Cirugía y reconstrucción mamaria en el cáncer de mama metastásico, una aproximación a la situación en España mediante encuesta y revisión de la literatura

Abstract

ObjectiveTo identify the current situation of locoregional surgery and breast reconstruction (BR) in patients with metastatic breast cancer (MBC) in Spain. MethodFrom April to September 2016, data were collected from an online survey sent to physicians involved in treating this group of patients. ResultsThere were 124 respondents: 46% plastic surgeons, 17.5% general surgeons, 30% gynecologists specialized in breast disease and 6.5% physicians from other specialties. A total of 47.5% of the respondents recommended locoregional surgery in MBC at the time of diagnosis. Eighty percent of respondents performed BR in MBC, of which 71.5% would consider it after a patient request. In patients not receiving radiotherapy, 84% of respondents chose immediate BR, 72.5% of them with a prosthesis. In irradiated patients, 77.5% of respondents preferred autologous reconstruction, 74.5% of them with latissimus dorsi myocutaneous flap. There were no differences between immediate BR or delayed-BR. Factors important in the decision to accept or refuse BR were a life expectancy of at least 2 years, the patient's comorbidities, tumor burden, response to systemic treatment, or more than 6 months of stable disease. The reasons for not performing BR were a poor prognosis and the risk of metastatic progression due to a temporary suspension of systemic treatment. ConclusionHalf of the respondents considered BR in a patient with MBC at diagnosis, assessing tumor burden, life expectancy, and stable disease. Protocols are required in this regard.