Resection margins and local recurrences in breast cancer: Comparison between conventional and oncoplastic breast conserving surgery

Abstract

Background: This retrospective cohort study aims to compare surgical margins, reoperations and local recurrences after conventional or oncoplastic breast conservation surgery (BCS). Furthermore, we aim to investigate differences between various oncoplastic techniques. Material and methods: We reviewed 1800 consecutive patients with primary invasive breast cancer (N ¼ 1707) or ductal carcinoma in situ (N ¼ 93) who underwent BCS at Helsinki University Hospital between 2010 and 2012. Results: Conventional BCS was performed in 1189 (66.1%) patients, oncoplastic BCS in 611 (33.9%). Various oncoplastic techniques were used. Patients with oncoplastic BCS had more often multifocal (p < 0.001), larger (p < 0.001), palpable tumours (p < 0.001) with larger resection specimens (p < 0.001). The amount of resected tissue varied substantially depending on the oncoplastic technique. Patients treated with oncoplastic BCS were younger (p < 0.001) and their tumours were more aggressive according to histological grade (p < 0.001), T-stage (p < 0.001), Ki-67 (p < 0.001) and lymph node status (p < 0.001). There was no difference, however, in surgical margins (p ¼ 0.578) or reoperation rates (p ¼ 0.430) between the groups. A total of 152 (8.4%) patients were reoperated because of insufficient margins, 96 (8.1%) in the conventional, 56 (9.2%) in the oncoplastic BCS group. The median follow-up time was 75 (2e94) months. There was no difference in local recurrence-free survival between the conventional and oncoplastic BCS groups (log-rank test, p ¼ 0.172). Conclusions: Oncoplastic BCS was used for larger, multifocal and more aggressive tumours. Nevertheless, no difference in reoperation rate or local recurrences were found. Oncoplastic BCS is as safe as conventional BCS enabling breast conserving for patients who otherwise were candidates for mastectomy.

Rates of re-excision and conversion to mastectomy after breast-conserving surgery with or without oncoplastic surgery: a nationwide population-based study

“…Although no long-term differences in recurrence rates and survival between BCS and OPS have been reported 13,19,22,[43][44][45] , current evidence regarding the impact of OPS on the re-excision rate is limited because the data are from single-centre studies with relatively few patients undergoing OPS (ranging from 31 to 1177), and in most studies the methodology was weak 11,13,44,[46][47][48] . The present results are in line with a meta-analysis 19 from 2018 that found a significantly lower risk of re-excision in patients who underwent OPS compared with those who had BCS (relative risk 0⋅66, 95 per cent c.i.…”

“…Oncoplastic surgery (OPS) improves cosmetic outcomes and is nowadays used in up to 34 per cent of patients with breast cancer undergoing BCS [10][11][12][13][14] . Previous studies 15,16 have demonstrated that by using OPS breast conservation becomes an alternative to mastectomy in patients with large and multifocal tumours.…”

“…Previous studies 15,16 have demonstrated that by using OPS breast conservation becomes an alternative to mastectomy in patients with large and multifocal tumours. Compared with BCS, OPS is associated with larger resections 17,18 , and good long-term survival outcomes 11,13,18,19 and quality of life [20][21][22] . Achieving larger tumour resections with OPS may also reduce the number of re-excisions owing to insufficient margins.…”

Re: Oncoplastic partial breast reconstruction improves patient satisfaction and aesthetic outcome for central breast tumours

“…2 The indications for every oncoplastic technique are different and various algorithms have been devised to assist with the decision process. [2][3][4] The choice is based on tumour and breast characteristics, extent of resection, previous surgery and expectations and wishes of the patient. [2][3][4] However, a 'good surgical hand' in oncoplastic techniques is not enough to optimize the oncological and aesthetic results!…”

“…First, the use of steroids in patients with amoebic colitis on the presumptive diagnosis of inflammatory bowel disease can lead to toxic megacolon and perforation. 3 Second, it has been found that the use of Loperamide, which is very commonly used in cases of diarrhoea, will increase the chance of developing fulminant amoebic colitis. 4…”