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

• Published in: Breast cancer research and treatment 2021-08, Vol.188 (3), p.641-648
• Main Authors: Siegel, Emily L., Whiting, Junmin, Kim, Younchul, Sun, Weihong, Laronga, Christine, Lee, M. Catherine
• Format: Article
• Language: English
• Subjects: Breast cancer; Cancer patients; Care and treatment; Clinical Trial; Comparative analysis; Complications and side effects; Dehiscence; Diseases; ErbB-2 protein; Hematoma; Mammaplasty; Mastectomy; Medical prognosis; Medicine; Medicine & Public Health; Necrosis; Oncology; Patient outcomes; Postwar reconstruction; Relapse; Smoking; Survival
• ISSN: 0167-6806; 1573-7217
• DOI: 10.1007/s10549-021-06241-4

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.