Oncoplastic breast surgery for the management of ductal carcinoma in situ (DCIS): is it oncologically safe? A retrospective cohort analysis

Lorenzi, Francesca De; Bella, Julien Di; Maisonneuve, Patrick; Rotmensz, Nicole; Corso, Giovanni; Orecchia, Roberto; Colleoni, Marco; Mazzarol, Giovanni; Rietjens, Mario; Loschi, Pietro; Marcelli, Stefano; Veronesi, Giulia; Galimberti, Viviana

doi:10.1016/j.ejso.2018.04.015

Cited by 15 publications

(14 citation statements)

References 18 publications

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“…DeLorenzi et al [21] compared OPS and BCS techniques for pure DCIS and reported surgical margin positivity rates as 4.5 and 3.5%, respectively. The IBTR rates have been found as similar between the groups.…”

Section: Discussionmentioning

confidence: 99%

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Efficacy and Safety of Glandular Flap Techniques in Surgical Treatment of Large Ductal Carcinoma in situ

Doğan

Gülçelik

2020

Breast Care

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Background: It is well known that full segmentary resection can be performed using oncoplastic surgery (OPS) techniques, and the anatomic resection of the ductal system is possible. Therefore, the efficacy and safety of OPS should be investigated in the treatment of ductal carcinoma in situ (DCIS). Patients and Methods: Patients who were diagnosed as pure DCIS and underwent surgical treatment and follow-up were retrospectively evaluated. Patients who underwent OPS and conventional breast-conserving surgery (BCS) were included in the study. The number of patients who required an intervention after the surgery and had a relapse during the follow-up period was determined in both groups. Results: There were 45 patients in the OPS group and 138 patients in the BCS group. The mean tumor size was larger in patients in the OPS group (36 ± 12 mm vs. 24 ± 8 mm, p = 0.02). Six (12.7%) patients were reoperated in the OPS group. Of these, 4 were re-excisions and 2 were mastectomies. In this group, breast conservation was possible in 45 (95.7%) patients. Thirty-nine (27%) patients were reoperated in the BCS group. Of these, 23 were re-excisions, and 16 were mastectomies. In this group, breast conservation was possible in 126 (88.7%) patients (p = 0.02). There was no significant difference between the groups in terms of 5-year cumulative local recurrence rates. While the 5-year local recurrence-free survival rate was 93.3% in the OPS group, it was 90.8% in the BCS group. Conclusion: This study provided evidence that OPS can be used safely in the surgical treatment of DCIS by reducing re-excision and completion mastectomy rates compared to BCS.

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Section: Discussionmentioning

confidence: 99%

“…To the best of our knowledge, the French study [10] with 68 patients is the largest series on this subject. The European Institute of Oncology study [21] is the only series that assigned BCS-performed patients as the control group. This study involves patients from 2000 to 2008, to whom level 1 or 2 techniques were performed as OPS.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and Safety of Glandular Flap Techniques in Surgical Treatment of Large Ductal Carcinoma in situ

Doğan

Gülçelik

2020

Breast Care

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“…One study reported on BMI [46] documenting a 52% risk reduction for a subsequent breast event in women with a BMI lower than 25 compared to women with a BMI of 25 or higher (HR (multivariate) 0.48 (95%-CI: 0.26e0.90)).…”

Section: Bmimentioning

confidence: 99%

“…Three studies [45,46,48] described statistically significant associations between menopausal status and the risk of developing a subsequent breast event. De Lorenzi et al [46] stated that the risk for a subsequent breast event was higher in women who were preor peri-menopausal (HR (multivariate) 1.89 (95%-CI: 1.09e3.29)) compared to post-menopausal women.…”

