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Postoperative complications after breast cancer surgery and effect on recurrence and survival: population-based cohort study
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Endocrine Surgery. Department of Surgery, South General Hospital, Stockholm, Sweden.ORCID iD: 0000-0002-0880-2468
Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Breast-, Endocrine Tumors and Sarcoma, Karolinska Comprehensive Cancer Center, Karolinska University Hospital , Stockholm , Sweden.
Department of Surgery, South General Hospital, Stockholm, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery.
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2024 (English)In: BJS Open, E-ISSN 2474-9842, Vol. 8, no 6, article id zrae137Article in journal (Refereed) Published
Abstract [en]

Background

There is conflicting evidence regarding whether postoperative complications after breast cancer surgery are associated with worse oncological outcome. This study aimed to assess the risk of systemic breast cancer recurrence after surgical site infection and also the impact of surgical site infection on locoregional recurrence, breast cancer-specific survival and overall survival.

Methods

This nationwide cohort study included patients who underwent surgery for primary breast cancer in Sweden between January 2008 and September 2019. The study cohort was identified in the Breast Cancer Database Sweden 3.0, a database linking the National Breast Cancer Quality Register to national population-based healthcare registers held by the National Board of Health and Welfare and Statistics Sweden. The primary exposure was surgical site infection within 90 days from surgery, and the primary outcome was systemic recurrence of breast cancer. Secondary outcomes included locoregional recurrence, overall survival and breast cancer-specific survival. Multivariable Cox regression analysis was performed to assess the association between exposure, predictors and outcomes.

Results

Of 82 102 patients included in the study, 15.7% experienced a surgical site infection within 90 days of surgery. Surgical site infection was not significantly associated with systemic recurrence, locoregional recurrence or breast cancer-specific survival after adjustment for confounding variables. Surgical site infection was significantly associated with worse overall survival, but the significant association disappeared in a sensitivity analysis excluding all patients with any kind of malignancy before breast cancer diagnosis.

Conclusion

Surgical site infection after breast cancer surgery does not significantly increase the risk of systemic recurrence. All possible actions should nevertheless be taken to reduce complication rates.

Place, publisher, year, edition, pages
Oxford University Press, 2024. Vol. 8, no 6, article id zrae137
National Category
Surgery Cancer and Oncology
Identifiers
URN: urn:nbn:se:uu:diva-544006DOI: 10.1093/bjsopen/zrae137ISI: 001377215100001PubMedID: 39673757Scopus ID: 2-s2.0-85212571234OAI: oai:DiVA.org:uu-544006DiVA, id: diva2:1916581
Funder
Percy Falks stiftelse för forskning beträffande prostatacancer och bröstcancerAvailable from: 2024-11-27 Created: 2024-11-27 Last updated: 2025-01-09Bibliographically approved
In thesis
1. Complications after Breast Cancer Surgery and Oncological Outcomes
Open this publication in new window or tab >>Complications after Breast Cancer Surgery and Oncological Outcomes
2025 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Breast cancer is the most common cancer worldwide for females. A frequent complication following breast cancer surgery is surgical site infection (SSI). Complications can result in diminished quality of life, increased morbidity, elevated healthcare costs, delayed initiation of adjuvant therapy, loss of reconstruction, and potentially adverse oncological outcomes. In Paper I, the primary objective was to investigate the purported association between SSI and breast cancer recurrence. In addition, the study aimed to explore a potential link between any postoperative infection and breast cancer recurrence. This population-based, retrospective cohort study found that neither SSI nor other postoperative infections were associated with worse oncologic outcomes. Paper II investigated risk factors for SSI following breast cancer surgery, as well as risk factors for other wound complications. This research was conducted through a prospectively registered cohort study. Multivariable analysis identified BMI 25-30 and BMI >30 as the only significant risk factors for SSI. Additionally, significant risk factors for any wound complication included mastectomy with or without reconstruction, as well as BMI 25-30 and BMI >30. In Paper III, the primary aim was to evaluate whether SSI increases the risk of systemic breast cancer recurrence. Secondary objectives included assessing the impact of SSI on the risk of locoregional recurrence (LRR), breast cancer-specific survival (BCSS), and overall survival (OS). This analysis utilized high-quality data from national population-based registers, checking for confounding variables such as patient and tumour characteristics. In conclusion, SSI following breast cancer surgery does not significantly increase the risk of systemic recurrence, LRR, overall death, or breast cancer-specific death. Paper IV evaluated the risk of systemic breast cancer recurrence following major systemic postoperative infection or other major event. It also assessed the impact of these exposures on LRR, OS, and BCSS. Utilizing the same cohort as in Paper III, the findings indicated that postoperative major systemic infection was associated with an increased risk of systemic recurrence, overall death and breast cancer-specific death, but not with LRR.

In conclusion, this thesis does not support the hypothesis that SSI is associated with poorer oncological outcomes. However, it demonstrates an association between major systemic infections and worse oncological outcomes.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2025. p. 99
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 2113
Keywords
Breast cancer surgery, postoperative complications, surgical site infection, systemic infection, postoperative major event, risk factors, recurrence, survival, population-based
National Category
Surgery
Research subject
Medical Science
Identifiers
urn:nbn:se:uu:diva-544007 (URN)978-91-513-2336-7 (ISBN)
Public defence
2025-02-07, H:son Holmdahlsalen, Akademiska sjukhuset, ing 100, våning 1, Dag Hammarskjölds Väg 8, Uppsala, 09:00 (Swedish)
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Supervisors
Available from: 2025-01-17 Created: 2024-12-09 Last updated: 2025-01-17

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Adwall, LindaMani, MariaNorlén, Olov

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