Limits...
Pre-operative thrombotic complications of neoadjuvant chemotherapy for breast cancer: Implications for immediate breast reconstruction.

Richards K, Forouhi P, Johnston A, Malata CM - Ann Med Surg (Lond) (2014)

Bottom Line: All patients received chemotherapy via central venous access and went on to present with local symptomatic thrombosis.There is significant variation in the anticoagulation management in this patient group.Identification of optimal anticoagulant regimes and the possibilities for prophylaxis may prove key in informing surgeons when planning the reconstructive process.

View Article: PubMed Central - PubMed

Affiliation: Clinical School of Medicine, Cambridge University, UK.

ABSTRACT

Unlabelled: Thrombotic complications arising during the treatment of breast cancer can impact the breast reconstruction pathway. We set out to review the details of cases of thromboembolism occurring during neoadjuvant chemotherapy and peri-operatively to study the impact of the event and its management on subsequent breast reconstruction.

Methods: We retrospectively reviewed the medical records of seven patients who had experienced a thrombotic event during their treatment of breast cancer between 2008 and 2012, who then proceeded to breast reconstruction. We recorded size and grade of tumour, neoadjuvant chemotherapeutic regimen, details of port insertion, planned reconstruction, thrombotic event and its management and the surgery performed and outcome.

Results: All patients received chemotherapy via central venous access and went on to present with local symptomatic thrombosis. They were managed with anticoagulant regimens at the time of mastectomy and reconstruction, which were unique for each patient. The results revealed delays to surgery and modifications to planned reconstruction.

Discussion: The majority of patients developing thrombotic complications go on to achieve successful reconstruction. There is significant variation in the anticoagulation management in this patient group. Identification of optimal anticoagulant regimes and the possibilities for prophylaxis may prove key in informing surgeons when planning the reconstructive process.

Conclusion: An awareness of the effects of thrombotic events in this patient group is important in terms of developing an understanding of its impact on the performance of reconstruction, on the management of anticoagulation peri-operatively and on monitoring for post-operative complications.

No MeSH data available.


Related in: MedlinePlus

Doppler ultrasound image demonstrating subclavian vein thrombosis.
© Copyright Policy - CC BY-NC-ND
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4372642&req=5

fig1: Doppler ultrasound image demonstrating subclavian vein thrombosis.

Mentions: The patient in case B is a 38 year old lady who presented with a grade II ER and HER2 receptor positive tumour of her left breast. She was initially managed with FEC/T primary chemotherapy through a tunnelled subclavian line. The original surgical intent was local excision with sentinel node biopsy. However, it was unfortunately decided she then required a mastectomy with axillary lymph node dissection and DIEP free flap reconstruction was planned. She developed an occlusive thrombosis of her right subclavian vein (Fig. 1), which was managed therapeutically with fondaparinux. The surgery was delayed by three months. During this time the patient received zoladex and letrozole, in addition to pre-operatively radiotherapy. The therapeutic fondaparinux was omitted one day prior to surgery. Prophylactic dose enoxaparin was given 6 h post-operatively and nocte for two further days. Treatment fondaparinux was recommenced on day three. The reconstruction was achieved as planned.


Pre-operative thrombotic complications of neoadjuvant chemotherapy for breast cancer: Implications for immediate breast reconstruction.

Richards K, Forouhi P, Johnston A, Malata CM - Ann Med Surg (Lond) (2014)

Doppler ultrasound image demonstrating subclavian vein thrombosis.
© Copyright Policy - CC BY-NC-ND
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4372642&req=5

fig1: Doppler ultrasound image demonstrating subclavian vein thrombosis.
Mentions: The patient in case B is a 38 year old lady who presented with a grade II ER and HER2 receptor positive tumour of her left breast. She was initially managed with FEC/T primary chemotherapy through a tunnelled subclavian line. The original surgical intent was local excision with sentinel node biopsy. However, it was unfortunately decided she then required a mastectomy with axillary lymph node dissection and DIEP free flap reconstruction was planned. She developed an occlusive thrombosis of her right subclavian vein (Fig. 1), which was managed therapeutically with fondaparinux. The surgery was delayed by three months. During this time the patient received zoladex and letrozole, in addition to pre-operatively radiotherapy. The therapeutic fondaparinux was omitted one day prior to surgery. Prophylactic dose enoxaparin was given 6 h post-operatively and nocte for two further days. Treatment fondaparinux was recommenced on day three. The reconstruction was achieved as planned.

Bottom Line: All patients received chemotherapy via central venous access and went on to present with local symptomatic thrombosis.There is significant variation in the anticoagulation management in this patient group.Identification of optimal anticoagulant regimes and the possibilities for prophylaxis may prove key in informing surgeons when planning the reconstructive process.

View Article: PubMed Central - PubMed

Affiliation: Clinical School of Medicine, Cambridge University, UK.

ABSTRACT

Unlabelled: Thrombotic complications arising during the treatment of breast cancer can impact the breast reconstruction pathway. We set out to review the details of cases of thromboembolism occurring during neoadjuvant chemotherapy and peri-operatively to study the impact of the event and its management on subsequent breast reconstruction.

Methods: We retrospectively reviewed the medical records of seven patients who had experienced a thrombotic event during their treatment of breast cancer between 2008 and 2012, who then proceeded to breast reconstruction. We recorded size and grade of tumour, neoadjuvant chemotherapeutic regimen, details of port insertion, planned reconstruction, thrombotic event and its management and the surgery performed and outcome.

Results: All patients received chemotherapy via central venous access and went on to present with local symptomatic thrombosis. They were managed with anticoagulant regimens at the time of mastectomy and reconstruction, which were unique for each patient. The results revealed delays to surgery and modifications to planned reconstruction.

Discussion: The majority of patients developing thrombotic complications go on to achieve successful reconstruction. There is significant variation in the anticoagulation management in this patient group. Identification of optimal anticoagulant regimes and the possibilities for prophylaxis may prove key in informing surgeons when planning the reconstructive process.

Conclusion: An awareness of the effects of thrombotic events in this patient group is important in terms of developing an understanding of its impact on the performance of reconstruction, on the management of anticoagulation peri-operatively and on monitoring for post-operative complications.

No MeSH data available.


Related in: MedlinePlus