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Meta-Analysis
. 2015 Sep;153(2):241-51.
doi: 10.1007/s10549-015-3539-4. Epub 2015 Aug 19.

The effect of immediate breast reconstruction on the timing of adjuvant chemotherapy: a systematic review

J Xavier Harmeling  1 , Casimir A E Kouwenberg, Eveline Bijlard, Koert N J Burger, Agnes Jager, Marc A M Mureau
Affiliations
Meta-Analysis

The effect of immediate breast reconstruction on the timing of adjuvant chemotherapy: a systematic review

J Xavier Harmeling et al. Breast Cancer Res Treat. 2015 Sep.

Abstract

Adjuvant chemotherapy is often needed to achieve adequate breast cancer control. The increasing popularity of immediate breast reconstruction (IBR) raises concerns that this procedure may delay the time to adjuvant chemotherapy (TTC), which may negatively impact oncological outcome. The current systematic review aims to investigate this effect. During October 2014, a systematic search for clinical studies was performed in six databases with keywords related to breast reconstruction and chemotherapy. Eligible studies met the following inclusion criteria: (1) research population consisted of women receiving therapeutic mastectomy, (2) comparison of IBR with mastectomy only groups, (3) TTC was clearly presented and mentioned as outcome measure, and (4) original studies only (e.g., cohort study, randomized controlled trial, case-control). Fourteen studies were included, representing 5270 patients who had received adjuvant chemotherapy, of whom 1942 had undergone IBR and 3328 mastectomy only. One study found a significantly shorter mean TTC of 12.6 days after IBR, four studies found a significant delay after IBR averaging 6.6-16.8 days, seven studies found no significant difference in TTC between IBR and mastectomy only, and two studies did not perform statistical analyses for comparison. In studies that measured TTC from surgery, mean TTC varied from 29 to 61 days for IBR and from 21 to 60 days for mastectomy only. This systematic review of the current literature showed that IBR does not necessarily delay the start of adjuvant chemotherapy to a clinically relevant extent, suggesting that in general IBR is a valid option for non-metastatic breast cancer patients.

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Figures

Fig. 1
Fig. 1
Flowchart of the study selection procedure
Fig. 2
Fig. 2
Differences between IBR and mastectomy only in time to chemotherapy in days. IBR immediate breast reconstruction; M mastectomy only. aAdditional information about this paper was required through correspondence with the authors. bTime to chemotherapy measured from pathological diagnosis. cTime to chemotherapy measured from multidisciplinary decision
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