Breast conservative surgery and local recurrence

Abstract

Five defined oncoplastic principles presented in our nomogramme (targeted breast surgery) allow the reconstruction of major segmental resection defects during breast-conserving therapy with high clinical applicability and result in favorable oncological and aesthetic outcome. Recurrence was not a function of traditional prognostic factors like T-size or nodal status (in a T1/T2, N0/N1 cohort), but of grading, intrinsic subtypes and non-invasive breast cancer components. Lobular histology, multi-centricity and DCIS were predictive for breast preservation failure and conversion to mastectomy.

Central round block repair of large breast resection defects: oncologic and aesthetic outcomes

“…The authors commented that most studies showed significant weaknesses including lack of robust design and methodological shortcomings. Well-designed prospective longitudinal studies with adequate follow-up are the only realistic way in which critics, who remain unconvinced by the existing data over three decades of oncoplastic surgery may be silenced (35)(36)(37)(38)(39).…”

Positive margins prediction in breast cancer conservative surgery: Assessment of a preoperative web-based nomogram

“…This may be related to novel approaches in OBS. Oncologic outcomes on OBS have been evaluated, with the risk of recurrence not being attributed to surgical technique or resected volume [3]. However, if positive margins are documented, these techniques (if tissue rearrangement and remodeling occurs) may difficult further margin resection [31,32].…”

Local re-operation and recurrence in oncoplastic breast surgery

“…However, with the new concepts of tumor biology, the determining factors are currently more related to the molecular biology of the tumor and adjuvant therapy than with the size of the resection margin. Such concept was popularized as "bigger is not better" 13,14 . Factors such as histological degree, components of noninvasive carcinoma, lobular histology, and multicentricity are predictive of conservative surgery failure and conversion to mastectomy 14 .…”

“…Such concept was popularized as "bigger is not better" 13,14 . Factors such as histological degree, components of noninvasive carcinoma, lobular histology, and multicentricity are predictive of conservative surgery failure and conversion to mastectomy 14 . There are countless risk factors associated with a high rate of new surgeries due to compromised margins.…”

“…Among the pathology laboratories, there is a lack of standardization in the processing of samples, especially in the accuracy of the microscopic margins evaluation, which subsequently creates a difficulty to study the effect of millimetric differences between the margins size 13 to optimize local control, and they highlight that no tumor cells touched the dye (in invasive carcinomas and in situ) as a negative criterion. This is based on the Houssami et al (2014) meta-analysis outcomes, which showed that margins of one, two, or five millimeters were not associated with different risks for local recurrence 14,24 . This fact corroborates the results of the clinical trial from the American College of Surgeons Oncology Group (ACOSOG), which provides more evidence on the concept that, in this current era of multiple therapies, minimizing the subclinical tumor margin is not essential to reduce local recurrence.…”