Oncoplastic Breast-Conserving Surgery According to Tumor Location

Cantürk, Nuh Zafer; Şimşek, Turgay; Gürdal, Sibel Özkan

doi:10.4274/ejbh.galenos.2021.2021-1-2

Cited by 21 publications

(26 citation statements)

References 32 publications

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“…Considering the evidence in the literature, oncoplastic surgery was found to have low recurrences while improving the cosmetic outcome and patients' quality of life [10,[57][58][59][60][61][62][63][64][65][66][67].…”

Section: Resultsmentioning

confidence: 99%

“…These techniques have demonstrated promising results as a safer tool to handle large, complex tumors and lesions in difficult anatomical locations, whether multifocal or progressing on neoadjuvant therapy. As expected, the application of oncoplastic techniques has witnessed the emergence of new problems with margin adequacy due to the unavoidable displacement or replacement of residual breast tissue surrounding the excised tumor, according to excision size and location [58][59][60]. Regardless, the current literature demonstrates that oncoplas-tic surgery is a safe option in terms of re-excision, completion mastectomy rates, and local and distant recurrence [10,[61][62][63][64][65][66]; such surgery is oncologically safe and has been recommended in the case of DCIS [67].…”

Section: Evolution Of Margin Acceptabilitymentioning

confidence: 90%

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Updates and Debate Concerning Margin Adequacy and Management following Breast-Conserving Surgery

Bertozzi¹,

Londero²,

Nanez³

et al. 2022

Clin. Exp. Obstet. Gynecol.

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Objective: Breast-conserving surgery (BCS) experienced a significant surge during the last decades due to the increase of early breast cancer detection. Central to the discussion is margin adequacy which represents one of the most significant predictive factors for local relapse. This paper aims to shed light on the problem of margins in breast surgery. Mechanism: We performed a systematic narrative review of the literature by conducting a search using Medline/PubMed, Scopus, and Embase. The following keywords were considered: "breast-conserving surgery" AND "margins"/"margin". Findings in Brief: In the case of invasive breast cancer, "no ink on tumor" can be considered an adequate margin, while for ductal carcinoma in situ (DCIS), a distance of 2 mm from tumor should be obtained. Many novel tools have been developed based both on the latest radiological imaging techniques and on the tissue expression of certain markers, with the aim of precise navigation of tumor excision and intraoperative evaluation of cavity excision margins. Oncoplastic surgery can be considered oncologically safe while improving the cosmetic outcome and patients' quality of life. The appropriate use of adjuvant treatments in the context of a multidisciplinary and personalized management of breast cancer is the only means to omit a second intervention in some carefully selected cases. Conclusions: Debate still exists concerning the definition of adequate clear margin following BCS for DCIS. Further studies are required to better assess multimodal treatment approaches in this condition.

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Section: Resultsmentioning

confidence: 99%

Section: Evolution Of Margin Acceptabilitymentioning

confidence: 90%

Updates and Debate Concerning Margin Adequacy and Management following Breast-Conserving Surgery

Bertozzi¹,

Londero²,

Nanez³

et al. 2022

Clin. Exp. Obstet. Gynecol.

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“…Additionally, in accordance with the results, we found that patients with tumors in the outer quadrant had a significantly better prognosis than those with tumors in the inner quadrant or center location. This may be because the outer quadrant is a favorable location for large-volume excision to gain adequate surgical margins, especially for small tumors ( 34 ). Therefore, the low-risk group was safe enough and may gain limited benefit from RT.…”

Section: Discussionmentioning

confidence: 99%

The role of radiotherapy in HER2+ early-stage breast cancer patients after breast-conserving surgery

Yang

Qiu²,

Ye³

et al. 2023

Front. Oncol.

