Operative and Oncologic Outcomes in 9861 Patients with Operable Breast Cancer: Single-Institution Analysis of Breast Conservation with Oncoplastic Reconstruction

Carter, Stacey A.; Lyons, Genevieve; Kuerer, Henry Mark; Bassett, Roland L.; Oates, Scott; Thompson, Alastair; Caudle, Abigail S.; Mittendorf, Elizabeth A.; Bedrosian, Isabelle; Lucci, Anthony; DeSnyder, Sarah M.; Babiera, Gildy; Yi, Min; Baumann, Donald P.; Clemens, Mark W.; Garvey, Patrick B.; Hunt, Kelly K.; Hwang, Rosa F.

doi:10.1245/s10434-016-5407-9

Cited by 134 publications

(107 citation statements)

References 27 publications

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“…Patients opting for reconstructive procedures (OS or M+R) were most significant with a diagnosis of DCIS. Previous analyses from 1998 to 2011 showed that mastectomy and M+R rates increased most significantly in lower-staged breast cancers characterized by negative nodal involvement, small radius, and non-invasive pathology [8, 12]. Such results correlate with our present findings of surgical reconstruction in patients with DCIS.…”

Section: Discussionsupporting

confidence: 90%

“…Although both M+R and OS inherently represent reconstructive techniques, OS has higher patient satisfaction [19, 20] and has also been shown to be cost-effective [23, 24]. Collectively, these fundamental principles may influence a patient’s decision for breast reconstruction, and thereby explain the trends seen in our present analysis [6, 12]. …”

Section: Discussionmentioning

confidence: 86%

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Surgical trends in breast cancer: a rise in novel operative treatment options over a 12 year analysis

Jonczyk

Jean

Graham

et al. 2018

Breast Cancer Res Treat

156

118

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Purpose Breast cancer surgical techniques are evolving. Few studies have analyzed national trends for the multitude of surgical options that include partial mastectomy (PM), mastectomy without reconstruction (M), mastectomy with reconstruction (M+R), and PM with oncoplastic reconstruction (OS). We hypothesize that the use of M is declining and likely correlates with the rise of surgery with reconstructive options (M+R, OS). Methods A retrospective cohort analysis was conducted using the ACS-NSQIP database from 2005 to 2016 and ICD codes for IBC and DCIS. Patients were then grouped together based on current procedural terminology (CPT) codes for PM, M, M+R, and OS. In each group, categories were sorted again based on additional reconstructive procedures. Data analysis was conducted via Pearson’s chi-squared test for demographics, linear regression, and a non-parametric Mann-Kendall test to assess a temporal trend. Results The patient cohort consisted of 256,398 patients from the NSQIP data base; 197,387 meet inclusion criteria diagnosed with IBC or DCIS. Annual breast surgery trends changed as follows: PM 46.3–46.1% (p = 0.21), M 35.8–26.4% (p = 0.001), M+R 15.9–23.0% (p = 0.03), and OS 1.8–4.42% (p = 0.001). Analyzing the patient cohort who underwent breast conservation, categorical analysis showed a decreased use of PM alone (96–91%) with an increased use of OS (4–9%). For the patient cohort undergoing mastectomy, M alone decreased (69–53%); M+R with muscular flap decreased (9–2%); and M+R with implant placement increased (20–40%)—all three trends p < 0.0001. Conclusion The modern era of breast surgery is identified by the increasing use of reconstruction for patients undergoing breast conservation (in the form of OS) and mastectomy (in the form of M+R). Our study provides data showing significant trends that will impact the future of both breast cancer surgery and breast training programs.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 86%

Surgical trends in breast cancer: a rise in novel operative treatment options over a 12 year analysis

Jonczyk

Jean

Graham

et al. 2018

Breast Cancer Res Treat

156

118

View full text Add to dashboard Cite

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“…TM procedures are more complex than standard BCS, with potential resource implications. Although complication rates and oncological safety have been reported in the literature the majority of published studies are retrospective, single‐centre, often single‐surgeon case series with limited follow‐up. Many are poorly designed and reported, with inconsistent end‐points that limit cross‐study comparison and meaningful data synthesis.…”

Section: Introductionmentioning

confidence: 99%

Current practice and short-term outcomes of therapeutic mammaplasty in the international TeaM multicentre prospective cohort study

O’Connell

Baker

Trickey

et al. 2018

British Journal of Surgery

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“…Since the end of 1900s, when oncoplastic approach began, it has been spreading over breast units, and it has increased notably in the last decade; as an example of this, Carter et al (12) state that the use of oncoplastic breast surgery experimented a nearly fourfold increase in the percentage of all breast cancer surgeries during the study period (2007 to 2014) in a single center study comprising 10,607 operations; 75% of the patients had an early cancer (T1 or T2 tumor) and the rate of positive or close margins was lower for oncoplastic techniques than conventional ones (5.8% vs. 8.3%).…”

Section: Hernanz Et Al Tailored Needle-guided Excisionmentioning

confidence: 99%

Oncoplastic breast conserving surgery with tailored needle-guided excision

et al. 2017

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Background: Breast conserving surgery (BCS) administered with oncoplastic approach (OBCS), when it is required, is currently the gold standard for the treatment of early breast cancer. Wire-guided localization (WL) is the most popular technique used to help surgeon in breast cancer excision. Currently, a universal and undeniable goal is to minimize the rate of positive margins and re-excision operation after BCS improving cosmetic outcome and decreasing health care costs. This study is aimed to report our experience combining OBCS and tailored WL as surgical approach for early breast cancers.Methods: We performed a retrospective study on 148 breast cancer patients who were treated with OBCS and tailored WL, which consists in individualization of the number and location of wires depending on patient particularities, in our Breast Unit from March 2013 to December 2015. A multivariate analysis was used to determine the association between clinic-pathologic variables, which can be known preoperatively, and margin status.Results: The rate of affected margins was 13.5% and 10.8% patients underwent re-interventions for oncologic reasons. Multifocality was strongly associated with involved margins [odds ratio (OR) 4.67].Conclusions: OBCS together with tailored WL obtains an acceptable rate of positive margins and high rate of final BCS.

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Operative and Oncologic Outcomes in 9861 Patients with Operable Breast Cancer: Single-Institution Analysis of Breast Conservation with Oncoplastic Reconstruction

Abstract: Patients undergoing BCS + R are not disadvantaged in terms of complications and short-term (3-year) outcomes compared with BCS patients or patients who underwent TM.

Cited by 134 publications

References 27 publications

Surgical trends in breast cancer: a rise in novel operative treatment options over a 12 year analysis

Surgical trends in breast cancer: a rise in novel operative treatment options over a 12 year analysis

Current practice and short-term outcomes of therapeutic mammaplasty in the international TeaM multicentre prospective cohort study

Oncoplastic breast conserving surgery with tailored needle-guided excision

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