Background: While radiotherapy (RT) and chemotherapy (CT) significantly improve breast cancer outcomes, they may affect breast reconstruction by causing vascular damage and delayed wound healing. This retrospective study evaluates how preoperative RT, CT, or the combination of both impacts intraoperative and postoperative outcomes in immediate or delayed deep inferior epigastric perforator (DIEP) flap breast reconstructions. Methods: We conducted a single-center review of all patients undergoing autologous DIEP flap reconstruction after mastectomy between 2018 and 2024. Patients were divided into four groups: RT only, CT only, a combination of RT and CT, and a control group with no preoperative therapies. Intraoperative and postoperative outcomes were then compared among these groups, with statistical significance defined asp< 0.05. Results: We included 114 patients representing 141 DIEP-flap breast reconstructions. Flap survival rate was 98.5%. In the univariate analysis, total microvascular recipient site complications were significantly higher in the RT + CT group (14.0%,p= 0.021). Donor-site complication rates differed significantly among the four groups (p= 0.025), with the highest rate observed in the RT + CT group (44.7%). In the logistic regression analysis, ischemia time was found as an independent risk factor for total recipient site complications, but not for microvascular complications (OR = 1.019, 95%-CI = 1.004–1.035,p= 0.014). Conclusions: Combined RT + CT significantly increased microsurgical complications. Ischemia time correlated with higher odds of total recipient site complications. Individualized patient management and diminished ischemia time are likely to improve flap survival.
背景：尽管放疗（RT）与化疗（CT）显著改善了乳腺癌的治疗效果，但它们可能通过引起血管损伤和延迟伤口愈合而影响乳房重建。本回顾性研究旨在评估术前单独放疗、单独化疗或两者联合治疗对即刻或延期腹壁下动脉穿支（DIEP）皮瓣乳房重建术中及术后结果的影响。方法：我们对2018年至2024年间所有接受乳房切除术后自体DIEP皮瓣重建的患者进行了单中心回顾分析。患者被分为四组：仅放疗组、仅化疗组、放疗联合化疗组以及术前未接受任何治疗的对照组。随后比较各组间的术中及术后结果，统计学显著性定义为p < 0.05。结果：本研究共纳入114例患者，涉及141例DIEP皮瓣乳房重建。皮瓣存活率为98.5%。单变量分析显示，放疗联合化疗组的总显微血管受区并发症发生率显著更高（14.0%，p = 0.021）。四组间的供区并发症发生率存在显著差异（p = 0.025），其中放疗联合化疗组的并发症发生率最高（44.7%）。在逻辑回归分析中，缺血时间被发现是总受区并发症的独立危险因素，但对显微血管并发症无显著影响（OR = 1.019，95% CI = 1.004–1.035，p = 0.014）。结论：放疗联合化疗显著增加了显微外科并发症的发生率。缺血时间与总受区并发症发生几率的升高相关。个体化的患者管理及缩短缺血时间可能有助于提高皮瓣存活率。
肿瘤(癌症)患者之家