.94, 95 per cent c.i. 2.72 to 8.95; P < 0.001). This remained significant after adjusting for Nottingham Prognostic Index group in the multivariable analysis. The 5-year recurrence-free survival rate for patients who had a wound complication was 64 per cent, compared with 89.2 per cent in patients without a complication (P < 0.001).Conclusion: This study has demonstrated that wound complications after immediate breast reconstructive surgery have significant implications for patients with breast cancer. Strategies are required to minimize the risk of postoperative wound complications in patients with breast cancer undergoing immediate reconstruction.