Oncoplastic Breast Surgery in India: Thinking Globally, Acting Locally

Koppiker, Chaitanyanand B.; Chintamani,; Dixit, Santosh

doi:10.1007/s12262-019-01890-8

Cited by 18 publications

(17 citation statements)

References 41 publications

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“…11 Koppiker et al also demonstrated that surgeons need to be trained enough to perform both the oncological and cosmetic segments of the surgery themselves, the "one surgeon-dual role" concept. 12 However, the learning curve is steep, and proper training courses and workshops need to be introduced to address this need.…”

Section: Discussionmentioning

confidence: 99%

A Survey on Oncoplastic Breast Surgery Awareness and Practice Patterns Among Indian Surgeons: A Cross-Sectional Study

Mishra¹,

Kelkar

Agrawal

et al. 2021

ijmsdr

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Purpose: To assess the perspective and practice patterns of Indian surgeons concerning OBS and compare urban and rural areas. Patients and methods: A thirteen-question survey was distributed through the social media platform WhatsApp (WhatsApp Inc, California, US) to various Indian surgical society groups across India from 5th May 2020 to 19th May 2020. The questions focused on the surgeons' experience, surgical management technique of choice in breast cancer patients, acceptance and practice of OBS, knowledge of type 1 and type 2 OBS, and axilla management. Results: Two hundred ninety surgeons responded to the survey out of about 1000, with a response rate of 29%. 17.99% of the surgeons (n=52) practiced in a rural region, while 82.01% (n=237) practiced in an urban region. 94.12% (n=272) of the surgeons reported awareness about oncoplastic breast surgery (OBS), whereas only 5.88% (n= 17) were unaware of the existence of this procedure. 62.97% (n=182) surgeons offered OBS to their breast cancer patients, while 37.02% (n=107) did not offer OBS. 49.37% of surgeons in the urban areas do not perform OBS, whereas 78.85% do not perform it in the rural regions. It also highlights that the percentage of surgeons performing OBS with a plastic surgeon (29.41%) is higher than those who carry out the procedure by themselves (15.92%). Conclusion: Most of the Indian surgeons are aware of OBS. In the rural areas, OBS's rate is minimal due to various reasons such as poverty, illiteracy, inaccessible radiotherapy centers, and the absence of training of surgeons in OBS. Few urban surgeons perform OBS themselves while most of them do it with the help of plastic surgeons. Mastectomy is the most commonly performed surgical intervention for breast cancer in rural regions. The practice of OBS should increase in India to improve the postoperative quality of life of breast cancer patients. Keywords: Oncoplastic Breast Surgery, Mastectomy, Breast-conserving surgery, Indian surgeons, Oncoplasty

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Section: Discussionmentioning

confidence: 99%

A Survey on Oncoplastic Breast Surgery Awareness and Practice Patterns Among Indian Surgeons: A Cross-Sectional Study

Mishra¹,

Kelkar

Agrawal

et al. 2021

ijmsdr

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“…The primary aim in BCS is to achieve a negative surgical margin while still preserving the aesthetically appealing breast. Adequate surgical margins have shown to decrease the incidence of local recurrence of the primary tumor [6][7][8][9][10]. To ensure negative margins, many techniques are suggested to assess the surgical margins.…”

Section: Discussionmentioning

confidence: 99%

“…Breast conservation surgery (BCS) is now an acceptable option for women with early-stage breast cancer and even in some cases of locally advanced breast cancer after response to neoadjuvant chemotherapy (NACT) [3][4][5]. Some patients who initially underwent breast conservation ultimately had mastectomy because of presence of close (less than 2mm) or positive surgical margins [6,7].…”

Section: Introductionmentioning

confidence: 99%

Intraoperative Specimen Ultrasonography: Is It a Reliable Tool for Margin Assessment Following Breast Conservation Surgery for Breast Carcinoma?

