Oncoplastic Level II Surgical Techniques for Breast Cancer Treatment: Long-Term Outcomes

Abstract

Background: Problems in patients who could not get adequate surgical margins (SM) and good cosmetic results with breast-conserving surgery (BCS) have been overcome with the introduction of oncoplastic surgery (OPS) methods. The purpose of this study was the documentation of level II techniques and the presentation of long-term survival results. Methods: The data on patients who had been prospectively registered in the database between 2007 and 2017 and who had been treated with level II OPS due to invasive breast cancer were examined. Results: A total of 1,074 patients were included in the study. The most commonly applied level II oncoplastic techniques were performed in the upper outer quadrantectomy with racquet incision in 334 (31%) patients, inferior pedicle flaps in 294 (27.3%), and vertical mammoplasty in 140 (13%). Reexcision was performed in 96 patients (8.9%). Total breast conservation rate was 96%. Five-year disease-free survival (DFS) was 88%, local recurrence-free survival (LRFS) 93.6%, and overall survival (OS) 96%. Ten-year DFS was 72%, LRFS 85.4%, and OS 90.2%. Conclusion: Level II OPS techniques have low reoperation and complication rates and a high rate of breast protection. The success of these techniques has been demonstrated in terms of long-term local control. Awareness of the fact that many patients who undergo OPS will not lose their breasts should be created, and regular training programs for OPS techniques should be conducted especially in developing countries. By revealing these results, it is hoped that the OPS and breast conservation rates will increase.

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].…”

Long-term oncological outcomes of oncoplastic breast-conserving surgery after a 10-year follow-up – a single center experience and systematic literature review

“…Large systematic reviews showed that oncoplastic surgery was more frequently performed in younger patients who required greater breast volume removal for larger tumors ( 23 , 25 , 27 ). While this may not translate to any survival benefit, there could be improvement in patients’ satisfaction rates given the lower rate of reoperation and conversion to mastectomy ( 28 ).…”

Oncological safety of oncoplastic surgery in breast cancer patients

“…Тем не менее существуют сложности в оценке онкологической безопасности ОПР по сравнению с классическими радикальными резекциями ввиду невозможности проведения крупных рандомизированных исследований [9]. По данным различных источников частота рецидивов после ОПР достигает 10% [10][11][12][13][14][15].…”