Breast cancer survivors have increased rate of mesh exposure complications from tension-free vaginal tape surgery: Study
USA: A recent study published in Urogynecology reported a higher rate of mesh exposure complications from tension-free vaginal tape (TVT) surgery in women with breast cancer compared with women without cancer, particularly those taking antiestrogenic therapy.
Placement of tension-free vaginal tape is a surgery that can help control stress urinary incontinence. This is urine leakage that occurs during laughing, coughing, lifting things, sneezing, or exercising. The surgery helps close the urethra and bladder neck. The urethra is the tube that carries urine from the bladder to the outside.
No current data are investigating the relationship between mesh-exposure complications following mid-urethral sling surgery and antiestrogen therapy. Considering this, Rosemary Noel Senguttuvan, Division of Gynecologic Oncology, Department of Surgery, City of Hope Comprehensive Cancer Center, Duarte, CA, and colleagues sought to investigate if there are increased mesh-exposure complications between a breast cancer population compared to a noncancer population, particularly in conjunction with hormone suppression (HS) therapy.
For this purpose, the researchers performed a retrospective chart review on patients with a breast cancer history undergoing TVT surgery at the institution between 2013 and 2021. A group of patients who underwent TVT surgery without a history of cancer were taken as control. Predictors of mesh exposure complications were identified by univariate and multivariate logistic regression analyses.
The following were the key findings of the study:
- One hundred twenty-one patients with breast cancer had TVT surgery.
- Two hundred ninety-seven patients without cancer had TVT surgery during the same period. Baseline characteristics across all groups were similar.
- 6.9% of patients experienced mesh exposure; this occurred at a higher rate in the cancer (15.7%) versus the noncancer population (3.4%).
- Women with breast cancer taking HS therapy had a higher rate of mesh exposure complications compared with those not taking HS therapy (25.0% versus 6.6%).
- The highest rate of mesh exposure complications occurred in the cohort taking estrogen receptor modulators, selective estrogen receptor modulators (27.8%) versus aromatase inhibitors (20.8%) versus no HS therapy (6.6%).
- On multivariate analysis, HS therapy use (odds ratio, 1.57) and diabetes mellitus (odds ratio, 4.53) were associated with increased TVT-related complications.
To conclude, the findings showed an increased rate of mesh erosion in breast cancer survivors taking antiestrogen therapy.
"Women with breast cancer had a higher rate of mesh exposure complications from tension-free vaginal tape surgery compared with women without cancer, particularly those taking antiestrogenic therapy," the researchers wrote.
Reference:
Senguttuvan, Rosemary Noel MD∗; Hadadianpour, Shiva MD∗; Ruel, Nora MA†; Chung, Christopher P. MD∗. Increased Rate of Mesh Erosion in Breast Cancer Survivors Taking Antiestrogen Therapy. Urogynecology 30(3):p 174-180, March 2024. | DOI: 10.1097/SPV.0000000000001436
