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

Abstract

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...

Clinical and patient-reported outcomes in oncoplastic breast conservation surgery from a single surgeon’s practice in a busy community hospital in Canada

“…A similar series from Ontario describes a single surgeon's OPBS practice in a community hospital setting. 4 This series, describing a similar population to that in our study, looked at clinical as well as oncological outcomes and confirmed a locoregional recurrence risk of 3.3% at a median of 18 months' follow-up. Although the study period in our series is arguably too short to observe any meaningful long-term oncological outcomes, our data collection is ongoing.…”

“…Knowles and colleagues reported an infection rate of 13.1% and hematoma rate of 8.7%. 4 Vitug and Newman reported an infection rate of 3.4%-18.3% and a hematoma rate of 2%-10%. 19 In our series, the complication rate in patients receiving level II oncoplastic procedures was 8.8%.…”

“…5 In addition to these benefits, the literature would suggest that local recurrence rates, overall survival and disease-free survival are similar after OPBS and traditional breast cancer surgery, with local recurrence rates ranging from 0% to 9.4%. 3,4,7,8 The rate of margin involvement is also similar in patients treated with only wide-local excision. 9,10 Oncoplastic breast surgery is the mainstay of breast cancer surgery in Europe.…”

“…OPBS allows for wide excision -perhaps avoiding a mastectomy -without sacrificing oncological outcomes. 3,4 Furthermore, data suggest that cosmetic outcomes after OPBS are superior to skin-or nipple-sparing mastectomy with immediate breast reconstruction. 5,6 Oncoplastic excisions also require less extensive reconstructive surgery and carry a risk of fewer complications than total mastectomy with immediate or delayed breast reconstruction.…”

Introducing oncoplastic breast surgery in a community hospital

“…Less established is whether these results can be replicated in community care settings. A recent 5-year case series by Knowles and colleagues 5 including 275 patients undergoing OPBS at a single advanced-level community hospital and regional cancer centre reported very favourable outcomes, including a positive margin rate of 13.5%, local recurrence in 3.3%, distant recurrence in 0.7%, and overall survival of 99.3%. Our centre had a similar margin involvement rate (10% post-OPBS), which is consistent with other studies in the literature.…”