Kumar¹,

Tandon²,

Chintamani³

2021

Cureus

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Background: Assessment of margins after breast conservation surgery is an essential part of management in breast cancer and is important in prognostication of the patient. Various intra-operative techniques like frozen section and imprint cytology are in use to ensure negative margins but have their limitations in the fact that 3D evaluation is not feasible. These lead to false negatives and also are operator dependent. In order to obviate these shortcomings, various centers are using specimen imaging (specimen mammogram and ultrasonography).Aims and Objectives: 1) To evaluate the accuracy of specimen ultrasonography in assessing the margins following breast conservation surgery (BCS). 2) To compare the accuracy of intra-operative specimen ultrasonography with frozen section for assessment of excision margins following BCS.Materials and methods: Sixty-two biopsy-proven patients with breast cancer who underwent BCS were included in this prospective study at a tertiary cancer care center. The oriented specimens were evaluated by specimen ultrasonography and later by frozen section. The final histopathology served as the gold standard.Results: Specimen ultrasonography is found to be superior to frozen section in providing detailed assessment of margins in patients undergoing breast conservation. Specimen ultrasonography was also able to detect additional lesions which might be missed on frozen section, especially the in-situ carcinoma.

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“…The disparity from western world stretches beyond economic factors and owe to limited number of surgeons adequately trained to perform oncoplastic procedures. Therefore, data on the efficacy of OPS in breast cancer treatment from low and middle socioeconomic country is not substantial [ 18 , [19] , [20] ]. With the advent of neo-adjuvant therapy allowing more and more breast conserving procedures to be performed and declining mortality of breast cancer patients due to advances in adjuvant treatments, more women will live with the surgical treatment decided for them.…”

Section: Introductionmentioning

confidence: 99%

Oncoplastic surgery: A suitable alternative to conventional breast conserving surgery in low - Middle income countries; a retrospective cohort study

Abidi

Vohra

Javed

et al. 2021

Annals of Medicine &Amp; Surgery

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Introduction Breast Conserving Surgery (BCS) with whole breast radiation is now standard of care as a safer alternative to Mastectomy in terms of loco-regional recurrence and long-term survival. Despite this, a frequent pitfall of conventional BCS is positive surgical margins and need for second surgery with a reported frequency of 12–59 % in literature. Oncoplastic Surgery can be a safer, more cost effective alternate to conventional BCS owing to its higher rate of negative surgical margins (4–6% vs 12–59 %) and better cosmetic results. We aim to prove utility of Oncoplastic surgery for Low-Middle income countries. Objective The aim of this study was to determine Oncoplastic Surgery as a more appropriate alternative to Conventional Breast Conserving Surgery for Low-Middle Income countries in terms of its lower positive margins and re-excision rates. Methodology A retrospective comparative single center study by reviewing patient's medical records from August 2016 to June 2020 was conducted. Rate of positive margins and re-excisions along with mean volume of resection specimen, mean tumor size and quadrant dealt by both surgical procedures were compared. Results Out of 421 patients 249 patients underwent oncoplastic surgery and were compared with 173 patients who had conventional breast conserving surgery. Positive margins were seen in 5 patients (2 %) in OPS group whereas in 31 (17.9 %) patients in BCS group (p value < 0.001). Therefore, 2 from OPS group and 17 from BCS group underwent re-excision (p value < 0.002).None in OPS group while 7 out of 17 patients in BCS group underwent mastectomy as second procedure. Mean tumor size in OPS group was 2.26 cm ± SD 1.66 and in BCS group was 1.94 cm ± SD 1.28. Majority of Lobular carcinoma and Ductal carcinoma in-situ, multifocal, upper inner and central quadrant tumors and those unresponsive to neo-adjuvant therapy were treated by Oncoplastic techniques. Conclusion Oncoplastic surgery has shown promising results as a safer tool to deal with large, complex tumors, lesions in difficult anatomical locations, multifocal or progressing on neo-adjuvant therapy. With its low Re-excision rates, it is a better alternative to traditional Breast Conserving approach for overburdened and resource limited health care system of Low-Middle Income countries. Multi-center, prospective trials are needed to determine its feasibility.

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Oncoplastic Breast Surgery in India: Thinking Globally, Acting Locally

Cited by 18 publications

References 41 publications

A Survey on Oncoplastic Breast Surgery Awareness and Practice Patterns Among Indian Surgeons: A Cross-Sectional Study

A Survey on Oncoplastic Breast Surgery Awareness and Practice Patterns Among Indian Surgeons: A Cross-Sectional Study

Intraoperative Specimen Ultrasonography: Is It a Reliable Tool for Margin Assessment Following Breast Conservation Surgery for Breast Carcinoma?

Oncoplastic surgery: A suitable alternative to conventional breast conserving surgery in low - Middle income countries; a retrospective cohort study

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