Impact Of Neoadjuvant Chemotherapy On Post-operational Complications And Effect After Endoscopic Total Skin-sparing Mastectomy And Immediate Breast Reconstruction With Implant

Breast cancer has ranked the first place among malignant tumors of women recently,which incidence rate is increasing year by year. With the continuous development of the comprehensive treatment of breast cancer, the prognosis has been improved obviously.With the development of endoscopic technology, its application in breast surgery has been more and more. Endoscopic skin-sparing mastectomy with immediate breast reconstruction with implants is completely removing the lesion and lymph nodes followed by immediate breast reconstruction with prosthesis, thus greatly improve the cosmetic effect. Its differnces from the modified radical mastectomy is that it retains the integrity of the nipple and areola skin, which resection of the lesion and lymph node tissues is through a small incision.It not only ensure the same operation effect compared with the latter, but also achieve better appearance through postoperative breast reconstruction with prosthesis, thus alleviate the psychological gap of the patients, making a better quality of life.Neoadjuvant chemotherapy is an important treatment before surgery as a part of the comprehensive treatment of breast cancer.Many researches report that it has no influence on post-operational complications after modified radical mastectomy as well as long-term effect.While there is little research show that if neoadjuvant chemotherapy can influence post-operational complications after endoscopic skin-sparing mastectomy with immediate breast reconstruction with implants.Hence,this study intends to use retrospective study and prospective randomized methods to investigate the impact of neoadjuvant chemotherapy on post-operational complications and effect after endoscopic total skin-sparing mastectomy and immediate breast reconstruction with implants, and provide evidence for standardized treatment for breast cancer clinical endoscopic operation.Methods & Results1. Impact of neoadjuvant chemotherapy on post-surgical complications and effect after endoscopic surgery of breast cancer: A retrospective studyMethods: We reviewed a total of 183 patients from 2007 to 2010 who is dianogsed advanced breast cancers in breast cancer center,southwest hospital of Third millitary medical university,and underwent endoscopic mastectomy. All the patients were seperated into 2 groups based on if they receive NCT before surgeries.There are 85 patients in the control group,who receive endoscopic surgery followed by post-surgical chemotherapy,and 98 are in the NCT group,who them receive a 2-4 cycles of NCT before surgeries. Compared the operation data, post-operative complications and long-term effectbetween two groups.Results:(1)There were no statistic difference in terms of operation times( 213.0±36.0 vs215.1±38.5,P=0.704)、amount of bleeding(79.0±24.3 vs74.1±20.0,P=0.144)and drainage(274.3±92.4 vs283.7±80.1,P=0.469) between two groups.(2)No statistic difference was observed about post-operational infection(3/98 vs5/85,P=0.475), necrosis of nipple or skin flap(6/98 vs5/85,P=0.946)and edema of the upper extremity(8/98 vs12/85,P=0.291)between two groups.(3) Follow-up time end on March 31 th,2015(Median times:66 months),and it showed no difference in terms of local recurrence(2/98 vs2/85,P=1.000), distant metastasis(12/98 vs9/85,P=0.726)and mortality rate(6/98 vs4/85,P=0.925).2. Impact of neoadjuvant chemotherapy on post-operational complications and effect after endoscopic total skin-sparing mastectomy and immediate breast reconstruction with implants:a prospective study.Methods: We included a total of 110 patients who received treaments in the Southwest Hospital Center Hospital and underwent ETSSM and immediate breast reconstruction with prosthesis implantation since January 1, 2013. Enrolled patients were randomly divided into two groups, including direct endoscopic operation for the control group, a total of 53 cases, given a 2-4 cycles of neoadjuvant therapy for neoadjuvant chemotherapy group, a total of 57 cases. Compared the operation data, post-operative complications, cosmetic effect and long-term effectbetween two groups.Results:(1)There were no statistic difference in terms of operation times(204.8±70.1 vs 210.3±68.3,p=0.674)、amount of bleeding(77.7±71.9 vs 72.8±61.2,p=0.703)and drainage(263.5±67.6 vs 255.1±77.3,p=0.544) between the NCT group and the control group.(2)No statistic difference was observed about post-operational infection or Seroma(5/57 vs6/53,P=0.656), necrosis of nipple or skin flap(5/57 vs5/53,P=0.904)and edema of the upper extremity(7/57 vs6/53,P=0.876)between two groups.(3) There were no statistic difference in terms of cosmetic effect(p>0.05).Most of them were excellent or good, in the mean time, the excellent or good rate of the NCT group was slightly higher than that of the control group(4)Follow-up time end on April 30 th,2015(Median times:12 months),no local recurrence was reported among all patients, there were two patients who were found distant metastasis, and one case in each group.and no mortality was reported among all patients.Conclusion:Both retrospective and prospective studies illustrate that neoadjuvant chemotherapy does not increase the incidence of postoperative complications of endoscopic surgery in patients with breast cancer, and ETSSM and breast reconstruction with implants after neoadjuvant chemotherapy is safe and effective.