Influencia de la radioterapia sobre la reconstrucción mamaria inmediata posmastectomía ahorradora de piel. ¿Afecta igual antes que después?

Resumen

Introducción

La mastectomía bilateral con reconstrucción inmediata (MB + RMI) está aumentando. La radioterapia incrementa las complicaciones, pero se han ampliado los criterios de administración. Queremos evaluar las tasas de complicaciones/secuelas realizando un análisis comparativo con una cohorte sin radioterapia.

Métodos

Análisis observacional analítico de cohortes retrospectivo de pacientes tratadas mediante MB como tratamiento de cáncer de mama con RMI entre 2000 y 2016. Se evalúan 3 grupos: grupo 1: pacientes previamente tratadas con cirugía local y radioterapia, y MB + RMI posterior; grupo 2: pacientes con MB + RMI y radioterapia posterior por un cáncer de novo, y grupo 3: pacientes con MB + RMI sin radioterapia previa ni posterior.

Evaluamos variables demográficas, técnicas quirúrgicas y morbilidad postoperatoria.

Resultados

Se intervinieron un total de 296 MB + RMI.

Grupo 1: 125 pacientes con radioterapia previa, administrada 21,69 meses antes de media. Tasa de complicaciones del 28,8%, secuelas 33,6% y reintervención 33,6%.

Grupo 2:71 pacientes con radioterapia tras reconstrucción 134,2 días de media. Tasa de complicaciones del 29,6%, secuelas 19,9% y reintervención 16,9%.

Grupo 3: 100 pacientes. Tasa de complicaciones del 30%, secuelas 21% y reintervención 20%.

Encontramos más secuelas en el grupo 1, con casi el doble de reintervenciones que en el grupo 2 (33,6% vs. 16,9%; p = 0,067).

Conclusiones

La tasa de complicaciones a largo plazo y la tasa de reintervenciones es mayor en el grupo MB + RMI con radioterapia previa que en los grupos MB + RMI con radioterapia posterior o MB + RMI sin radioterapia.

Abstract

Introduction

The use of bilateral mastectomy with immediate reconstruction is increasing. Radiotherapy increases complications; however, its uses have been extended. We evaluate the profile of the complications and long-term failure of reconstruction through a comparative analysis with a cohort without radiotherapy.

Methods

Retrospective analysis of patients with breast cancer who underwent mastectomy with immediate reconstruction during 2000-2016. Three groups were evaluated: 1) patients who received radiotherapy and posterior breast reconstruction; 2) patients with bilateral mastectomy and immediate reconstruction following adjuvant radiotherapy; 3) patients who did not receive radiotherapy at all. Demographic variables, surgical techniques and postoperative morbidity were assessed.

Outcomes and complications were compared between cohorts. Analysis was done with SPSS Statistics.

Results

296 bilateral mastectomies with immediate reconstruction. Mean age 48.4 ± 9. No differences in comorbidity in the different groups.

Group 1: 125 patients. Radiotherapy given 21.69 months before, on average. Complication rate: 20%. Failure of reconstruction rate: 20%. Reoperation rate: 33.6%.

Group 2: 71 patients. Radiotherapy after reconstruction: mean 134.2 days. Complication rate: 36.7%. Failure of reconstruction rate: 21.1%. Reoperation rate: 16.9%.

Group 3: 100 patients. Complication rate: 25%. Failure of reconstruction rate: 21%. Reoperation rate: 20%.

Morbidity published in patients after radiotherapy before or after reconstruction is higher than complications in patients who did not receive radiotherapy. Even so, in our series they were similar.

We found a higher sequelae rate in group 1, with almost double the rate of reoperation.

Conclusions

Patients who underwent radiotherapy before reconstruction had a higher risk of developing failure of reconstruction and needing reoperation than those patients who received radiotherapy after breast reconstruction or did not receive radiotherapy at all.