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

Abstract

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.

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

“…In the present study, use of OPS among patients who underwent BCS decreased between 2012 and 2018 (from 30⋅3 to 26⋅4 per cent), specifically in volume reduction and replacement techniques. A large multicentre study 10 from the USA showed a significant rise in the OPS rate from 4⋅3 to 9⋅0 per cent between 2005 and 2016. Among those who underwent OPS, the percentage who had volume displacement was similar to that in the present study (85.2 and 83⋅4 per cent respectively).…”

“…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.…”

A novel monitorization technique for nerve protection during axillary surgery of the breast cancer patients

“…To date, similar survival outcomes and acceptable local recurrence rates have been obtained according to increased efficacy of regional and systemic treatment options. Thus, the surgical option has evolved toward breast preservation and oncoplastic breast surgery techniques . Nevertheless, despite all these changes, modified radical mastectomy (MRM) remains an important option in the surgical treatment of breast cancer.…”

Comparison of breast cancer patients who underwent partial mastectomy (PM) with mini latissimus dorsi flap (MLDF) and subcutaneous mastectomy with implant (M + I) regarding quality of life (QOL), cosmetic outcome and survival rates

“…In the 1980's, the latissimus dorsi myocutaneous flaps became the preferred autogenous reconstruction method for breast reconstruction after mastectomies, and it started to be used also in partial mastectomies after 1990's [9][10][11][12]. Volume replacement with MLDF provides a cosmetically successful breast reconstruction especially in patients with large tumor/breast volume ratio, who otherwise would be referred to mastectomy [13][14][15][16].…”