Abstract
As breast cancer surgery continues to evolve, this study highlights the acute complication rates and predisposing risks following partial mastectomy (PM), mastectomy(M), mastectomy with muscular flap reconstruction (M + MF), mastectomy with implant reconstruction (M + I), and oncoplastic surgery (OPS). Data was collected from the American College of Surgeons NSQIP database (2005–2017). Complication rate and trend analyses were performed along with an assessment of odds ratios for predisposing risk factors using adjusted linear regression. 226,899 patients met the inclusion criteria. Complication rates have steadily increased in all mastectomy groups (p < 0.05). Cumulative complication rates between surgical categories were significantly different in each complication cluster (all p < 0.0001). Overall complication rates were: PM: 2.25%, OPS: 3.2%, M: 6.56%, M + MF: 13.04% and M + I: 5.68%. The most common predictive risk factors were mastectomy, increasing operative time, ASA class, BMI, smoking, recent weight loss, history of CHF, COPD and bleeding disorders (all p < 0.001). Patients who were non-diabetic, younger (age < 60) and treated as an outpatient all had protective OR for an acute complication (p < 0.0001). This study provides data comparing nationwide acute complication rates following different breast cancer surgeries. These can be used to inform patients during surgical decision making.
Highlights
Breast cancer surgery is adapting to rising patient preferences for breast reconstructive procedures.Treatment of breast cancer surgery can be classified into two overall groups: breast conserving therapy (BCT) including partial mastectomy (PM) and oncoplastic surgery (OPS), and mastectomy (MAST)including mastectomy alone (M) and M with breast reconstruction (M + R)
The M + I group had the highest incidence of younger patients and a lower incidence of the following preoperative indicators: lower American Society of Anesthesiologist (ASA) class, fewer open wound infections or systemic infections within
As surgical interventions evolve according to oncological guidelines, patient preferences and modern reconstructive surgeries, the importance of determining and acknowledging complication rates is critical for every surgeon
Summary
Breast cancer surgery is adapting to rising patient preferences for breast reconstructive procedures.Treatment of breast cancer surgery can be classified into two overall groups: breast conserving therapy (BCT) including partial mastectomy (PM) and oncoplastic surgery (OPS), and mastectomy (MAST)including mastectomy alone (M) and M with breast reconstruction (M + R). Breast cancer surgery is adapting to rising patient preferences for breast reconstructive procedures. Treatment of breast cancer surgery can be classified into two overall groups: breast conserving therapy (BCT) including partial mastectomy (PM) and oncoplastic surgery (OPS), and mastectomy (MAST). Including mastectomy alone (M) and M with breast reconstruction (M + R). From 2005 to 2017, the use of breast reconstruction significantly increased compared to other types of breast cancer surgery for patients with both ductal carcinoma in situ (DCIS) and invasive carcinoma (IvBC) [1]. Known for its extensive use of tissue mobilization and re-arrangement to ensure optimal reshaping with breast cosmesis [2], the use of OPS (a form of breast reconstruction) has doubled from 2% to 5%. Mastectomy with muscular flap reconstruction (M + MF) has declined from 4.5% to only 1% [1]
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