A Svee1, M Mani1, K Sandquist1, T Audolfsson2, Y Folkvaljon3, A E Isern4,5, A Ringberg6, J Manjer7, A Falk-Delgado1, F Wärnberg3. 1. Department of Plastic and Maxillofacial Surgery, Uppsala University, Uppsala, Sweden. 2. Department of Plastic and Reconstructive Surgery, Oslo University Hospital, Oslo, Norway. 3. Department of Surgery, Uppsala University Hospital and Department of Surgical Sciences, Uppsala University, Uppsala, Sweden. 4. Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway. 5. Volvat Stokkan, Trondheim, Norway. 6. Department of Plastic and Reconstructive Surgery, Lund University, Malmö, Sweden. 7. Department of Surgery, Skåne University Hospital Malmö, Lund University, Malmö, Sweden.
Abstract
BACKGROUND: Women who undergo autologous breast reconstruction have been reported to have an increased risk of breast cancer recurrence compared with those who have mastectomy alone. It has been suggested that more extensive surgery possibly activates dormant micrometastases. The aim of this study was to evaluate whether delayed unilateral deep inferior epigastric perforator (DIEP) flap reconstruction after mastectomy increases the risk of breast cancer recurrence or affects mortality among women previously treated for breast cancer. METHODS: This was a matched retrospective cohort study including women with a previous unilateral invasive breast cancer who received a delayed DIEP flap breast reconstruction and a control cohort of individually matched women with unilateral breast cancer who underwent mastectomy but no autologous breast reconstruction. Matching criteria comprised: year of diagnosis (+/-3 years), age at diagnosis (+/-5 years), type of cancer and demographic region. The primary endpoints were local recurrence or distant metastasis, and overall mortality was a secondary endpoint. Absolute risk of recurrent disease and mortality was analysed, and relative risks were estimated using Cox proportional hazards analysis. RESULTS: There were 225 women in the DIEP cohort and 450 in the no-DIEP cohort. The median follow-up time was 125 months. There was no difference in absolute risk of recurrence between the cohorts. The hazard ratio for breast cancer recurrence in DIEP versus no-DIEP cohorts was 0·76 (95 per cent c.i. 0·47 to 1·21). CONCLUSION: There is no increased risk in breast cancer recurrence after delayed DIEP flap reconstruction compared with mastectomy alone.
BACKGROUND:Women who undergo autologous breast reconstruction have been reported to have an increased risk of breast cancer recurrence compared with those who have mastectomy alone. It has been suggested that more extensive surgery possibly activates dormant micrometastases. The aim of this study was to evaluate whether delayed unilateral deep inferior epigastric perforator (DIEP) flap reconstruction after mastectomy increases the risk of breast cancer recurrence or affects mortality among women previously treated for breast cancer. METHODS: This was a matched retrospective cohort study including women with a previous unilateral invasive breast cancer who received a delayed DIEP flap breast reconstruction and a control cohort of individually matched women with unilateral breast cancer who underwent mastectomy but no autologous breast reconstruction. Matching criteria comprised: year of diagnosis (+/-3 years), age at diagnosis (+/-5 years), type of cancer and demographic region. The primary endpoints were local recurrence or distant metastasis, and overall mortality was a secondary endpoint. Absolute risk of recurrent disease and mortality was analysed, and relative risks were estimated using Cox proportional hazards analysis. RESULTS: There were 225 women in the DIEP cohort and 450 in the no-DIEP cohort. The median follow-up time was 125 months. There was no difference in absolute risk of recurrence between the cohorts. The hazard ratio for breast cancer recurrence in DIEP versus no-DIEP cohorts was 0·76 (95 per cent c.i. 0·47 to 1·21). CONCLUSION: There is no increased risk in breast cancer recurrence after delayed DIEP flap reconstruction compared with mastectomy alone.
Authors: Claudia A Bargon; Danny A Young-Afat; Mehmet Ikinci; Assa Braakenburg; Hinne A Rakhorst; Marc A M Mureau; Helena M Verkooijen; Annemiek Doeksen Journal: Cancer Date: 2022-07-27 Impact factor: 6.921
Authors: Joachim Geers; Hans Wildiers; Katrien Van Calster; Annouschka Laenen; Giuseppe Floris; Marc Vandevoort; Gerd Fabre; Ines Nevelsteen; Ann Smeets Journal: BMC Cancer Date: 2018-10-19 Impact factor: 4.430