Section: Menopausal Statusmentioning

confidence: 99%

The impact of patient characteristics and lifestyle factors on the risk of an ipsilateral event after a primary DCIS: A systematic review

et al. 2020

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Objective: The majority of 'low-risk' (grade I/II) Ductal Carcinoma In Situ (DCIS) may not progress to invasive breast cancer during a women's lifetime. Therefore, the safety of active surveillance versus standard surgical treatment for DCIS is prospectively being evaluated in clinical trials. If proven safe and selectively implemented in clinical practice, a significant group of women with low-risk DCIS may forego surgery and radiotherapy in the future. Identification of modifiable and non-modifiable risk factors associated with prognosis after a primary DCIS would also enhance our care of women with low-risk DCIS. Methods: To identify modifiable and non-modifiable risk factors for subsequent breast events after DCIS, we performed a systematic literature search in PUBMED, EMBASE and Scopus. Results: Six out of the 3870 articles retrieved were included for final data extraction. These six studies included a total of 4950 patients with primary DCIS and 640 recorded subsequent breast events. There was moderate evidence for an association of a family history of breast cancer, premenopausal status, high BMI, and high breast density with a subsequent breast cancer or further DCIS. Conclusion:There is a limited number of recent studies published on the impact of modifiable and nonmodifiable risk factors on subsequent events after DCIS. The available evidence is insufficient to identify potential targets for risk reduction strategies, reflecting the relatively small numbers and the lack of longterm follow-up in DCIS, a low-event condition.

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“…14 No publication has specifically investigated the outcomes of synchronous multicentric and multifocal breast cancers treated by oncoplastic surgery, although small cohorts of patients with synchronous multiple cancers are included in the published series. [15][16][17][18][19][20] A recent systematic review by Winters et al 21 aimed to compare clinical outcomes after breast-conserving surgery versus mastectomy for multifocal and multicentric cancers, collectively defined as multiple ipsilateral breast cancers. Most of the studies they included were historical and did not report on ONC.…”

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confidence: 99%

Oncoplastic Breast-Conserving Surgery for Synchronous Multicentric and Multifocal Tumors: Is It Oncologically Safe? A Retrospective Matched-Cohort Analysis

et al. 2021

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Background Oncoplastic surgery is a well-established approach that combines breast-conserving treatment for breast cancer and plastic surgery techniques. Although this approach already has been described for multicentric and multifocal tumors, no long-term oncologic follow-up evaluation and no comparison with patients undergoing mastectomy have been published. This study aimed to evaluate whether oncoplastic surgery is a safe and reliable treatment for managing invasive primary multicentric and multifocal breast cancer. Methods The study compared a consecutive series of 100 patients with multicentric or multifocal tumors who had undergone oncoplastic surgery (study group) with 100 patients who had multicentric or multifocal tumors and had undergone mastectomy (control group) during a prolonged period. The end points evaluated were disease-free survival (DFS), overall survival (OS), cumulative incidence of local recurrence (CI-L), regional recurrence (CI-R), and distant recurrence (CI-D), all measured from the date of surgery. Results The OS and DFS were similar between the two groups. The incidence of local events was higher in the oncoplastic group, whereas the incidence of regional events was slightly higher in the mastectomy group. These differences were not statistically significant. The cumulative incidence of distant events was similar between the two groups. Conclusions To the authors’ knowledge, the current study provides the best available evidence suggesting that the oncoplastic approach is a safe and reliable treatment for managing invasive multifocal and multicentric breast cancers.

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Oncoplastic breast surgery for the management of ductal carcinoma in situ (DCIS): is it oncologically safe? A retrospective cohort analysis

Cited by 15 publications

References 18 publications

Efficacy and Safety of Glandular Flap Techniques in Surgical Treatment of Large Ductal Carcinoma in situ

Efficacy and Safety of Glandular Flap Techniques in Surgical Treatment of Large Ductal Carcinoma in situ

The impact of patient characteristics and lifestyle factors on the risk of an ipsilateral event after a primary DCIS: A systematic review

Oncoplastic Breast-Conserving Surgery for Synchronous Multicentric and Multifocal Tumors: Is It Oncologically Safe? A Retrospective Matched-Cohort Analysis

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