Plastic Surgery Research Council
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PSRC 60th Annual Meeting

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Neoadjuvant Radiotherapy Is Not Associated with Increased Post-Mastectomy/Reconstruction Morbidity Events: A Critical Analysis Of 85,851 Patients From The ACS-NSQIP Database
Pablo A. Baltodano, MD1, José M. Flores, MPH2, Lyonell Kone, MHS1, Nicholas B. Abt, BS1, Karim A. Sarhane, MD, MSc1, Danielle H. Rochlin, BA1, Francis M. Abreu, BS2, Richard C. Zellars, MD1, Martin A. Makary, MD, MPH1, Gedge D. Rosson, MD1.
1Johns Hopkins University School of Medicine, Baltimore, MD, USA, 2Johns Hopkins School of Public Health, Baltimore, MD, USA.

Purpose: Neoadjuvant radiotherapy (NRT) is a novel therapeutic approach to breast cancer that reduces local recurrences and increases overall survival. However, its effect on postoperative morbidity remains ill defined. We sought to assess the impact of NRT on 30-day postoperative morbidity after mastectomy.
Methods: We analyzed all females undergoing mastectomy with and without immediate breast reconstruction from 2005-2011 in the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) databases (a prospective, risk adjusted, outcomes-based registry). De-identified data were obtained for demographics and perioperative factors. Outcomes included morbidity and surgical site occurrences (SSO, i.e., wound infections and dehiscence). Morbidity variables included flap/graft/prosthesis, cardiac, respiratory, neurological, urinary, and venous thromboembolism outcomes. Logistic regression was used to estimate the crude and adjusted effect of NRT on postoperative 30-day morbidity and SSO. Our analysis adjusted for 21 perioperative variables (Table 1).
Results: The study population included 85,851 women: 61,039 (71.1%) mastectomy-only and 16,863 (19.6%) immediate breast reconstruction patients. A total of 266 (0.4%) mastectomy-only and 75(0.4%) immediate breast reconstruction patients received NRT (Figure 1). In the mastectomy-only population, no significant differences in the odds of morbidity (ORAdjusted_Morbidity: 0.75; P=0.34) or SSO (ORAdjusted_SSO: 1.61; P=0.22) were observed between NRT and no NRT groups on multivariable analysis. In the immediate breast reconstruction population, the odds of morbidity (OR_Adjusted_Morbidity: 0.21; P=0.059) or SSO (OR_Adjusted_SSO: 0.81; P=0.79) between NRT and no NRT groups on multivariable analysis were also similar (Table 1).
Conclusions: This large retrospective study revealed that NRT is not associated with increased 30-day postoperative morbidity or SSO in breast cancer patients undergoing mastectomy with or without immediate reconstruction. This results suggest that NRT is not a contraindication to immediate breast reconstruction, and provide a strong basis for future prospective studies to assess long-term morbidity and survival associated with NRT.


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