Comparison of Oncoplastic Breast-Conserving Surgery and Breast-Conserving Surgery Alone: A Meta-Analysis

Abstract

PurposeThe use of oncoplastic reconstruction for breast-conserving surgery (BCS) extends benefits beyond merely minimizing poor cosmetic results. However, the feasibility and oncological safety of oncoplastic surgery (OPS) are controversial.MethodsThis meta-analysis aimed to compare the short-term and long-term oncological outcomes of BCS alone and BCS plus OPS. Relevant studies published before July 2017 in the Embase, the Cochrane Library, PubMed, and Web of Science databases were screened and collected. The meta-analysis was performed using STATA software (Stata Corp.).ResultsA total of 3,789 patients from 11 studies were included, with 2,691 patients in the BCS-alone group and 1,098 patients in the BCS plus OPS group. The demographics were similar between both groups, and no significant difference was observed in pathological T and N stages between the two groups. Re-excision was less common (relative risk [RR], 0.66; p=0.009) and the positive-margin rate was lower, but not significantly (RR, 0.83; p=0.191), in the BCS plus OPS group than in the BCS-alone group. The local and distal recurrence rates were similar in both groups. Both disease-free survival (hazard ratio [HR], 1.19; 95% confidence interval [CI], 0.96–1.49; p=0.112) and overall survival (HR, 1.14; 95% CI, 0.76–1.69; p=0.527) did not differ between the two groups.ConclusionA combination of BCS and OPS is preferred over BCS alone for decreasing re-excisions and provides similar long-term survival as BCS alone in patients with breast cancer.

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

“…Heterogeneous definitions of insufficient margins, ranging from 'tumour within 10 mm from the ink margin' to 'tumour on ink', may partly explain the difference between the findings here and those of other studies 18,19 . The present overall re-excision rate of 15⋅2 per cent is within the range (0-15⋅7 per cent) reported in other studies 13,[53][54][55] that used the same definition of 'tumour on ink'.…”

“…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). Nonetheless, the overall use of OPS here was still substantially higher than in most previous studies 18,19 .…”

“…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. 0⋅48 to 0⋅90).…”

“…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.…”

Onkoplastisk brystbevarende kirurgi

“…Undersøkelser som foreligger, er av retrospektiv karakter og fra enkeltstående institusjoner (6,7,11). I en nyere metaanalyse av ni tidligere studier som sammenlignet onkoplastisk brystbevarende med enkel brystbevarende kirurgi, med begrenset observasjonstid, fant man signifikant lavere reeksisjonsrate og samtidig en tendens til faerre lokalresidiv etter onkoplastisk brystbevarende kirurgi (evidensnivå 2a) (20).…”