Abstract P6-14-02: Does immediate breast reconstruction delay oncologic therapy?
Authors: Bargallo-Rocha Juan Enrique , Vargas-Salas Daniela , Gutiérrez-Zacarías Luz M , Torres-Domínguez Juan Alejandro , Juárez-Cabello Luis Erick , Cabrera-Galeana Paula Anel 
Published: March 2020

Background: As life expectancy improves in women with breast cancer (BC), all efforts to enhance patients´ quality of life (QOL) have gained great importance. It is known that breast reconstruction (BR) surgery has a big impact in QOL and consequently it has become a valuable element in the multidisciplinary approach of BC patients. It is clear that as long as it does not suppose an interference for their oncologic treatment, patients must have offered immediate breast reconstruction as part of their surgical treatment. However, concerns about delay in oncologic therapy, especially because of postoperative complications may influence oncologic specialists to discourage patients to take this option in certain scenarios. In this study we evaluated the association between immediate BR and delay in time to oncologic treatment (TOT), defined as number of days between surgery and the initiation of oncologic adjuvant therapy (chemotherapy, endocrine and radiotherapy).

Methods: IRB approval was obtained for a retrospective review of all patients undergoing BC surgery with immediate BR and received adjuvant oncologic therapy at the National Cancer Institute of Mexico from 2017 to 2019. We performed a 2:1 statistical matching with randomly selected patients from an institutional database who underwent only oncologic surgery and adjuvant therapy using year of surgery (2014-2016) and clinical stage as selection criteria. Demographic, tumor and surgical variables were analyzed in the bivariate analysis. According to the variable TOT, we categorized patients into 3 groups: &lt;20, 20 to 50, and &gt;50 days. We performed a quantile regression to identify the association with delay in TOT. A logistic regression was used to analyze postoperative complications in reconstructed patients as possible risk factors for delay.

Results: We analyzed 456 patients undergoing BC surgery, of which 152 (33.3%) underwent immediate BR. Clinical Stage II was the most prevalent in all grousps. Among all patients 60% underwent total mastectomy (TM), 23.5% TM and alloplastic BR, 6.6% TM and autologous BR, 6.6% breast conservative surgery and 3.3% oncoplastic surgery. Patients not reconstructed had a higher median age (53.4 years versus 45.4; p=0.000), higher rates of diabetes (12.5% versus 5.9%; p=0.029) and higher rates of systemic hypertension (23.6% versus 10.5%; p=0.001). In the reconstructed group, the median TOT was 29 days (12 to 179) versus 29.5 days (6 to 188) in the not reconstructed (p=0.43). Among the 21% of reconstructed patients who experienced postoperative complications, we found 16 (10.5%) surgical site infections, 24 (15%) reinterventions, 4 (2.6%) hematoma and 1 (0.65%) flap loss. The complication group did not show delay in the TOT (p=0.09) with a median TOT of 41.5 days. There is a global BR failure rate of 11.8% and it has no association with delay in TOT (p=0.842).

Conclusions: In our series, we found a median TOT of 29 days in both groups. There is no difference in TOT between the reconstructed and the not reconstructed groups in terms of delay of TOT. When analyzing the reconstructed group by incidence of postoperative complications, which is one of the main concerns, we also found they did not have a significant impact in delay of therapy. We considered that a multidisciplinary approach, an effective communication between the plastic and the oncologic team and careful patient education are of major importance to get an early detection of complications, prompt management and recanalization of patient to continue their oncologic therapy as planned. Our results support previous findings that breast reconstruction should continue to be encouraged in order to provide good QOL for BC patients without interfering with oncologic outcomes.

Citation Format: Juan Enrique Bargallo-Rocha, Daniela Vargas-Salas, Luz M Gutiérrez-Zacarías, Juan Alejandro Torres-Domínguez, Luis Erick Juárez-Cabello, Paula Anel Cabrera-Galeana. Does immediate breast reconstruction delay oncologic therapy? [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P6-14-02.