Comparison of clinicopathologic, cosmetic and quality of life outcomes in 700 oncoplastic and conventional breast-conserving surgery cases: A single-centre retrospective study

Kelemen, P. B.; Pukancsik, Dávid; Újhelyi, Mihály; Sávolt, Ákos; Kovács, Eszter; Ivády, Gabriella; Kenessey, István; Kovács, Tibor; Stamatiou, Alexia; Smanykó, Viktor; Mátrai, Zoltán

doi:10.1016/j.ejso.2018.09.006

Cited by 62 publications

(59 citation statements)

References 39 publications

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“…Arguably, the pertinent influence is the pre‐operative tumour size, notably in the M‐L and S‐I dimensions. The increased pre‐operative tumour size and surgical specimen weight in the OBS group compared with the WLE group is of no surprise and has been demonstrated by several studies 9,10 …”

Section: Discussionmentioning

confidence: 76%

“…The increased preoperative tumour size and surgical specimen weight in the OBS group compared with the WLE group is of no surprise and has been demonstrated by several studies. 9,10 An overarching advantage with the OBS is the ability to preserve or improve breast aesthetics despite higher tumour-to-breast ratios. Specifically, WLE has been reported to yield inadequate aesthetic outcomes in 20-25% of patients, after both subjective and objective assessment.…”

Section: Discussionmentioning

confidence: 99%

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Achieving margin clearance following oncoplastic breast surgery in comparison with simple wide local excision: a three‐dimensional specimen assessment

Garreffa

Kankam

Bali

et al. 2020

ANZ Journal of Surgery

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Background: Pre-operative breast tumour radial dimensions often determine the choice between simple wide local excision (WLE) and oncoplastic breast surgery (OBS). We reviewed the three-dimensional interplay between tumour and surgical specimen dimensions in the two cohorts. Methods: Demographic, tumour and treatment data were collected for all patients undergoing OBS by a single surgeon and compared with a randomly selected cohort of WLE patients treated. The relationship between tumour and specimen medio-lateral, superoinferior and antero-posterior dimensions were explored in both groups. Subgroup analyses were performed in the OBS cohort (parenchymal displacement versus replacement). Results: We identified 60 OBS patients (63 breasts), comparing them with 60 WLE patients. Pre-operative tumour estimated size was significantly larger in the OBS cohort and concordant with macroscopic tumour radial dimensions and final microscopic tumour size. Surgical specimen weight was more than 3.5 times higher in the OBS group and its radial dimensions were almost double. No significant difference was observed for the anteroposterior dimensions. The rate of margin re-excisions and completion mastectomies were lower in the OBS cohort. WLE patients with positive margins had a lower tumour-tospecimen ratio, whereas, the requirement for further surgery in the OBS cohort was associated with larger tumour dimensions. Conclusion: Despite larger tumour dimensions, OBS is not inferior to WLE in providing clear surgical margins. Our analysis of the three-dimensional spatial relationship between cancer and surgical specimen, although not completely conclusive, can be helpful in the selection of the most appropriate surgical approach for every patient.

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Section: Discussionmentioning

confidence: 76%

Section: Discussionmentioning

confidence: 99%

Achieving margin clearance following oncoplastic breast surgery in comparison with simple wide local excision: a three‐dimensional specimen assessment

Garreffa

Kankam

Bali

et al. 2020

ANZ Journal of Surgery

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“…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.…”

Section: Discussionmentioning

confidence: 99%

“…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.…”

Section: Introductionmentioning

confidence: 99%

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

Heeg

Jensen

Hølmich

et al. 2020

British Journal of Surgery

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Background: There is no consensus regarding the impact of oncoplastic surgery (OPS) on rates of re-excision and conversion to mastectomy following breast-conserving surgery (BCS). Here these two outcomes after BCS and OPS were compared in a nationwide population-based setting. Methods: In Denmark, all OPS is registered and categorized into volume displacement, volume reduction or volume replacement. Patients who underwent BCS or OPS between 2012 and 2018 were selected from the Danish Breast Cancer Group database. Multivariable analyses were performed to adjust for confounders, and propensity score matching to limit potential confounding by indication bias. Results: A total of 13 185 patients (72⋅5 per cent) underwent BCS and 5003 (27⋅5 per cent) OPS. Volume displacement was used in 4171 patients (83⋅4 per cent), volume reduction in 679 (13⋅6 per cent) and volume replacement in 153 (3⋅1 per cent). Re-excision rates were 15⋅6 and 14⋅1 per cent after BCS and OPS respectively. After adjusting for confounders, patients were less likely to have a re-excision following OPS than BCS (odds ratio (OR) 0⋅80, 95 per cent c.i. 0⋅72 to 0⋅88), specifically after volume displacement and reduction. The rate of conversion to mastectomy was similar after OPS and BCS (3⋅2 versus 3⋅7 per cent; P = 0⋅105), but with a lower risk in adjusted analysis (OR 0⋅69, 0⋅58 to 0⋅84), specifically after volume displacement and reduction procedures. Findings were similar after propensity score matching. Conclusion: A modest decrease in re-excision rate and less frequent conversion to mastectomy were observed after OPS compared with BCS.

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Oncoplastic breast-conserving surgery for women with primary breast cancer

Nanda

Hodgkinson

et al. 2021

Cochrane Database of Systematic Reviews

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Comparison of clinicopathologic, cosmetic and quality of life outcomes in 700 oncoplastic and conventional breast-conserving surgery cases: A single-centre retrospective study

Cited by 62 publications

References 39 publications

Achieving margin clearance following oncoplastic breast surgery in comparison with simple wide local excision: a three‐dimensional specimen assessment

Achieving margin clearance following oncoplastic breast surgery in comparison with simple wide local excision: a three‐dimensional specimen assessment

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

Oncoplastic breast-conserving surgery for women with primary breast cancer

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