In a recent study titled “Pre-operative thrombotic complications of neoadjuvant chemotherapy for breast cancer: Implications for immediate breast reconstruction”, published in the Annals of Medicine and Surgery, a team of researchers led by Professor Charles M. Malata, Consultant Plastic & Reconstructive Surgeon at the Cambridge Breast Unit and Professor of Academic Plastic Surgery at the Postgraduate Medical Institute of Anglia Ruskin University, reviewed the cases of thromboembolism that can occur during neoadjuvant chemotherapy and can delay or modify breast reconstruction plans.
There is an increased used of neoadjuvant, primary or upfront chemotherapy in the treatment of bigger operable of locally advanced breast cancers. However, pre-operative thromboembolic occurrences can have a major impact on post-chemotherapy surgery, especially in cases where breast cancer reconstruction is foreseen.
“There is limited research on the impact of this complication on breast reconstruction pathways and guidance for optimal management of these patients. My colleagues and I present our clinical experience over four years of patients with breast cancer who developed thrombotic complications of their neoadjuvant chemotherapy venous lines prior to mastectomy and immediate breast reconstruction,” the authors note in their study.
The team preformed a retrospective cohort study of seven patients, between 2008 and 2012, who suffered from pre-operative line thrombosis. Patient age, tumor size and grade, receptor status and chemotherapy regime were registered, allowing the team to analyze the key elements of thromboembolic events and its consequences for reconstruction.
The results showed that in 1 patient, management of thrombosis delayed surgery for 3 weeks, and resulted in 2 additional surgeries to efficiently complete breast reconstruction. In another patient, even though reconstruction was considered normal, there was a 3-month delay and an additional anticoagulation therapy, along with pre-operative radiation therapy.
“As these cases demonstrate, line-associated thrombosis will be increasingly encountered by surgeons as more patients receive neoadjuvant chemotherapy and are managed by indwelling venous access devices. With multidisciplinary cooperation among surgeons, oncologists, and hematologists, the surgical management plan for these patients can remain largely unaffected.” the authors state. “Reconstructive surgeons should, however, be flexible enough to alter their surgical plan in patients who develop line-related thrombosis”, they conclude.