Position Statement on Defining and Standardizing an Oncoplastic Approach to Breast-Conserving Surgery in Canada

Arnaout, Angel; Ross, Douglas C.; Khayat, Eman; Richardson, J. C.; Kapala, Marianna; Hanrahan, Renee; Zhang, J; Doherty, Christopher; Brackstone, Muriel

doi:10.3747/co.26.4195

Cited by 15 publications

(20 citation statements)

References 11 publications

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“…The findings of this study demonstrate that OPS is an attractive alternative to standard lumpectomy in the treatment of breast cancer for Canadian general surgeons who have participated in additional training in OPS. 17 The short-and long-term outcomes and complication rates in this study are comparable with those of other OPS studies, as well as studies of standard BCS. The findings of this study should encourage other Canadian breast and general surgeons to learn OPS and integrate it into their breast practice.…”

Section: Resultssupporting

confidence: 83%

An alternative to standard lumpectomy: a 5-year case series review of oncoplastic breast surgery outcomes in a Canadian setting

Knowles

Maxwell

Lumsden

et al. 2020

CJS

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Background: Oncoplastic surgery (OPS) is becoming the new standard of care for breast-conserving surgery (BCS). It has become increasingly popular in Europe; however, it has not yet been widely accepted in North America. This study aims to describe the experience with OPS at a Canadian tertiary care centre. Methods: This study is a retrospective case series consisting of consecutive OPS cases at a single Canadian centre, the Royal Victoria Regional Health Centre in Barrie, Ontario, between 2009 and 2015. Results: A total of 275 women who consecutively underwent OPS were included. The average size of the tumour was 17 mm (standard deviation [SD] 13 mm; range 0-110 mm). The average specimen weight was 155 g (SD 146 g; range 15-1132 g). Invasive ductal carcinoma was the most common diagnosis (237 patients, 86.2%), followed by ductal carcinoma in situ (18 patients, 6.6%) and then invasive lobular carcinoma (15 patients, 5.5%). A positive margin was recorded in 37 (13.5%) patients. Immediate postoperative complications included seroma and edema (32.7%), wound infection (13.1%), hematoma (8.7%) and delayed wound healing (6.5%). A delay to adjuvant therapy due to postoperative complications occurred in 7 of 217 (3.2%) patients. The median follow-up was 18 months. There were local and distant recurrences in 9 (3.3%) and 2 (0.7%) patients, respectively. Overall survival was 99.3%. Conclusion: The findings of this study are comparable to results in the literature on OPS and demonstrate that OPS is an attractive alternative to standard lumpectomy for Canadian general surgeons who treat breast cancer. Contexte : La chirurgie oncoplastique (COP) est en passe de devenir la nouvelle norme pour la chirurgie conservatrice du sein (CCS). Elle est de plus en plus populaire en Europe, mais elle n'a pas encore été largement adoptée en Amérique du Nord. Cette étude vise à décrire l'expérience d'un établissement de soins tertiaires au Canada en matière de COP. Méthodes : Cette étude repose sur une série rétrospective de cas de COP dans un établissement canadien, le Centre régional de santé Royal Victoria de Barrie, en Ontario, entre 2009 et 2015. Résultats : En tout, 275 cas consécutifs de COP ont été inclus. La taille moyenne des tumeurs était de 17 mm (écart-type [É.-T.] 13 mm; éventail 0-110 mm). Le poids moyen des spécimens était de 155 g (É.-T. 146 g; éventail 15-1132 g). Le diagnostic le plus fréquent était le carcinome canalaire invasif (237 patientes, 86,2 %), suivi du carcinome canalaire in situ (18 patientes, 6,6 %), puis du carcinome lobulaire invasif (15 patientes, 5,5 %). Une marge positive a été enregistrée chez 37 patientes (13,5 %). Parmi les complications postopératoires immédiates, mentionnons sérome et oedème (32,7 %), infection de plaie (13,1 %), hématome (8,7 %) et retard de cicatrisation de la plaie (6,5 %). Un retard du traitement adjuvant dû à des complications postopératoires est survenu chez 7 patientes sur 217 (3,2 %). Le suivi médian a été de 18 mois. On a noté des récurrences locales et à distance chez 9 (3...

