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Br J Cancer. 2019 Apr;120(9):883-895. doi: 10.1038/s41416-019-0438-1. Epub 2019 Mar 29.

The impact of immediate breast reconstruction on the time to delivery of adjuvant therapy: the iBRA-2 study.

Collaborators (414)

Barnes NLP, Blazeby J, Conroy E, Dave RV, Gardiner M, Harnett A, Holcombe C, O'Brien C, O'Connell R, Potter S, Rattay T, Skillman J, Williamson P, Curnier A, Tadros A, Depasquale I, Masannat YA, Smyth E, Fuller M, Bourne R, Heys S, Hamo I, Aloraifi F, Fopp L, Bali R, Bache S, Benyon SL, Irwin MS, Agrawal A, Malata CM, Murphy C, Misky A, Chicken DW, Abdullah N, Hill ADK, Cullinane C, Irwin G, McIntosh SA, Refsum S, Sloan S, Mallon P, Sirianni C, Khattak I, Sirianni C, Nagachandra G, Kiruparan P, Debanth D, Davey S, Curran TA, Svenning M, Govindarajulu S, Rayter Z, Ainsworth R, Cawthorn S, Sahu A, Wilson S, Prousskaia E, Accurso A, Rocco N, Micco RD, Accurso A, Limite G, Ceccarino R, Liccardo R, Coco G, Nizamoglu M, Morgan M, Ramakrishnan V, Catanuto G, Wilkins A, McManus P, Kneeshaw P, Grover K, Mahapatra T, Wooler B, Elahi B, Ihsan N, Bucknor A, Reissis D, Hunter J, Wood S, Jallali N, Henry FP, Verjee LS, Lee J, Khan SM, Azmy I, Massey J, Hollywood C, Oluwajana M, Bathla S, Seward J, Harding-MacKean C, Lane R, Murali K, Biswas B, Trapszo P, Seetharam S, Kennedy K, Alder L, Graja T, Amin K, Kokan J, Roshanlall C, Gill E, Kulkarni D, Dixon JM, Young O, Saleem T, Biddle M, Kearns M, Weiler-Mithoff E, Chew B, Malyon A, Scott J, McGill D, Mackay I, Bains S, Barrows S, Rattay T, Pilgrim S, Shokuhi S, Lambert K, Kenny F, Valassiadou K, Kaushik M, Krupa J, Dragoumis D, Ain Q, Lampropoulos P, Moss S, Khalil H, Haq A, Balasubramanian B, Charalampoudis P, Hamed H, Kothari A, Kovacs T, Douek M, Mehmood I, Ray B, Adelekan M, Humphreys L, Tayeh S, Choy C, Parvanta L, Michieletto S, Saibene T, O'Brien J, Down S, Downey S, Pereira J, Sami AS, Gvaramadze A, Jibril JA, Thekkinkattil D, Udayasankar S, Khawaja S, Shariaha Y, Holt S, James R, Rizki H, Kirkpatrick K, Ravichandran D, Shrestha D, Barua E, Akolekar D, Hamad A, Kleidi E, Hignett S, Pope V, Naseem S, Isherwood J, Soulsby R, Taylor A, Chin K, Nguyen D, Guest F, Thorne A, Lefemine V, Kirchhoff C, Murphy DC, Lo M, Harcourt R, Pain SJ, Hussien MI, Zechmeister K, Sassoon EM, Figus A, Haywood RM, Ali R, Alexander S, Harnett A, Geropantas K, Epurescu D, Lewis R, Fafemi O, Gahir J, Gandamihardja T, Kelsall J, Muhibullah N, Otieno C, Mazari F, Dauria M, Whisker L, Macmillan D, Gutteridge E, Rasheed T, Khout H, Asgeirsson K, McCulley S, Mariniello MD, Roncella M, Ghilli M, Colizzi L, Rossetti E, Marzia LR, Fustaino L, Li AQ, Harvey KL, Windle R, Remoundos DD, Roy P, MacLean G, Adwani A, Popa E, Goh S, Shetty G, Clark S, Bernaudo L, Agrawal A, Mansfield L, Tebbal S, Patel A, Grassi V, Pujji O, Hamnett K, Basu N, Granger E, Durbar M, Pikoulas P, Garnsey C, Walker P, Vollermere AJ, Michalakis I, Jones R, Youssef M, Ives C, Masood M, Dunn J, Olsen S, Ferguson D, Tillett R, Allan A, Woollard A, Canny R, Woollard A, Mosahebi A, Hamilton S, Ghali S, Marsh D, Chana J, Sojitra N, Younis I, Rainsbury D, Chand N, Kalles V, Stebbing A, Harris K, Laws S, Holcombe C, Tansley A, Mitchell G, de Sousa E, Henderson J, Chandrashekar M, Pereira B, Constantinou C, Elfadl D, Irakleidis F, Hernan I, Byrne M, To N, O'Connell R, Rusby J, Barry P, Krupa K, Allum W, MacNeill F, Roche N, Gui G, Ramsey K, Harris P, James S, Power K, Potter S, Sutton R, McIntosh J, Laurence N, MacLennan L, Milligan R, Cain H, Critchley A, O'Donoghue J, Kalra L, Collis N, Weston-Petrides G, Fiddes R, Brown V, Aertssen A, Slade-Sharman D, Khan M, McGuiness C, Amorosi V, di Pompeo Fabio S, Exarchos G, Jiwa N, Hu J, Ledwidge S, Johnson L, Peel A, Dhooma N, Farrell E, Devane L, Tevlin R, McDermott E, Prichard R, Evoy D, Rothwell J, Geraghty J, Morrison C, Lawlor C, Langlands F, Taylor L, Turton P, Achuthan R, Horgan K, Mckenzie S, Hogan B, Lansdown M, Navin C, Sherwin L, Mortimer C, Garg N, Adam R, Arif T, Kryjak Z, Ali D, Sowdi R, Fage E, Mylvaganam S, Matey P, Vidya R, Sircar T, Asaad O, Bhaskar P, Dordea M, Chrysafi A, McCartan D, Dave R, Foster R, Wilson R, Okwemba S, Majeed Y, O'Brien C, Mathen V, Murphy J, Barnes N, Gandhi A, Harvey J, Kirwan CC, Johnson R, Patel K, Ribas MD, Vigneswaran N, Challoner T, Skillman J, Park A, Rizkalla M, Tomlins A, McEvoy K, Jafferbhoy S, Soumian S, Narayanan S, Kirby R, Bajrusevic S, Maalo J, Charalambous M, Lai LM, Chong K, Thomson S, Monib S, Chagla L, Audisio R, Taghizadeh R, Iqbal A, James K, Callaghan M, Poonawala S, Lund J, Vinayagam R, Jafferbhoy S, Thrush S, Thomas RB, Mullan M, Taylor J, Yoshimura R, Mathew T, Jones BM, Munot K, Nasr R, Piper J, El-Sharief D, Mustafa M.

