Early Postoperative Outcomes in Breast Conservation Surgery Versus Simple Mastectomy with Implant Reconstruction: A NSQIP Analysis of 11,645 Patients

Pyfer, Bryan J.; Chatterjee, Abhishek; Chen, Lilian; Nigriny, John F.; Czerniecki, Brian J.; Tchou, Julia; Fisher, Carla S.

doi:10.1245/s10434-015-4770-2

Cited by 55 publications

(39 citation statements)

References 36 publications

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“…Of the 163 LVOS patients requiring further surgery, 45 (27.6%) had additional re-resection and 118 (72.4%) had completion mastectomy. Of the 520 SL patients requiring further surgery, 421 (81.0%) underwent re-excision and 99 (19.0%) had comple- [3]. Complications included seroma, hematoma, skin necrosis and revision surgery, which presumed the need for debridement and associated costs.…”

Section: Literature Review and Health Statesmentioning

confidence: 99%

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A Cost-Utility Analysis Comparing Oncoplastic Breast Surgery to Standard Lumpectomy in Large Breasted Women

Chatterjee¹,

Offodile²,

Asban³

et al. 2018

ABCR

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Purpose: Ablative options, beyond mastectomy, for large breasted patients with breast cancer include oncoplastic resection via reduction pattern and standard lumpectomy. Oncoplastic resection also entails a contralateral procedure for symmetry and the potential benefit of a superior cosmetic outcome. Our aim was to examine the cost-effectiveness of this treatment strategy comparing it to standard lumpectomy in treating breast cancer patients. Methods: A literature review was performed of the probabilities and outcomes related to treatment of unilateral breast cancer via oncoplastic resection or unilateral lumpectomy. Utility score surveys were used to estimate the quality adjusted life years (QALYs) associated with a successful procedure, additional margins excision and post-operative complications. A decision analysis tree was developed to highlight the more cost-effective strategy. An Incremental Cost-Utility Ratio (ICUR) was calculated. Sensitivity analysis was performed to check the robustness of our data. Results: Oncoplastic resection was associated with fewer positive margins relative to standard lumpectomy (10.0% versus 18%). In cases with positive margins, a greater percentage of oncoplastic resection patients chose a mastectomy compared to the lumpectomy patients (72% versus 19%). Utility scores for a successful operation favored oncoplastic resection (92.6 versus 86.

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Section: Literature Review and Health Statesmentioning

confidence: 99%

“…Each treatment varies with regards to clinical outcomes, such as positive margin rates [1] [2] and postoperative complication rates [3] [4] [5]. Variability in operative technique such as the need to operate on one versus both breasts leads to variation in costs.…”

Section: Introductionmentioning

confidence: 99%

A Cost-Utility Analysis Comparing Oncoplastic Breast Surgery to Standard Lumpectomy in Large Breasted Women

Chatterjee¹,

Offodile²,

Asban³

et al. 2018

ABCR

Self Cite

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“…As a pre-invasive lesion, mastectomy may be overtreatment for many women with small, localized DCIS. Women considering mastectomy should be counseled regarding the increased surgical complication rate associated with mastectomy compared to BCS (22) and the possible impact on body image and sexual functioning post-surgery (23). …”

Section: Standard Treatment Options For Dcismentioning

confidence: 99%

Controversies in the Treatment of Ductal Carcinoma in Situ

Barrio

Zee

2017

Annu. Rev. Med.

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Ductal carcinoma in situ (DCIS) accounts for 20% of all newly diagnosed breast cancers. Mastectomy was once the gold standard for the treatment of DCIS; however, breast-conserving surgery (BCS) has been adopted as the treatment of choice for patients with small, screen-detected lesions. Both adjuvant radiation and hormonal therapy following BCS have been demonstrated in randomized trials to reduce the risk of invasive recurrence, but neither affects survival. With the variety of surgical and adjuvant treatment options available, there has been great interest in tailoring the treatment to the individual, with the goal of optimizing the balance of risks and benefits according to the values and priorities of the woman herself. Prospective studies of women with “low-risk” DCIS have successfully identified women at lower than average risk, but have not achieved the goal of identifying a subset of women with DCIS at minimal risk of recurrence after surgical excision alone.

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“…It might also delay the initiation of adjuvant chemotherapy. As an alternative, many patients elect to undergo mastectomy with or without reconstruction, which is a vastly different clinical course, associated with higher complications 26,27 . Moreover, the need for secondary procedures has a significant economic cost, which is of particular concern in a publicly funded health care system.…”

Section: Discussionmentioning

confidence: 99%

“…Based on our decision analysis, if the current reoperation rate in Canada were to be lowered to 10% from 23%, the average savings per patient in the population undergoing initial attempted bcs would be $1,055. That amount is likely an underestimate because it does not take into account the costs associated with any complications that might occur out of hospital 26,27 or any secondary procedures for complications, which are more likely in patients who choose mastectomy and reconstruction 48 . The economic implications are significant, especially in a publicly funded universal health care system, given that the potential savings are at least $1.9 million annually in the province of British Columbia alone.…”

Section: Discussionmentioning

confidence: 99%

Reoperation Costs in Attempted Breast-Conserving Surgery: A Decision Analysis

Pataky

Baliski

2016

Current Oncology

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Early Postoperative Outcomes in Breast Conservation Surgery Versus Simple Mastectomy with Implant Reconstruction: A NSQIP Analysis of 11,645 Patients

Abstract: BCS has fewer overall early postoperative wound, infectious, and bleeding complications despite a significantly higher rate of preexisting risk factors.

Cited by 55 publications

References 36 publications

A Cost-Utility Analysis Comparing Oncoplastic Breast Surgery to Standard Lumpectomy in Large Breasted Women

A Cost-Utility Analysis Comparing Oncoplastic Breast Surgery to Standard Lumpectomy in Large Breasted Women

Controversies in the Treatment of Ductal Carcinoma in Situ

Reoperation Costs in Attempted Breast-Conserving Surgery: A Decision Analysis

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