A population-based audit of surgical practice and outcomes of oncoplastic breast conservations in Scotland – An analysis of 589 patients

Romics, László; Macaskill, E. Jane; Fernandez, Teresa de Souza; Simpson, Louise; Morrow, Elizabeth; Pitsinis, Vassilis; Tovey, Sian; Barber, Matthew D.; Masannat, Yazan; Stallard, Sheila; Weiler-Mithoff, Eva; Malyon, Andrew; Mansell, James; Campbell, Esther; Doughty, Julie; Dixon, J. M.

doi:10.1016/j.ejso.2018.04.004

Cited by 22 publications

(22 citation statements)

References 42 publications

(85 reference statements)

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“…This is consistent with several other previous studies [8,17e19]. A trend towards a higher risk of reoperation in the DCIS group (15.1%) and in the invasive lobular carcinoma group (12.3%) was observed, as reported earlier [8,11,20], yet this did not reach statistical significance (p ¼ 0.007).…”

Section: Resection Margins and Reoperationssupporting

confidence: 92%

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Resection margins and local recurrences in breast cancer: Comparison between conventional and oncoplastic breast conserving surgery

Niinikoski

Leidenius

Vaara

et al. 2019

European Journal of Surgical Oncology

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Background: This retrospective cohort study aims to compare surgical margins, reoperations and local recurrences after conventional or oncoplastic breast conservation surgery (BCS). Furthermore, we aim to investigate differences between various oncoplastic techniques. Material and methods: We reviewed 1800 consecutive patients with primary invasive breast cancer (N ¼ 1707) or ductal carcinoma in situ (N ¼ 93) who underwent BCS at Helsinki University Hospital between 2010 and 2012. Results: Conventional BCS was performed in 1189 (66.1%) patients, oncoplastic BCS in 611 (33.9%). Various oncoplastic techniques were used. Patients with oncoplastic BCS had more often multifocal (p < 0.001), larger (p < 0.001), palpable tumours (p < 0.001) with larger resection specimens (p < 0.001). The amount of resected tissue varied substantially depending on the oncoplastic technique. Patients treated with oncoplastic BCS were younger (p < 0.001) and their tumours were more aggressive according to histological grade (p < 0.001), T-stage (p < 0.001), Ki-67 (p < 0.001) and lymph node status (p < 0.001). There was no difference, however, in surgical margins (p ¼ 0.578) or reoperation rates (p ¼ 0.430) between the groups. A total of 152 (8.4%) patients were reoperated because of insufficient margins, 96 (8.1%) in the conventional, 56 (9.2%) in the oncoplastic BCS group. The median follow-up time was 75 (2e94) months. There was no difference in local recurrence-free survival between the conventional and oncoplastic BCS groups (log-rank test, p ¼ 0.172). Conclusions: Oncoplastic BCS was used for larger, multifocal and more aggressive tumours. Nevertheless, no difference in reoperation rate or local recurrences were found. Oncoplastic BCS is as safe as conventional BCS enabling breast conserving for patients who otherwise were candidates for mastectomy.

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Section: Resection Margins and Reoperationssupporting

confidence: 92%

“…This is comparable to other studies. Romics et al [11] reported a LR rate of 2.7% during a median of 30 months follow-up, Clough et al a LR rate of 2.2% during a median of 55 months follow-up [8] and Rietjens at al. [9] a LR of 3.4% during a median of 74 months follow-up.…”

Section: Local Recurrencesmentioning

confidence: 97%

Resection margins and local recurrences in breast cancer: Comparison between conventional and oncoplastic breast conserving surgery

Niinikoski

Leidenius

Vaara

et al. 2019

European Journal of Surgical Oncology

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“…Oncoplastic breast conservation surgery has been shown as a safe alternative to mastectomy and immediate breast reconstruction in selected patients based on the combined data of iBRA-2 and TeaM studies of 2916 patients (17). Further, the Scottish audits of oncoplastic breast conservations indicate that oncoplastic surgery can widen the indications for breast conservation, and provide good oncological outcome with low complication rates in our hands, hence it can be a reasonable alternative to mastectomy with immediate reconstruction (18)(19)(20)(21). One unit in Italy did offer immediate breast reconstruction even during the peak of the COVID-19 pandemic as it is indicated by Fragetti et al who reported 15 nipple-sparing mastectomies with immediate J o u r n a l P r e -p r o o f reconstruction done in 13 patients, although reconstructive techniques were not disclosed (14).…”

