A systematic review and meta-analysis on the effect of neoadjuvant chemotherapy on complications following immediate breast reconstruction
Date
2020Author
Varghese, Jajini
Gohari, Shireen S.
Rizki, Hirah
Faheem, Michael
Langridge, Benjamin
Kümme, Sherko
Johnson, Laura
Schmid, Peter
Metadata
Show full item recordAbstract
Background
The impact of neoadjuvant chemotherapy (NACT) on surgical outcomes following immediate breast
reconstruction (IBR) remains unclear. While it is generally considered safe practice to perform an IBR post
NACT, reported complication rates in published data are highly variable with the majority of studies including
fewer than 50 patients in the NACT and IBR arm. To evaluate this further, we conducted a systematic review
and meta-analysis on the effect of NACT on autologous and implant based immediate breast reconstructions. We
aimed to assess for differences in the post-operative course following IBR between patients who received NACT
with those who did not.
Methods
PubMed, EMBASE, and Cochrane Library were searched from 1995 to Sept 2, 2020 to identify articles that
assessed the impact of NACT on IBR. All included studies assessed outcomes following IBR. Only studies
comparing reconstructed patients receiving NACT to a control group of women who did not receive NACT were
included. Unadjusted relative risk of outcomes between patients who received or did not receive NACT were
synthesized using a fixed-effect meta-analysis. The evidence was assessed using the Newcastle Ottawa Scale
scores and GRADE. Primary effect measures were risk ratios (RRs) with 95% confidence intervals.
Results
A total 17 studies comprising 3249 patients were included in the meta-analyses. Overall, NACT did not increase
the risk of complications after immediate breast reconstructions (risk ratio [RR]: 0.91, 95% CI 0.74 to 1.11,
p=0.34). There was a moderate, but not significant, increase in flap loss following NACT compared with
controls (RR: 1.23, 95% CI 0.70 to 2.18, p=0.47; I
2
=0%). Most notably, there was a statistically significant
increase in implant/expander loss after NACT ( RR: 1.54, 95% CI 1.04 to 2.29, p = 0.03; I
2
=34%). NACT was
not shown to significantly increase the incidence of hematomas, seromas or wound complications, or result in a
significant delay to commencing adjuvant therapy (RR: 1.59, 95% CI 0.66 to 3.87, p =0.30).
Conclusion
Immediate breast reconstruction after NACT is a safe procedure with an acceptable post-operative complication
profile. It may result in a slight increase in implant loss rates, but it does not delay commencing adjuvant
therapy.
Palabras clave
Effect of neoadjuvant chemotherapy; Complications followingLink to resource
https://doi.org/10.1016/j.breast.2020.11.023Collections
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