TY - JOUR
T1 - Complications and thromboembolic events associated with tamoxifen therapy in patients with breast cancer undergoing microvascular breast reconstruction
T2 - a systematic review and meta-analysis
AU - Parikh, Rajiv P.
AU - Odom, Elizabeth B.
AU - Yu, Liyang
AU - Colditz, Graham A.
AU - Myckatyn, Terence M.
N1 - Funding Information:
RPP and EBO are supported by a National Institutes of Health (NIH) Ruth L. Kirschstein National Research Service Award Institutional Research Training Grant (T32CA190194, PI Colditz). No funding was provided directly for this study. The content is solely the responsibility of the authors and does not necessarily represent the official view of the NIH.
Publisher Copyright:
© 2017, Springer Science+Business Media New York.
PY - 2017/5/1
Y1 - 2017/5/1
N2 - Purpose: Tamoxifen therapy is integral in the treatment of patients with hormone receptor-positive breast cancer. However, there is an association between tamoxifen and thromboembolic events. Flap and systemic thromboembolic events have devastating consequences in microvascular breast reconstruction. Currently, there are conflicting data on the association between tamoxifen therapy and thromboembolic complications for patients undergoing microvascular breast reconstruction. The objective of this study is to determine if perioperative tamoxifen therapy modifies the risk of complications and thromboembolic events for patients with breast cancer undergoing microvascular breast reconstruction. Methods: A comprehensive literature search was performed across six databases from January 2003 to February 2016. Pooled estimates and relative risk (RR) were calculated using a random-effects model, confounding was examined with meta-regression, and risk of bias was evaluated. Primary outcomes were thrombotic flap complications and total flap loss. Study quality was assessed using Downs and Black criteria. Results: Of 95 studies reviewed, 4 studies comprising 1700 patients and 2245 procedures were included for analysis. Compared to non-recipients, patients on tamoxifen were at increased risk of developing thrombotic flap complications (pooled RR 1.5; 95% CI 1.14–1.98) and total flap loss (pooled RR 3.35; 95% CI 0.95–11.91). There was no significant heterogeneity present in either outcome and no evidence of publication bias. Conclusions: Perioperative tamoxifen therapy may increase the risk of thrombotic flap complications and flap loss for patients with breast cancer undergoing microvascular reconstruction. These findings further the ability of providers to make evidence-based recommendations in the perioperative management of patients with breast cancer.
AB - Purpose: Tamoxifen therapy is integral in the treatment of patients with hormone receptor-positive breast cancer. However, there is an association between tamoxifen and thromboembolic events. Flap and systemic thromboembolic events have devastating consequences in microvascular breast reconstruction. Currently, there are conflicting data on the association between tamoxifen therapy and thromboembolic complications for patients undergoing microvascular breast reconstruction. The objective of this study is to determine if perioperative tamoxifen therapy modifies the risk of complications and thromboembolic events for patients with breast cancer undergoing microvascular breast reconstruction. Methods: A comprehensive literature search was performed across six databases from January 2003 to February 2016. Pooled estimates and relative risk (RR) were calculated using a random-effects model, confounding was examined with meta-regression, and risk of bias was evaluated. Primary outcomes were thrombotic flap complications and total flap loss. Study quality was assessed using Downs and Black criteria. Results: Of 95 studies reviewed, 4 studies comprising 1700 patients and 2245 procedures were included for analysis. Compared to non-recipients, patients on tamoxifen were at increased risk of developing thrombotic flap complications (pooled RR 1.5; 95% CI 1.14–1.98) and total flap loss (pooled RR 3.35; 95% CI 0.95–11.91). There was no significant heterogeneity present in either outcome and no evidence of publication bias. Conclusions: Perioperative tamoxifen therapy may increase the risk of thrombotic flap complications and flap loss for patients with breast cancer undergoing microvascular reconstruction. These findings further the ability of providers to make evidence-based recommendations in the perioperative management of patients with breast cancer.
KW - Breast cancer
KW - Breast reconstruction
KW - Selective estrogen receptor modulator
KW - Tamoxifen
KW - Thromboembolism
UR - http://www.scopus.com/inward/record.url?scp=85028236845&partnerID=8YFLogxK
U2 - 10.1007/s10549-017-4146-3
DO - 10.1007/s10549-017-4146-3
M3 - Review article
C2 - 28185144
AN - SCOPUS:85028236845
SN - 0167-6806
VL - 163
JO - Breast Cancer Research and Treatment
JF - Breast Cancer Research and Treatment
IS - 1
ER -