A systematic review and meta-analysis of the clinical and quality of life outcomes of immediate and delayed autologous microvascular flap-based breast reconstruction in the context of radiotherapy
Association of Breast Surgery ePoster Library. Khajuria A. 05/13/19; 257150; P107
Mr. Ankur Khajuria
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P107
Topic: Oncoplastic and aesthetic surgery
Introduction: Effects of post-mastectomy radiotherapy (PMRT) on autologous breast reconstruction (BRR) are controversial. This review evaluates clinical and quality of life (QoL) outcomesafter immediate and delayed free flaps (DIEP, TRAM and SIEA). Methods The review was registered a priori on PROSPERO (CRD42017077945). EMBASE, MEDLINE, Google Scholar, CENTRAL, SCI and Clinicaltrials.gov were searched (August 2000-2018). Two independent reviewers evaluated complications, aesthetic and QoL outcomes. Study quality and risk of bias were assessed using GRADE and Cochrane's ROBINS-I tool respectively. Results: 15/631 studies, with 1633 patients (407 PMRT, 414 no RT and 812 neo-adjuvant RT), were included. There were 3 prospective/12 retrospective cohort studies and no RCTs. Quality was low, with moderate-serious risk of bias. There were no differences in Grade III Clavien-Dindo complications between PMRT and no RT groups (OR 1.53, p=0.42, CI 0.55-4.26), nor between neoadjuvant RT and no RT (OR 1.24, p=0.39, CI 0.76-2.04) or pooled PMRT/neoadjuvant RT versus no RT (OR 1.37, p=0.18, CI 0.87-2.15). One study (n=106) reported lower BREAST-Q median breast satisfaction in PMRT group (64 vs 75, p=0.008); two studies reported no differences in reconstructed breast symptoms using BREAST-Q, however, one (n=125) reported greater breast symptoms in PMRT group using EORTC-QLQ-BR23 (median difference 8, p<0.0001). Three studies (n=161) reported inferior aesthetic outcomes in PMRT group. Conclusions: Immediate autologous BRR with PMRT may be acceptable, however current evidence is poor quality and inconclusive. Level-I evidence with evaluation of a priori core outcome sets and cost-effectiveness is required for national guidelines and optimising shared-informed consent.
Topic: Oncoplastic and aesthetic surgery
Introduction: Effects of post-mastectomy radiotherapy (PMRT) on autologous breast reconstruction (BRR) are controversial. This review evaluates clinical and quality of life (QoL) outcomesafter immediate and delayed free flaps (DIEP, TRAM and SIEA). Methods The review was registered a priori on PROSPERO (CRD42017077945). EMBASE, MEDLINE, Google Scholar, CENTRAL, SCI and Clinicaltrials.gov were searched (August 2000-2018). Two independent reviewers evaluated complications, aesthetic and QoL outcomes. Study quality and risk of bias were assessed using GRADE and Cochrane's ROBINS-I tool respectively. Results: 15/631 studies, with 1633 patients (407 PMRT, 414 no RT and 812 neo-adjuvant RT), were included. There were 3 prospective/12 retrospective cohort studies and no RCTs. Quality was low, with moderate-serious risk of bias. There were no differences in Grade III Clavien-Dindo complications between PMRT and no RT groups (OR 1.53, p=0.42, CI 0.55-4.26), nor between neoadjuvant RT and no RT (OR 1.24, p=0.39, CI 0.76-2.04) or pooled PMRT/neoadjuvant RT versus no RT (OR 1.37, p=0.18, CI 0.87-2.15). One study (n=106) reported lower BREAST-Q median breast satisfaction in PMRT group (64 vs 75, p=0.008); two studies reported no differences in reconstructed breast symptoms using BREAST-Q, however, one (n=125) reported greater breast symptoms in PMRT group using EORTC-QLQ-BR23 (median difference 8, p<0.0001). Three studies (n=161) reported inferior aesthetic outcomes in PMRT group. Conclusions: Immediate autologous BRR with PMRT may be acceptable, however current evidence is poor quality and inconclusive. Level-I evidence with evaluation of a priori core outcome sets and cost-effectiveness is required for national guidelines and optimising shared-informed consent.