Author information

1
Department of Breast Surgery, The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, SM2 5PT, UK.
2
Department of Cancer Studies, Clinical Sciences Building, University of Leicester, Leicester, LE2 2LX, UK.
3
Nightingale Breast Unit, Manchester University NHS Foundation Trust, Southmoor Road, Manchester, M23 9LT, UK.
4
Population Health Sciences, Bristol Medical School, 39 Whatley Road, Clifton, Bristol, BS8 2PS, UK.
5
Department of Plastic Surgery, University Hospitals Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry, CV2 2DX, UK.
6
Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Nuffield Orthopaedic Centre, Windmill Road, Headington, Oxford, OX3 7HE, UK.
7
Department of Surgery and Cancer, Imperial College London, London, UK.
8
Norfolk and Norwich Hospital, Norwich, UK.
9
Population Health Sciences, Bristol Medical School, 39 Whatley Road, Clifton, Bristol, BS8 2PS, UK. shelley.potter@bristol.ac.uk.
10
Bristol Breast Care Centre, North Bristol NHS Trust, Southmead Road, Bristol, BS10 5NB, UK. shelley.potter@bristol.ac.uk.
11
Linda McCartney Centre, Royal Liverpool and Broadgreen University Hospital, Prescot Street, Liverpool, L7 8XP, UK.

Abstract

BACKGROUND:

Immediate breast reconstruction (IBR) is routinely offered to improve quality-of-life for women requiring mastectomy, but there are concerns that more complex surgery may delay adjuvant oncological treatments and compromise long-term outcomes. High-quality evidence is lacking. The iBRA-2 study aimed to investigate the impact of IBR on time to adjuvant therapy.

METHODS:

Consecutive women undergoing mastectomy ± IBR for breast cancer July-December, 2016 were included. Patient demographics, operative, oncological and complication data were collected. Time from last definitive cancer surgery to first adjuvant treatment for patients undergoing mastectomy ± IBR were compared and risk factors associated with delays explored.

RESULTS:

A total of 2540 patients were recruited from 76 centres; 1008 (39.7%) underwent IBR (implant-only [n = 675, 26.6%]; pedicled flaps [n = 105,4.1%] and free-flaps [n = 228, 8.9%]). Complications requiring re-admission or re-operation were significantly more common in patients undergoing IBR than those receiving mastectomy. Adjuvant chemotherapy or radiotherapy was required by 1235 (48.6%) patients. No clinically significant differences were seen in time to adjuvant therapy between patient groups but major complications irrespective of surgery received were significantly associated with treatment delays.

CONCLUSIONS:

IBR does not result in clinically significant delays to adjuvant therapy, but post-operative complications are associated with treatment delays. Strategies to minimise complications, including careful patient selection, are required to improve outcomes for patients.

PMID:
30923359
PMCID:
PMC6734656
[Available on 2020-03-29]
DOI:
10.1038/s41416-019-0438-1

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