Br J Surg. 2016 Feb 29. doi:
10.1002/bjs.10102. [Epub ahead of print]
Winters Z E, et al
BACKGROUND: The aim of this study was to estimate the impact
2 and 3 years after surgery of implant-assisted latissimus dorsi (LDI) and
autologous latissimus dorsi (ALD) flap breast reconstructions on
patient-reported outcomes (PROs), and, secondarily, to determine whether
baseline characteristics can predict PROs.
METHODS: This was a multicentre prospective cohort study. The
European Organization for Research and Treatment of Cancer (EORTC) Quality of
Life Core Questionnaire (QLQ-C30) and breast cancer module (QLQ-BR23),
Functional Assessment of Cancer Therapy - Breast (FACT-B), and Hospital Anxiety
and Depression Scale (HADS) PROs were completed before surgery and at 2 and
3 years after breast reconstruction. The effects of LDI and ALD, adjusted for
baseline clinicodemographic characteristics, were estimated with multiple
linear regressions. Effect sizes above 0·5 were considered clinically
important.
RESULTS: Some 206 patients (LDI 93, ALD 113) were recruited
in 2007-2013; 66·5 per cent were node-negative and 34·6 per cent received radiotherapy.
Women with adverse clinicopathological factors were more likely to have
received radiotherapy and to undergo ALD. Patients in both surgical groups
showed clinically important effects at 2 and 3 years, including improvements in
emotional scales, but worse physical functioning, social well-being, body image
and anxiety. Radiotherapy adversely affected social functioning at 2 years
(P = 0·002). Women undergoing ALD reconstruction had significantly improved
sexual functioning at 3 years (P = 0·003) relative to those who had LDI
procedures, even after adjusting for case mix (P = 0·007). At 3 years, younger
women experienced worse physical well-being than older women (P = 0·006), and
chemotherapy was associated with worse arm symptoms (P = 0·005).
CONCLUSION: Clinically important changes occurred in physical
functioning, breast symptoms, body image and psychological distress. These
results will guide selections of key PRO domains and sample-size calculation of
future studies.