Systematic review of partial breast reconstruction with pedicled perforator artery flaps: Clinical, oncological and cosmetic outcomes

The use of chest wall perforator flaps (CWPFs) following breast conservation surgery for breast cancer has become a useful tool in the armamentarium of the oncoplastic breast surgeon, however robust evidence for the technique is lacking. The aim of this study was to conduct a systematic review appraising the current evidence for the use of CWPFs, evaluating clinical, oncological and cosmetic outcomes. A PRISMA-compliant systematic review, with PROSPERO published protocol a priori and search of all relevant database and trial registries between 1990 to July 2020. Eleven studies amounting to 432 cases were reviewed and considered to be at high risk of bias due to small sample size, selective outcome reporting and selection bias. Heterogeneity due to lack of consensus of outcome measures prevented meaningful analysis. Fifty-two (12.3%) clinical complications were recorded: seroma (n = 9; 2.1%), fat necrosis (n = 9; 2.4%), haematoma (n = 8; 1.9%), infection (n = 9; 2.1%), and flap necrosis (n = 9; 2.1%). Thirty-four (10.8%) patients had an involved positive margin, 29 patients underwent re-excision (9.3%) and four underwent completion mastectomy (1.3%). One local recurrence and six distant recurrences were observed during a mean follow up of 21 months (1-49). A pooled patient cosmetic satisfaction descriptor of good or excellent was described in 93% of cases. CWPFs are a safe method of partial breast reconstruction following BCS. They are associated with a low complication rate, acceptable short-term oncological outcomes and satisfactory cosmetic outcome. There is a relative paucity in quality of data in this field and larger prospective studies are needed to investigate outcomes further.

Abstract P4-13-09: Immediate breast reconstruction versus delayed breast reconstruction: An analysis of oncological outcomes

Introduction

Breast reconstruction is an important option for patients who undergo mastectomy for breast cancer. Several studies have investigated outcomes for patients who undergo either immediate or delayed reconstruction versus mastectomy alone but few have evaluated the relationship of the timing of reconstruction to oncological outcome.

Aim

To determine if there is a difference in oncological outcomes for patients who undergo delayed versus immediate breast reconstruction following mastectomy for breast cancer.

Methods

Patients who underwent immediate or delayed breast reconstruction between 2005 and 2006 were identified from a database maintained prospectively at the regional plastic surgery unit. Tumour pathology details were obtained retrospectively from the electronic patient record and from local electronic laboratory systems. Details of treatment, and recurrence and mortality data were obtained by review of each patient's electronic record. In the delayed reconstruction cohort, patients who underwent reconstruction 6-60 months after initial cancer surgery were included. In the immediate reconstruction group, patients who had recurrence or died within the first 6 months after surgery were excluded. Logistic regression survival analysis was carried out for the two cohorts and compared using Chi square test.

Results

193 patients who underwent immediate reconstruction and 116 patients who underwent delayed reconstruction were identified. Patients who had immediate reconstruction were more likely to have DCIS only, compared to those who had delayed reconstruction, but otherwise there was no significant difference between the two groups in terms of pathological characteristics or type of reconstruction performed (autologous or implant-based). Of those who had delayed reconstruction, median time from initial cancer surgery to reconstructive surgery was 27 months (6-58 months). There were 49 breast cancer deaths, 13 deaths from other causes and 65 recurrences. Median follow up time from reconstruction, of those who survived, was 111 months (29-134 months). Median follow up from initial cancer surgery was 116 months (46-185 months). There was no difference in breast cancer specific survival between the two groups when measured from time of cancer surgery (delayed reconstruction HR 1.05, 95% CI 0.59-1.89, p=0.861) or from time of reconstruction (delayed reconstruction HR 1.33, 95% CI 0.75-2.40, p=0.334). There was no difference in recurrence rates between the two groups when measured from time of cancer surgery (delayed reconstruction HR 0.94, 95% CI 0.56-1.60, p=0.822) or from time of reconstruction (delayed reconstruction HR 1.23, 95% CI 0.73-2.07, p=0.433).

Conclusion

Our data has demonstrated no difference in cancer specific survival or recurrence rates in patients who underwent mastectomy with immediate breast reconstruction compared to patients who had delayed reconstruction.

Citation Format: Morrow ES, Dolan RD, Blackhall V, Romics L. Immediate breast reconstruction versus delayed breast reconstruction: An analysis of oncological outcomes [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P4-13-09.

Outcome in excised thymomas: role of prognostic factors and impact of additional malignancies on survival

Background and aims:

Although the management of thymomas has been extensively evaluated, the value of prognostic factors in the outcome of these patients remains unclear.

Methods and results:

The medical records of all patients who underwent resection of thymoma between January 1985 and September 2010 at a single thoracic unit were reviewed. Patients were followed up with reference to disease recurrence and development of additional malignancies (AM). Total thymectomy was performed in all 68 cases. Mean follow-up time was four years. Mean survival was 63.9 months. Mean disease-free interval was 13 months. Factors affecting prognosis were Masaoka staging and WHO histological sub-type. Patients with thymomas had a higher risk of developing AM when compared with a control population of individuals with other tumours ( p = 0.0002). Among thymomas, the cortical subtype was associated with a higher risk of AM ( p = 0.047) and mortality ( p = 0.001).

Conclusions:

This data confirms that Masaoka staging and WHO histologic sub-type are the most important prognostic factors in patients with thymoma. Moreover, thymomas predominantly arising from the thymic cortex are associated with a higher risk of developing other malignancies and with poorer survival. The cortical origin of thymoma could therefore be considered as a significant prognostic factor.