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BackgroundDue to radioresistance, some HER2+ patients may gain limited benefit from radiotherapy (RT) after breast-conserving surgery (BCS). This study aimed to develop an individualized nomogram to identify early-stage HER2+ patients who could omit RT after BCS.MethodsThe data of HER2+ patients with T0-2N0M0 breast cancer after BCS between 2010 and 2015 were extracted from Surveillance, Epidemiology, and End Results (SEER). Based on the independent prognostic factors determined by the Cox analysis in patients without RT after propensity score matching (PSM), the nomogram and risk stratification model were constructed, and then the prognosis of patients with and without RT was compared in each stratified group.ResultsA total of 10799 early-stage HER2+ patients after BCS were included. Baseline characteristics were similar between groups after PSM. Multivariate Cox analysis indicated that RT could improve overall survival (OS) (HR: 0.45, P<0.001) and breast cancer-specific survival (BCSS) (HR: 0.53, P<0.001). Age, marital status, tumor location, tumor size, and chemotherapy were identified by multivariate Cox analysis in patients without RT and were incorporated into a well-validated nomogram. The risk stratification model based on the nomogram indicated that RT was associated with improved OS (HR 0.40, P< 0.001) and BCSS (HR 0.39, P< 0.001) in the high-risk group but not in the low-risk group [OS: HR 1.04, P = 0.94; BCSS: HR 1.06, P = 0.93].ConclusionRT could significantly improve the OS and BCSS of HER2+ early-stage breast cancer patients after BCS on the whole. For high-risk patients, RT is an essential component of cancer therapy. However, the omission of radiotherapy may be considered for low-risk HER2+ early-stage patients. Further validation and improvement of the nomogram by prospective study or randomized controlled trials are warranted.

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“…Glandular density, patient-related risk factors (smoking, obesity, diabetes, previous surgery, etc. ), adjuvant treatments, patient preferences and expectations are other specific factors that will influence decision making with regards to the OBS technique [7,8].…”

Section: Review Oncoplastic Approaches To Breast Conservationmentioning

confidence: 99%

“…The objective is tumor excision without skin resection, and to repair partial breast defects effectively to reduce the risk of deformity that will occur with the effect of RT. The main principles are the localization of the tumor, planning the incision, dissecting the subcutaneous flap widely beyond the tumor, identifying the tumor, removing the specimen, undermining the breast anterior to the pectoralis fascia, marking the tumor cavity, and closure of the defect with mobilized tissue pillars [8].…”

Section: Review Oncoplastic Approaches To Breast Conservationmentioning

confidence: 99%

Oncoplastic and Reconstructive Breast Surgery: A Comprehensive Review

Çıtgez¹,

Yiğit²,

Baş³

2022

Cureus

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Most of the approaches that were valid until recently in breast cancer surgery have undergone significant changes with rising awareness, increasing number of patients, and knowledge. It is important to repair the damage caused by surgical treatment performed in accordance with oncological principles and to obtain good cosmetic results. The quality-of-life indexes increase and body image is positively affected by the development of oncoplastic surgery and reconstruction techniques.The oncoplastic techniques are commonly used for the closure of glandular defects. Surgeons must pay attention to the breast volume, tumor location, the amount of breast tissue that would be removed, and the oncoplastic technique that may be required. Oncoplastic breast surgery allows wide local excision of the mass with good cosmetic results. In addition, a contralateral breast lift, breast augmentation or breast reduction may be required to accommodate the conceptually reconstructed breast. The use of oncoplastic breast surgery techniques results in lower mastectomy rates with equivalent local and long-term survival rates as compared with mastectomy and offers women the option of plastic and reconstructive interventions performed at the time of initial surgery. Mastectomy may be needed for large tumors, as breast-conserving surgery may not be possible or may not produce satisfactory cosmetic results. Breast reconstruction methods after mastectomy include autologous or implant-based breast reconstructions, which can be performed at the same time as the breast cancer surgery (immediate reconstruction) or at a later time (delayed reconstruction).Oncoplastic and reconstructive breast surgery minimizes the impact of breast cancer surgery and yields equivalent survival outcomes without psychological morbidity. With advanced techniques, better breast image than before can also be achieved. In this review, the technical details of oncoplastic breast surgery, surgical margin positivity management, reconstruction methods, radiation therapy given after reconstruction surgery, radiologic imaging modalities, and management of complications are discussed.

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Oncoplastic Breast-Conserving Surgery According to Tumor Location

Cited by 21 publications

References 32 publications

Updates and Debate Concerning Margin Adequacy and Management following Breast-Conserving Surgery

Updates and Debate Concerning Margin Adequacy and Management following Breast-Conserving Surgery

The role of radiotherapy in HER2+ early-stage breast cancer patients after breast-conserving surgery

Oncoplastic and Reconstructive Breast Surgery: A Comprehensive Review

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