Using complications associated with postmastectomy radiation and immediate breast reconstruction to improve surgical decision making

Dara Christante, Su Ellen Johnson Pommier, Brian S. Diggs, Bethany T. Samuelson, AiLien Truong, Carol Marquez, Juliana Hansen, Arpana Naik, John Vetto, Rodney Pommier

Research output: Contribution to journalArticle

45 Citations (Scopus)

Abstract

Objectives: To identify factors independently associated with surgical complications in oncologic and reconstructive surgery and to examine sentinel lymph node (SLN) biopsy data, along with variables that are typically known prior to definitive resection, for their ability to impact the prediction of need for postmastectomy irradiation (PMRT). Design: Retrospective review. Setting: University hospital. Patients: Mastectomy patients with stage I to III breast cancer treated in 2000 to 2008. Main Outcome Measures: Complication rates of oncologic and reconstructive surgery requiring reoperation and clinicopathologic variables that independently predict complications and/or PMRT administration by multivariate analysis. Results: Among 100 of 302 mastectomy patients who underwent PMRT, complications occurred in 44% who underwent immediate breast reconstruction (IBR) and 7% who did not (P <.001). Postmastectomy irradiation independently predicted the occurrence of a complication (odds ratio, 3.3; P <.001). Implants were removed in 31% of patients who underwent PMRT and 6% of patients who did not (P = .005). Three percent of patients with T2 or smaller tumors and zero positive SLN required PMRT. Among those with T2 tumors, 49% with a positive axilla lymph node underwent PMRT. Independent predictors of PMRT need were T2 vs T1 tumors, positive axillary lymph node status, and the number of positive SLNs, with odds ratios of 5.8 (P <.001), 14.5 (P <.001), and 2.1 (P = .001), respectively. Conclusions: Postmastectomy irradiation was associated with a high rate of surgical complications and implant loss among patients who underwent IBR. Determining the number of positive SLNs prior to definitive resection and reconstructive operations may reduce complications and implant loss by guiding surgical decision making. Patients with a negative SLN are unlikely to require PMRT. Those with positive SLN(s) are high-risk IBR candidates with a quantifiable PMRT risk.

Original languageEnglish (US)
Pages (from-to)873-878
Number of pages6
JournalArchives of Surgery
Volume145
Issue number9
DOIs
StatePublished - 2010

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Mammaplasty
Decision Making
Radiation
Reconstructive Surgical Procedures
Mastectomy
Lymph Nodes
Odds Ratio
Sentinel Lymph Node Biopsy
Neoplasms
Axilla
Aptitude
Reoperation
Multivariate Analysis
Outcome Assessment (Health Care)
Breast Neoplasms

ASJC Scopus subject areas

  • Surgery
  • Medicine(all)

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Using complications associated with postmastectomy radiation and immediate breast reconstruction to improve surgical decision making. / Christante, Dara; Pommier, Su Ellen Johnson; Diggs, Brian S.; Samuelson, Bethany T.; Truong, AiLien; Marquez, Carol; Hansen, Juliana; Naik, Arpana; Vetto, John; Pommier, Rodney.

In: Archives of Surgery, Vol. 145, No. 9, 2010, p. 873-878.

Research output: Contribution to journalArticle

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abstract = "Objectives: To identify factors independently associated with surgical complications in oncologic and reconstructive surgery and to examine sentinel lymph node (SLN) biopsy data, along with variables that are typically known prior to definitive resection, for their ability to impact the prediction of need for postmastectomy irradiation (PMRT). Design: Retrospective review. Setting: University hospital. Patients: Mastectomy patients with stage I to III breast cancer treated in 2000 to 2008. Main Outcome Measures: Complication rates of oncologic and reconstructive surgery requiring reoperation and clinicopathologic variables that independently predict complications and/or PMRT administration by multivariate analysis. Results: Among 100 of 302 mastectomy patients who underwent PMRT, complications occurred in 44{\%} who underwent immediate breast reconstruction (IBR) and 7{\%} who did not (P <.001). Postmastectomy irradiation independently predicted the occurrence of a complication (odds ratio, 3.3; P <.001). Implants were removed in 31{\%} of patients who underwent PMRT and 6{\%} of patients who did not (P = .005). Three percent of patients with T2 or smaller tumors and zero positive SLN required PMRT. Among those with T2 tumors, 49{\%} with a positive axilla lymph node underwent PMRT. Independent predictors of PMRT need were T2 vs T1 tumors, positive axillary lymph node status, and the number of positive SLNs, with odds ratios of 5.8 (P <.001), 14.5 (P <.001), and 2.1 (P = .001), respectively. Conclusions: Postmastectomy irradiation was associated with a high rate of surgical complications and implant loss among patients who underwent IBR. Determining the number of positive SLNs prior to definitive resection and reconstructive operations may reduce complications and implant loss by guiding surgical decision making. Patients with a negative SLN are unlikely to require PMRT. Those with positive SLN(s) are high-risk IBR candidates with a quantifiable PMRT risk.",
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AU - Christante, Dara

AU - Pommier, Su Ellen Johnson

AU - Diggs, Brian S.

AU - Samuelson, Bethany T.

AU - Truong, AiLien

AU - Marquez, Carol

AU - Hansen, Juliana

AU - Naik, Arpana

AU - Vetto, John

AU - Pommier, Rodney

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AB - Objectives: To identify factors independently associated with surgical complications in oncologic and reconstructive surgery and to examine sentinel lymph node (SLN) biopsy data, along with variables that are typically known prior to definitive resection, for their ability to impact the prediction of need for postmastectomy irradiation (PMRT). Design: Retrospective review. Setting: University hospital. Patients: Mastectomy patients with stage I to III breast cancer treated in 2000 to 2008. Main Outcome Measures: Complication rates of oncologic and reconstructive surgery requiring reoperation and clinicopathologic variables that independently predict complications and/or PMRT administration by multivariate analysis. Results: Among 100 of 302 mastectomy patients who underwent PMRT, complications occurred in 44% who underwent immediate breast reconstruction (IBR) and 7% who did not (P <.001). Postmastectomy irradiation independently predicted the occurrence of a complication (odds ratio, 3.3; P <.001). Implants were removed in 31% of patients who underwent PMRT and 6% of patients who did not (P = .005). Three percent of patients with T2 or smaller tumors and zero positive SLN required PMRT. Among those with T2 tumors, 49% with a positive axilla lymph node underwent PMRT. Independent predictors of PMRT need were T2 vs T1 tumors, positive axillary lymph node status, and the number of positive SLNs, with odds ratios of 5.8 (P <.001), 14.5 (P <.001), and 2.1 (P = .001), respectively. Conclusions: Postmastectomy irradiation was associated with a high rate of surgical complications and implant loss among patients who underwent IBR. Determining the number of positive SLNs prior to definitive resection and reconstructive operations may reduce complications and implant loss by guiding surgical decision making. Patients with a negative SLN are unlikely to require PMRT. Those with positive SLN(s) are high-risk IBR candidates with a quantifiable PMRT risk.

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