P107
Topic: Oncoplastic and aesthetic surgery
Introduction: Effects of post-mastectomy radiotherapy (PMRT) on autologous breast reconstruction (BRR) are controversial. This review evaluates clinical and quality of life (QoL) outcomesafter immediate and delayed free flaps (DIEP, TRAM and SIEA). Methods The review was registered a priori on PROSPERO (CRD42017077945). EMBASE, MEDLINE, Google Scholar, CENTRAL, SCI and Clinicaltrials.gov were searched (August 2000-2018). Two independent reviewers evaluated complications, aesthetic and QoL outcomes. Study quality and risk of bias were assessed using GRADE and Cochrane's ROBINS-I tool respectively. Results: 15/631 studies, with 1633 patients (407 PMRT, 414 no RT and 812 neo-adjuvant RT), were included. There were 3 prospective/12 retrospective cohort studies and no RCTs. Quality was low, with moderate-serious risk of bias. There were no differences in Grade III Clavien-Dindo complications between PMRT and no RT groups (OR 1.53, p=0.42, CI 0.55-4.26), nor between neoadjuvant RT and no RT (OR 1.24, p=0.39, CI 0.76-2.04) or pooled PMRT/neoadjuvant RT versus no RT (OR 1.37, p=0.18, CI 0.87-2.15). One study (n=106) reported lower BREAST-Q median breast satisfaction in PMRT group (64 vs 75, p=0.008); two studies reported no differences in reconstructed breast symptoms using BREAST-Q, however, one (n=125) reported greater breast symptoms in PMRT group using EORTC-QLQ-BR23 (median difference 8, p<0.0001). Three studies (n=161) reported inferior aesthetic outcomes in PMRT group. Conclusions: Immediate autologous BRR with PMRT may be acceptable, however current evidence is poor quality and inconclusive. Level-I evidence with evaluation of a priori core outcome sets and cost-effectiveness is required for national guidelines and optimising shared-informed consent.
Topic: Oncoplastic and aesthetic surgery
Introduction: Effects of post-mastectomy radiotherapy (PMRT) on autologous breast reconstruction (BRR) are controversial. This review evaluates clinical and quality of life (QoL) outcomesafter immediate and delayed free flaps (DIEP, TRAM and SIEA). Methods The review was registered a priori on PROSPERO (CRD42017077945). EMBASE, MEDLINE, Google Scholar, CENTRAL, SCI and Clinicaltrials.gov were searched (August 2000-2018). Two independent reviewers evaluated complications, aesthetic and QoL outcomes. Study quality and risk of bias were assessed using GRADE and Cochrane's ROBINS-I tool respectively. Results: 15/631 studies, with 1633 patients (407 PMRT, 414 no RT and 812 neo-adjuvant RT), were included. There were 3 prospective/12 retrospective cohort studies and no RCTs. Quality was low, with moderate-serious risk of bias. There were no differences in Grade III Clavien-Dindo complications between PMRT and no RT groups (OR 1.53, p=0.42, CI 0.55-4.26), nor between neoadjuvant RT and no RT (OR 1.24, p=0.39, CI 0.76-2.04) or pooled PMRT/neoadjuvant RT versus no RT (OR 1.37, p=0.18, CI 0.87-2.15). One study (n=106) reported lower BREAST-Q median breast satisfaction in PMRT group (64 vs 75, p=0.008); two studies reported no differences in reconstructed breast symptoms using BREAST-Q, however, one (n=125) reported greater breast symptoms in PMRT group using EORTC-QLQ-BR23 (median difference 8, p<0.0001). Three studies (n=161) reported inferior aesthetic outcomes in PMRT group. Conclusions: Immediate autologous BRR with PMRT may be acceptable, however current evidence is poor quality and inconclusive. Level-I evidence with evaluation of a priori core outcome sets and cost-effectiveness is required for national guidelines and optimising shared-informed consent.
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