Oncoplastic Breast-Conserving Surgery for Tumors Larger than 2 Centimeters: Is it Oncologically Safe? A Matched-Cohort Analysis

Lorenzi, Francesca De; Loschi, Pietro; Bagnardi, Vincenzo; Rotmensz, Nicole; Hubner, Gabriel; Mazzarol, Giovanni; Orecchia, Roberto; Galimberti, Viviana; Veronesi, Giulia; Colleoni, Marco; Toesca, Antonio; Peradze, Nickolas; Rietjens, Mario

doi:10.1245/s10434-016-5124-4

Cited by 79 publications

(38 citation statements)

References 36 publications

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“…Although this associated rise is multifactorial, it can be attributed to increased life expectancy, hormone use, prevalence of obesity treatment, and screening options [s3]. Simultaneously, surgical interventions are transitioning towards a reconstructive approach that ensures aesthetic satisfaction in combination with oncologic safety [4, 5]. …”

Section: Introductionmentioning

confidence: 99%

Surgical trends in breast cancer: a rise in novel operative treatment options over a 12 year analysis

Jonczyk

Jean

Graham

et al. 2018

Breast Cancer Res Treat

163

118

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Purpose Breast cancer surgical techniques are evolving. Few studies have analyzed national trends for the multitude of surgical options that include partial mastectomy (PM), mastectomy without reconstruction (M), mastectomy with reconstruction (M+R), and PM with oncoplastic reconstruction (OS). We hypothesize that the use of M is declining and likely correlates with the rise of surgery with reconstructive options (M+R, OS). Methods A retrospective cohort analysis was conducted using the ACS-NSQIP database from 2005 to 2016 and ICD codes for IBC and DCIS. Patients were then grouped together based on current procedural terminology (CPT) codes for PM, M, M+R, and OS. In each group, categories were sorted again based on additional reconstructive procedures. Data analysis was conducted via Pearson’s chi-squared test for demographics, linear regression, and a non-parametric Mann-Kendall test to assess a temporal trend. Results The patient cohort consisted of 256,398 patients from the NSQIP data base; 197,387 meet inclusion criteria diagnosed with IBC or DCIS. Annual breast surgery trends changed as follows: PM 46.3–46.1% (p = 0.21), M 35.8–26.4% (p = 0.001), M+R 15.9–23.0% (p = 0.03), and OS 1.8–4.42% (p = 0.001). Analyzing the patient cohort who underwent breast conservation, categorical analysis showed a decreased use of PM alone (96–91%) with an increased use of OS (4–9%). For the patient cohort undergoing mastectomy, M alone decreased (69–53%); M+R with muscular flap decreased (9–2%); and M+R with implant placement increased (20–40%)—all three trends p < 0.0001. Conclusion The modern era of breast surgery is identified by the increasing use of reconstruction for patients undergoing breast conservation (in the form of OS) and mastectomy (in the form of M+R). Our study provides data showing significant trends that will impact the future of both breast cancer surgery and breast training programs.

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Section: Introductionmentioning

confidence: 99%

Surgical trends in breast cancer: a rise in novel operative treatment options over a 12 year analysis

Jonczyk

Jean

Graham

et al. 2018

Breast Cancer Res Treat

163

118

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“…In the recent decades, the surgical management of breast cancer has steadily evolved from radical surgery to breast conservation. As a result, oncoplastic surgical techniques have emerged and are expanding dramatically . Oncoplastic surgery combines oncologic resection with immediate breast reconstruction using techniques derived from plastic surgery.…”

Section: Discussionmentioning

confidence: 99%

Oncoplastic breast surgery: Achieving oncological and aesthetic outcomes

Paridon

Kamali

Paul

et al. 2017

Journal of Surgical Oncology

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“…In the case where breast size is larger and tumor is large (e.g., T2-T3 invasive cancer) breast cancer, neoadjuvant chemotherapy should certainly be in the discussion to reduce tumor size and facilitate breast conservation. However, newer oncoplastic breast conservation techniques now allow very large partial mastectomies followed by the use of mastopexy or breast reduction techniques to rearrange the breast to maintain and possibly improve post-operative breast form (12)(13)(14). The need to reduce tumor size preoperatively in this circumstance may not be as critical as oncoplastic surgical techniques can remove these large tumors while maintaining breast aesthetics.…”

Section: Neoadjuvant Chemotherapy and The Timing Of Definitive Surgerymentioning

confidence: 99%

Neoadjuvant therapy for treatment of breast cancer: the way forward, or simply a convenient option for patients?

Chatterjee

Erban

2017

Gland Surg.

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The complexity of managing early stage breast cancer is well known. Optimal treatment is increasingly multidisciplinary and in the modern era informed by sophisticated molecular tools to help select and guide therapy. Major phase III trials have determined that the order of systemic therapy relative to surgery does not influence important endpoints such as event free survival and overall survival (OS), but questions remain as to how best to utilize these most essential services. For example, there is still uncertainty regarding the ideal timing, intensity, and duration of proposed therapy. For treating physicians, evidence based standardization of these practices is both possible and critically important. Optimization of care will increasingly rely on well-designed studies that have addressed the choice as well as the timing of the steps involved in multidisciplinary breast cancer treatment. Understanding when factors under the oncologist's control will influence outcome, cost and convenience is essential in the era of quality and value-based medical decision making. The timing of surgery before or after chemotherapy for breast cancer is one such factor. Investigators are to be commended for addressing these questions, which may generate additional hypotheses concerning the biology of metastasis and the nature of recurrence.

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Oncoplastic Breast-Conserving Surgery for Tumors Larger than 2 Centimeters: Is it Oncologically Safe? A Matched-Cohort Analysis

Abstract: To our knowledge, the present study provides the best available evidence to suggest that oncoplastic approach is a safe and reliable treatment for managing invasive pT2 breast cancers.

Cited by 79 publications

References 36 publications

Surgical trends in breast cancer: a rise in novel operative treatment options over a 12 year analysis

Surgical trends in breast cancer: a rise in novel operative treatment options over a 12 year analysis

Oncoplastic breast surgery: Achieving oncological and aesthetic outcomes

Neoadjuvant therapy for treatment of breast cancer: the way forward, or simply a convenient option for patients?

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