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Section: Resultssupporting

confidence: 83%

An alternative to standard lumpectomy: a 5-year case series review of oncoplastic breast surgery outcomes in a Canadian setting

Knowles

Maxwell

Lumsden

et al. 2020

CJS

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“…Level I resections comprise <20% of the breast volume, and level II up to 50%. 4 In Canada, level 1 includes up to 15% resection volume, level II includes 16%–25% or a tumor in the upper inner quadrant or lower pole, and level 3 includes resections between 26% and 60% of the breast volume and any contralateral symmetrizing procedures 9 (Table 1 ).…”

Section: Discussionmentioning

confidence: 99%

Key Areas for Development in Oncoplastic Breast Reconstruction

Molina

Shelby

Janis

2020

Plastic and Reconstructive Surgery - Global Open

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Background: Oncoplastic breast reconstruction addresses lumpectomy or partial mastectomy defects after breast conserving surgery. A large subset of breast cancer patients may be candidates for oncoplastic partial breast reconstruction, but are likely underserved in the United States due to multiple factors. In this article, the authors provide an understanding of current trends in the literature and an overview of key areas for improvement in the delivery of breast cancer surgical care. Methods: A literature search of peer-reviewed articles relating to oncoplastic breast reconstruction was performed. In addition, current US laws relating to breast reconstruction, and communication and content from key surgical societies were reviewed. Key areas of improvement were identified after qualitative review of all sources. Results: Thirty-four relevant resources were included. There is a large potential population need for oncoplastic breast reconstruction, but no current accurate estimate of patients undergoing this type of reconstruction. There are a multitude of definitions and algorithms attempting to define and organize oncoplastic breast surgery. Legislative initiatives could be improved to prevent coverage gaps. Coding and billing for oncoplastic surgery is not standardized, which complicates both clinical implementation and research efforts. Collaboration between national societies is needed. Conclusions: Oncoplastic partial breast reconstruction is an important part of the total package of care that can be offered to the breast cancer patient. Improvements in legislation, coding, and billing, and unification of national society communications and initiatives can lead to better surgical outcomes for the breast cancer patient.

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“…The favorable oncologic and aesthetic and oncologic outcomes associated with OPM have led to an increase in uptake of these procedures [7,13]. There have been well described concerns in the literature about radiation boost delivery and accurate localization for these patients [14][15][16].…”

Section: Discussionmentioning

confidence: 99%

Implications of Oncoplastic Breast Surgery on Radiation Boost Delivery in Localized Breast Cancer

Gladwish

Sauve²,

DiDiodato³

et al. 2020

Preprint

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Background:Oncoplastic partial mastectomy (OPM) is a technique utilized to improve aesthetic and survivorship outcomesin patients with localized breast cancer. This technique leads to breast tissue rearrangement, which can have an impact on target definition for boost radiotherapy (BRT). The aim of this study was to determine if the choice of surgical technique independently affected the decision to deliver a radiation boost.Materials and Methods: This was a retrospective study of patients treated between January 2017 and December 2018. We selected consecutive patients based on surgical procedure; 50 undergoing standard breast conserving surgery and 50 having had an OPM. The primary outcome was average treatment effect (ATE) of surgery type on reception of BRT, accounting for patient age, tumor grade, lymphovascular space invasion, margin status and ER status as potential confounding variables. Secondary outcomes included ATE of surgery type on the time to reception of radiotherapy and incidence of ipsilateral breast tumor recurrence (IBTR). The ratio of boost seroma volume to pathologic tumor size was also compared between the two groups. Treatment effects regression adjustment and inverse-probability weighted analysis was used to estimate ATEs for both primary and secondary outcomes.Results: Median age was 64 years (range 37 – 88). The median tumor size was 1.5 cm (range 0.1 – 6.5). The majority of patients were ≤ stage IIA (78%), invasive ductal subtype (80%), LVSI negative (78%), margin negative (90%) and ER/PR +ve (69%). Overall, surgical technique was not associated with differences in the proportion of patients receiving BRT (ATE 6.0% (95% CI -4.5, 16.0)). There were no differences in delays to radiation treatment between the two groups (ATE 32.8 days (95% CI -22.1, 87.7)). With a median follow-up time of 419 days (range 30 – 793), there were only 5 recurrences, with 1 case of IBTR in each group. There was no difference in the ratio of seroma volume to tumor size between the two groups (p=0.38).Conclusions: OPM did not affect the decision to offer localized BRT following standard whole breast radiotherapy, or significantly affect treatment times or radiation volumes. The decision to offer OPM should include a multi-disciplinary approach.

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Position Statement on Defining and Standardizing an Oncoplastic Approach to Breast-Conserving Surgery in Canada

Cited by 15 publications

References 11 publications

An alternative to standard lumpectomy: a 5-year case series review of oncoplastic breast surgery outcomes in a Canadian setting

An alternative to standard lumpectomy: a 5-year case series review of oncoplastic breast surgery outcomes in a Canadian setting

Key Areas for Development in Oncoplastic Breast Reconstruction

Implications of Oncoplastic Breast Surgery on Radiation Boost Delivery in Localized Breast Cancer

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