Microsurgery on Steroids: The Impact of Chronic Immunosuppressive Therapy on Outcomes Following Free Flap Breast Reconstruction

IF 2.7 3区医学 Q2 ONCOLOGY

Clinical breast cancer Pub Date : 2026-04-01 Epub Date: 2026-01-30 DOI:10.1016/j.clbc.2026.01.014

Samuel A. Knoedler , Thomas Schaschinger , Tobias Niederegger , Leonard Knoedler , Omar Allam , Felix Klimitz , Joanna Kempa-Timler , Karen Lynn Zhao , Stefano Pompei , Barbara Kern , Henriette Grundig , Giuseppe Sofo , Francesco Mazzarone , Fortunay Diatta , Martin Kauke-Navarro

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引用次数: 0

Abstract

Background

Free flap breast reconstruction (FFBR) is a well-established technique for postmastectomy rehabilitation. However, chronic immunosuppressive therapy may compromise wound healing, increase infection susceptibility, and adversely affect surgical results. However, evidence regarding the impact of chronic immunosuppression on FFBR outcomes remains sparse.

Methods

We analyzed the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database (2013-2023), identifying female breast cancer patients who underwent immediate FFBR. Chronic immunosuppression was defined as continuous systemic administration of corticosteroids or other immunosuppressants for ≥ 30 days preoperatively. Multivariable logistic regression and propensity score matching were applied to assess the impact of immunosuppression on surgical outcomes.

Results

Of 5473 patients (mean age 52 ± 9.4 years; mean BMI 30 ± 5.6 kg/m²), 139 (2.5%) were chronically immunosuppressed. In confounder-adjusted multivariable analysis, chronic immunosuppression was independently associated with an increased risk of any complication (OR 1.5; 95% CI, 1.0-2.2; P = .048) and surgical complications (OR 2.0; 95% CI, 1.3-3.0; P = .0011), particularly postoperative bleeding (23% vs. 10%; P < .001). No significant associations were observed with medical complications (P = .73), reoperations (P = .11), or readmissions (P = .45). Propensity score matching validated these correlations, revealing elevated odds of any complications (OR 1.7; P = .044) and surgical complications (OR 2.4; P = .0026) in chronically immunosuppressed patients.

Conclusion

Chronic immunosuppression doubles the risk of surgical complications following FFBR, with postoperative bleeding representing the predominant concern. These findings mandate enhanced perioperative surveillance and bleeding prevention protocols for immunosuppressed patients while supporting the continued feasibility of FFBR in this population when appropriate precautions are implemented.

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类固醇显微外科：慢性免疫抑制治疗对游离皮瓣乳房重建后预后的影响。

背景：游离皮瓣乳房重建（FFBR）是一种成熟的乳房切除术后康复技术。然而，慢性免疫抑制治疗可能会损害伤口愈合，增加感染易感性，并对手术结果产生不利影响。然而，关于慢性免疫抑制对FFBR结果影响的证据仍然很少。方法：我们分析了美国外科医师学会国家手术质量改进计划（ACS-NSQIP）数据库（2013-2023），确定了立即接受FFBR的女性乳腺癌患者。慢性免疫抑制被定义为术前连续全身使用皮质类固醇或其他免疫抑制剂≥30天。应用多变量logistic回归和倾向评分匹配来评估免疫抑制对手术结果的影响。结果：5473例患者（平均年龄52±9.4岁，平均BMI 30±5.6 kg/m²）中，139例（2.5%）为慢性免疫抑制。在混杂因素调整后的多变量分析中，慢性免疫抑制与任何并发症（OR 1.5; 95% CI, 1.0-2.2; P = 0.048）和手术并发症（OR 2.0; 95% CI, 1.3-3.0; P = 0.0011）的风险增加独立相关，特别是术后出血（23%对10%，P < 0.001）。与医学并发症（P = 0.73）、再手术（P = 0.11）或再入院（P = 0.45）无显著相关性。倾向评分匹配验证了这些相关性，显示慢性免疫抑制患者出现任何并发症（OR 1.7, P = 0.044）和手术并发症（OR 2.4, P = 0.0026）的几率升高。结论：慢性免疫抑制使FFBR术后并发症的风险增加一倍，术后出血是主要的关注点。这些发现要求加强免疫抑制患者的围手术期监测和出血预防方案，同时支持在实施适当预防措施的情况下，FFBR在该人群中的持续可行性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical breast cancer 医学-肿瘤学

CiteScore

5.40

自引率

3.20%

发文量

174

审稿时长

48 days

期刊介绍： Clinical Breast Cancer is a peer-reviewed bimonthly journal that publishes original articles describing various aspects of clinical and translational research of breast cancer. Clinical Breast Cancer is devoted to articles on detection, diagnosis, prevention, and treatment of breast cancer. The main emphasis is on recent scientific developments in all areas related to breast cancer. Specific areas of interest include clinical research reports from various therapeutic modalities, cancer genetics, drug sensitivity and resistance, novel imaging, tumor genomics, biomarkers, and chemoprevention strategies.