Oncoplastic Breast-Conserving Surgery for Synchronous Multicentric and Multifocal Tumors: Is It Oncologically Safe? A Retrospective Matched-Cohort Analysis

Abstract

Background Oncoplastic surgery is a well-established approach that combines breast-conserving treatment for breast cancer and plastic surgery techniques. Although this approach already has been described for multicentric and multifocal tumors, no long-term oncologic follow-up evaluation and no comparison with patients undergoing mastectomy have been published. This study aimed to evaluate whether oncoplastic surgery is a safe and reliable treatment for managing invasive primary multicentric and multifocal breast cancer. Methods The study compared a consecutive series of 100 patients with multicentric or multifocal tumors who had undergone oncoplastic surgery (study group) with 100 patients who had multicentric or multifocal tumors and had undergone mastectomy (control group) during a prolonged period. The end points evaluated were disease-free survival (DFS), overall survival (OS), cumulative incidence of local recurrence (CI-L), regional recurrence (CI-R), and distant recurrence (CI-D), all measured from the date of surgery. Results The OS and DFS were similar between the two groups. The incidence of local events was higher in the oncoplastic group, whereas the incidence of regional events was slightly higher in the mastectomy group. These differences were not statistically significant. The cumulative incidence of distant events was similar between the two groups. Conclusions To the authors’ knowledge, the current study provides the best available evidence suggesting that the oncoplastic approach is a safe and reliable treatment for managing invasive multifocal and multicentric breast cancers.

Editorial on Oncoplastic Breast-Conserving Surgery for Synchronous Multicentric and Multifocal Tumors: Is It Oncologically Safe? A Retrospective Matched-Cohort Analysis

“…The implications of this study 4 are quite significant. As with past studies noting the success of oncoplastic surgery in pushing the boundaries of breast conservation in larger cancers, 5,6 the paper by De Lorenzi et al 4 suggests that, even in situations with multiple cancers, oncoplastic surgery may provide a breast conservation option for the patient. The results of this study supporting the safety of oncoplastic surgery add additional complexity to the treatment options in multifocal or multicentric breast surgery.…”

“…Furthermore, the relative fiscal impact of each choice with specific regards to financial toxicity to the patient has yet to be studied in detail, but is definitely a significant real-world issue that impacts decision-making. 9 In sum, De Lorenzi et al 4 provide an excellent study noting the comparable oncologic safety of oncoplastic surgery to mastectomy in multifocal and multicentric breast cancer.…”

“…De Lorenzi et al 4 performed a retrospective matched cohort analysis comparing oncologic outcomes between oncoplastic surgery and mastectomy patients who have either multicentric or multifocal breast tumors. They compared 100 patients who consecutively underwent oncoplastic surgery and evenly matched them to 100 patients undergoing mastectomy.…”

“…The patient should be informed that, with a mastectomy operation and reconstruction, it is likely that several stages 7 or corrective operations may be needed in addition to the possible shortand long-term complications of the preferred reconstructive modality (implant versus autologous tissue). Therefore, while De Lorenzi's paper 4 provides critical oncologic outcome information that needs to be discussed as part of the shared decision-making discussion between the surgical team and the patient with regards to local/ regional recurrence and survival, each operative choice has its vast array of possible postsurgical outcomes that weigh into the eventual choice taken by the patient. Recent studies have demonstrated that oncoplastic surgery in general has higher patient-reported outcomes compared with mastectomy operations.…”

ASO Author Reflections: The Safety of Oncoplastic Surgery for Multicentric and Multifocal Breast Tumors

“…The study results showed that the disease-free and the overall survival rates were similar in the two groups suggesting that the oncoplastic approach is safe and effective for multifocal and multicentric breast cancer. 4…”