Comparative study of surgical and oncological outcomes in oncoplastic versus non oncoplastic breast-conserving surgery for breast cancer treatment

Abstract

Summary Background: Oncoplastic surgery has been increasingly used in breast cancer treatment and allows the performance of breast-conserving surgery in cases of larger tumors with unfavorable location or tumor-breast disproportion. Purpose: To compare surgical and oncological outcomes of patients undergoing oncoplastic and nononcoplastic breast-conserving surgery. Methods: Retrospective cohort study with convenience sampling of 866 patients who consecutively underwent breast-conserving surgery from 2011 to 2015. Results: The mean follow-up was 50.4 months. Nononcoplastic breast conservation surgery was performed on 768 (88.7%) patients and oncoplastic surgery on 98 (11.3%) patients. Patients in the oncoplastic group were younger (p<0.0001) and most were premenopausal (p<0.0001). Comorbidities such as diabetes (p=0.003) and hypertension (p=0.0001) were less frequent in this population. Invasive carcinoma >2 cm (p<0.0001), multifocality (p=0.004), ductal in situ carcinoma (p=0.0007), clinically positive axilla (p=0.004), and greater weight of surgical specimens (p<0.0001) were more frequent in the oncoplastic group. A second surgery for margin re-excision was more frequently performed in the nononcoplastic group (p=0.027). There was more scar dehiscence in the oncoplastic group (p<0.001), but there was no difference in early major complications (p=0.854), conversion to mastectomy (p=0.92), or local recurrence (p=0.889). Conclusion: Although used for the treatment of larger and multifocal tumors, surgical re-excisions were performed less often in the oncoplastic group, and there was no increase in conversion to mastectomy or local recurrence. In spite of the higher rate of overall complications in the oncoplastic group, major complications were similar in both groups.

Postdiagnosis body fatness, weight change and breast cancer prognosis: Global Cancer Update Program (CUP global) systematic literature review and meta‐analysis

“…The meta‐analyses included 101 publications reporting postdiagnosis BMI (assessed from at‐diagnosis to on average 5.8 years postdiagnosis), waist circumference (at‐diagnosis to 7.9 years postdiagnosis), waist‐to‐hip ratio (at‐diagnosis to 2.5 years postdiagnosis) and pre‐ to postdiagnosis weight gain or loss (from 1 year before to 1 year or more after diagnosis) 27,39‐138 . In addition, 119 publications were descriptively synthesized…”

Updates and Debate Concerning Margin Adequacy and Management following Breast-Conserving Surgery

“…Considering the evidence in the literature, oncoplastic surgery was found to have low recurrences while improving the cosmetic outcome and patients' quality of life [10,[57][58][59][60][61][62][63][64][65][66][67].…”

“…As expected, the application of oncoplastic techniques has witnessed the emergence of new problems with margin adequacy due to the unavoidable displacement or replacement of residual breast tissue surrounding the excised tumor, according to excision size and location [58][59][60]. Regardless, the current literature demonstrates that oncoplas-tic surgery is a safe option in terms of re-excision, completion mastectomy rates, and local and distant recurrence [10,[61][62][63][64][65][66]; such surgery is oncologically safe and has been recommended in the case of DCIS [67].…”

Does breast oncoplastic surgery improve quality of life?

“…When evaluating studies that selected patients for OS, it is necessary to consider that most of them are retrospective, and even in prospective patients, there may be a selection bias. Commonly, patients subjected to OS have a large tumour size, are younger, undergo neoadjuvant chemotherapy, have higher education, or are potentially more demanding, not accepting major defects or mastectomy without reconstruction, a fact that may influence the results ( 24 , 74 ).…”