Section: Discussionmentioning

confidence: 99%

A prospective cohort study of the safety of breast cancer surgery during COVID-19 pandemic in the West of Scotland

Romics¹,

Doughty²,

Stallard³

et al. 2021

The Breast

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This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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“…Mastectomy rates were different according to histological types of tumor: 49.7% (1,960/3,942, 95% CI 48.1–51.3) for DCIS,1,4–6,8,11,13,14 50.9% (9,446/18,566, 95% CI 50.2–51.6) for invasive BC, 55.7% (95% CI 54.5–56.9) for ductal invasive BC, 70.5% (95% CI 68.3–72.7) for lobular invasive BC, and 60.9% (95% CI 57.8–64.0) for other invasive histological types 2…”

Section: Discussionmentioning

confidence: 99%

<p>Positive or close margins: reoperation rate and second conservative resection or total mastectomy?</p>

Houvenaeghel¹,

Lambaudie²,

Bannier³

et al. 2019

CMAR

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Introduction Reoperation after breast-conserving surgery (BCS) could be proposed for positive or close margins. Reoperation type, re-excision or mastectomy, depends on several factors in relation to patient’s and tumor’s characteristics. We have analyzed our breast cancer (BC) database in order to determine second and third attempts for BCS and mastectomy rates, as well as associated factors for type of surgery. Methods All patients with BCS between 1995 and 2017 were included. Patient’s characteristics, pathologic results, and treatments were analyzed. Reoperation rate, type of reoperation, second reoperation, and associated factors of reoperation, mastectomy, and third intervention were determined. Three periods were determined: P1–P3. Results We analyzed 10,761 patients: 1,161 with ductal carcinoma in situ (DCIS) and 9,600 with invasive BC. The reoperation rate was 41.4% for DCIS and 28.0% for invasive BC. Using multivariate analysis, we identified tumor size >20 mm as being a risk factor for reoperation, whereas age >50 years, P2–3, and some localization decreased reoperation rates. For invasive BC, age >40 years, triple-negative tumors, neoadjuvant chemotherapy, and noncentral tumors decreased reoperation rates and lobular tumor, multifocal tumors, lymphovascular invasion, DCIS component, and Her2-positive tumors increased reoperation rates. For patients requiring reoperation, re-excision was performed in 48.1% (1,523/3,168) and mastectomy was required after first re-excision in 13.46% (205/1,523). For DCIS, mastectomy rates were higher for grade 2 and tumor ≥20 mm. For invasive BC, mastectomy rates were higher for lobular, multifocal, ≥20 mm, Her2-positive tumors and diffuse positive margins and lower for age >50 years and during the last period. Even if interval time between surgery and adjuvant treatments was higher for patients with reoperation, survival rates were not different between patients with and without reoperation. Conclusion A decrease in reoperation and mastectomy rates had been reported with several associated factors. A third intervention with mastectomy was required in 13.5% of patients. This information should be done in case of reoperation.

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A population-based audit of surgical practice and outcomes of oncoplastic breast conservations in Scotland – An analysis of 589 patients

Abstract: This study demonstrated that measured outcomes of OBC in a population-based multi-centre setting can be comparable to the outcomes of large volume single centre series.

Cited by 22 publications

References 42 publications

Resection margins and local recurrences in breast cancer: Comparison between conventional and oncoplastic breast conserving surgery

Resection margins and local recurrences in breast cancer: Comparison between conventional and oncoplastic breast conserving surgery

A prospective cohort study of the safety of breast cancer surgery during COVID-19 pandemic in the West of Scotland

<p>Positive or close margins: reoperation rate and second conservative resection or total mastectomy?</p>

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