Breast Reconstruction Statistical Evaluation - Research Paper Example

Research paper: Breast Reconstruction Statistical Evaluation Supervisor Section Study and background The article brings to light breast cancer treatment as being multidisciplinary. There are new challenges facing surgeons and patients regarding frequent offers of both radiotherapy and an immediate breast reconstruction after mastectomy. With chest wall irradiations, breast cancer-related mortality and locoregional recurrence in women with high risks for recurrence after mastectomy, have greatly decreased. It is also evident that most women who undergo mastectomy would desire to have an immediate breast reconstruction procedure (Durkan et al., 2012). The objective of the article is to bring out a comparison between the outcomes of immediate latissimus dorsi mycocutaneous flap, also known as Lat Flap, to tissue/expander implant, EI, reconstruction after mastectomy followed by Post Mastectomy Radiation Therapy (PMRT). It is also noted that PMRT, however, has an effect of increasing surgical complication risks and may cause adverse effects on the reconstructed breast. The sample size of the study is 29, women with invasive breast cancer who were treated between 2009 and 2011 in the same institution. There was a median follow-up of 11 and 13 months for Lat Flap and EI respectively, after completion of post mastectomy radiation therapy, which showed a trend of wound complications that required reoperation that included expander/implant los in the EI group (Durkan et al., 2012). Through the comparison, capsular contracture turned out to be the most sequel of PMRT in the group of Lat Flap with 67%. It was, however, treated with capsulotomy during the time of nipple-areola reconstruction. The comparison ultimately suggests immediate breast reconstruction with a latissimus dorsi mycocutaneous flap to be a workable option for women undergoing mastectomy and are likely to require chest wall irradiation. The research design encompassed the procedures employed and methodology while conducting the research. A review was conducted with approval by the concerned Institutional Review Board, and on approval the team conducted a retrospective review to identify patients with invasive breast cancer and treated with mastectomy and immediate breast reconstruction that was followed by post mastectomy radiation therapy between February 23, 2009, and June 24, 2011. The team then did an analysis of the medical charts with respect to various variable including; unilateral or bilateral mastectomy, tumor size and characteristics, age of the patient, lymph node involvement, BRCA mutadon status, radiation therapy, chemotherapy use, type of reconstructive surgery performed, completion of reconstruction, total number of operations, length of follow-up, need for revision after final reconstruction, and complications including capsular contracture, wound infection, and implant loss (Durkan et al 2012). The methods of reconstruction employed at the institution were based on patients’ preferences and surgeon discretion. There was no precise protocol referring patients to a particular reconstruction type. There was an x2 test of proportions which was employed for the evaluation of associations for noncontinuous data, while continuous variables were reported as median values and an analysis made using Student’s unpaired t test. A P value of < 0.05 was considered significant. In the view of the article, the question to be answered is brought out as a demonstration of wound complication rate differences between Lat Flap and EI reconstructions in the setting of post mastectomy radiation therapy. The study population is selected after a careful review, data is obtained, analyzed, interpreted and eventually a conclusion was drawn. Section 2 Statistical methods The team upon approval collected data from radiation oncology database with the aim of interpreting and doing an analysis that would lead to the arrival at a conclusion of comparing the outcomes of immediate latissimus dorsi mycocutaneous flap, also known as Lat Flap, to tissue/expander implant, EI, reconstruction after mastectomy followed by Post Mastectomy Radiation Therapy (PMRT) as stated earlier. They employed continuous and non continuous variables. X2 test of proportions was used to evaluate associations for noncontinuous data and continuous variables reported as median values. The team using the obtained data from the institution looked out for patients who had undergone mastectomy in the radiation oncology database and identified those who had undergone both mastectomy and immediate breast reconstruction before radiation therapy between February 23, 2009, and June 14, 2011. The number of patients who underwent reconstruction with tissue expanders followed by implant exchange, IE, or immediate implant placement was twenty. Those who underwent reconstruction with latissimus dorsi mycocutaneous flaps, Lat Flaps, with tissue expanders or implants were nine (Durkan et al., 2012). The team used tables to record the patients’ data which were the characteristics for the Lat Flap group median number percentage, the EI group number median percentage, and the P value. Among the patients’ characteristic were mastectomy side, skin sparing, age of the patient, body mass index (BMI), length of follow-up in months, recent smoking history, whether diabetic or not, BRCA status, tumor stage, nodal stage, invasive tumor margin, receptor status, chemotherapy, nipple sparing. Tabulated data also presented the outcomes of the radiation therapy after mastectomy and immediate breast reconstruction by the reconstruction type. The table contained the total number of operations for each patient, the radiation type at the time of radiation, capsular contracture, expander/implant loss, completed reconstruction, the total minor wound complication, seroma, skin necrosis, and cellulitis (Durkan et al., 2012). Variables such as cormobid conditions that is, diabetes mellitus, obesity, and cigarette smoking showed the two groups to be similar with respect to the characteristics. They increased the risk for wound complications and with respect to hormonal therapy and chemotherapy. The two main analyses that are normally employed in statistical analysis would be descriptive and inferential. In this case, the statistics appear as though they are more of non-parametric than parametric. The presented statistical tests on the parameters that the team carried out were not made on assumptions. The parameters ought not to have been assumed since the patients’ characteristics that formed these parameters were data that were recorded and obtained from the data base. No assumptions on the sample population or these parameters were made. The analysis of statistics also appeared to be of a descriptive nature since the data sets were in measures that are quantitative, in percentage forms that are tabulated. The tables present percentage and median values. Section 3 Evaluation of statistics used The sample size that was employed by the team was 29 women with invasive breast cancer who were treated between 2009 and 2011 in the same institution (Durkan et al., 2012). The sample size appears small and limited. This might have had effects of compromising the accuracy of the outcomes of the two methods of breast reconstruction. A larger sample size than the one that was obtained might have had increased levels of accuracy of the outcomes of the study. The variables used in the article shows a record including an invasive tumor margin of less than 2milimetres and up to 3 nodal stages (Durkan et al., 2012). Tumors of less than 5centimetres margin with less than four positive lymph nodes would be more inclusive than the former, although it would bring about challenges of prediction of the patients requiring. This would require analysis pathologically of the mastectomy specimen and the completion of axillary tissue so as to enable the prediction of the patients that require post mastectomy radiation therapy since patient-driven demand for immediate rather than delayed breast reconstruction appears to be on the rise, which could be jeopardized by radiation. It is also worth noting that there is no consensus about the optimal timing and reconstructive strategy for patients who are undergoing mastectomy and require radiotherapy that is postoperative. The study, however, showed Lat Flap and EI reconstructions to having comparable minor wound complication rates in the setting of post mastectomy radiation therapy. Lat Flap reconstruction reportedly had a tendency toward having less potential for expander/implant loss than EI reconstruction. Reference Durkan, B., Amersi, F., Phillips, E. H., Sherman, R., & Dang, C. M. (2012). Postmastectomy radiation of latissimus dorsi myocutaneous flap reconstruction is well tolerated in women with breast cancer. The American Surgeon, 78 (10): 1122-7. Read More