Abstract Background Postoperative complications may activate prometastatic systemic pathways through tissue damage, wound healing, infection, and inflammation. Postoperative complications are associated with inferior survival in several types of cancer. The aim was to determine the association between postoperative complications and survival in breast cancer. Methods This population-based cohort included women operated for T1–3 N0–3 M0 invasive breast cancer in Sweden from 2008 to 2017. Only major surgical postoperative complications leading to readmission and/or reoperation within 30 days were considered. Main outcomes were overall survival (OS) and breast cancer-specific survival (BCSS). Prospectively collected nationwide register data were used. Multivariable Cox models were adjusted for clinical and socioeconomic confounders and co-morbidity. Results Among 57 152 women, major surgical postoperative complications were registered for 1854 patients. Median follow-up was 6.22 (0.09–11.70) years. Overall, 9163 patients died, and 3472 died from breast cancer. Major surgical postoperative complications were more common after mastectomy with or without immediate reconstruction (7.3 and 4.3 per cent respectively) than after breast-conserving surgery (2.3 per cent). Unadjusted 5-year OS and BCSS rates were 82.6 (95 per cent c.i. 80.8 to 84.5) and 92.1 (90.8 to 93.5) per cent respectively for women with a major surgical postoperative complication, and 88.8 (88.6 to 89.1) and 95.0 (94.8 to 95.2) per cent for those without a complication (P < 0.001). After adjustment, all-cause and breast cancer mortality rates remained higher after a major surgical postoperative complication (OS: HR 1.32, 95 per cent c.i. 1.15 to 1.51; BCSS: HR 1.31, 1.04 to 1.65). After stratification for type of breast surgery, this association remained significant only for women who had mastectomy without reconstruction (OS: HR 1.41, 1.20 to 1.66; BCSS: HR 1.36, 1.03 to 1.79). Conclusion Major surgical postoperative complications are associated with inferior survival, especially after mastectomy. These results underline the importance of surgical de-escalation.

中文翻译：

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乳腺癌的主要手术术后并发症和生存率：瑞典针对 57 152 名女性进行的基于人群的登记研究

摘要 背景术后并发症可能会通过组织损伤、伤口愈合、感染和炎症激活促转移的全身途径。术后并发症与多种癌症的生存率较低有关。目的是确定乳腺癌术后并发症与生存之间的关联。 方法这个基于人群的队列包括 2008 年至 2017 年在瑞典接受 T1-3 N0-3 M0 浸润性乳腺癌手术的女性。仅考虑导致 30 天内再次入院和/或再次手术的重大手术术后并发症。主要结局是总生存期（OS）和乳腺癌特异性生存期（BCSS）。使用了前瞻性收集的全国登记数据。多变量 Cox 模型针对临床和社会经济混杂因素和共病进行了调整。 结果在 57 152 名女性中，有 1854 名患者登记了主要手术术后并发症。中位随访时间为 6.22 (0.09–11.70) 年。总体而言，共有 9163 名患者死亡，其中 3472 人死于乳腺癌。乳房切除术伴或不伴立即重建术后主要手术并发症（分别为 7.3% 和 4.3%）比保乳手术后（2.3%）更常见。对于有重大手术术后并发症的女性，未经调整的 5 年 OS 和 BCSS 率分别为 82.6（95% CI 80.8 至 84.5）和 92.1（90.8 至 93.5）%，以及 88.8（88.6 至 89.1）和 95.0（94.8 至 93.5）%。对于没有并发症的患者，这一比例为 95.2)% (P < 0.001)。调整后，重大手术术后并发症后的全因死亡率和乳腺癌死亡率仍然较高（OS：HR 1.32，95％ci 1.15至1.51；BCSS：HR 1.31，1.04至1.65）。对乳房手术类型进行分层后，这种相关性仅对于接受乳房切除术但未进行重建的女性仍然显着（OS：HR 1.41、1.20 至 1.66；BCSS：HR 1.36、1.03 至 1.79）。 结论主要的手术术后并发症与较差的生存率相关，尤其是在乳房切除术后。这些结果强调了手术降级的重要性。