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Gaffney KA, Karamchandani MM, De La Cruz Ku G, Wareham C, Homsy C, Nardello S, Chatterjee A, Persing SM. Oncoplastic Surgery Outcomes in the Older Breast Cancer Population: A Matched-Cohort Comparison Study. Ann Plast Surg 2024; 93:183-188. [PMID: 38980943 DOI: 10.1097/sap.0000000000004018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2024]
Abstract
BACKGROUND Oncoplastic breast surgery (OBS) is a form of breast conservation surgery (BCS) that involves a partial mastectomy followed by immediate volume displacement or volume replacement surgical techniques. To date, there are few studies evaluating OBS in older patients. Therefore, we sought to determine if outcomes differed between patients 65 years and older versus younger patients who underwent oncoplastic surgical procedures. METHODS A retrospective chart review was performed for all oncoplastic breast operations within a single health system from 2015 to 2021. Patients were stratified by age, with patients 65 years and older (OBS65+) identified and then matched with younger patients (OBS <65) based on BMI. Primary outcomes were positive margin rates and overall complication rates; secondary outcomes were locoregional recurrence (LR), distant recurrence (DR), disease-free survival (DFS), overall survival (OS), and long-term breast asymmetry. RESULTS A total of 217 patients underwent OBS over the 6-year period, with 22% being OBS65+. Preoperatively, older patients experienced higher American Anesthesia (ASA) scores, Charlson Co-morbidity index (CCI) scores, and higher rates of diabetes mellitus, hypertension, and grade 3 breast ptosis. Despite this, no significant differences were found between primary or secondary outcomes compared to younger patients undergoing the same procedures. CONCLUSIONS Oncoplastic breast reconstruction is a safe option in patients 65 years and older, with overall similar recurrence rates, positive margin rates, and survival when compared to younger patients. Although the older cohort of patients had greater preoperative risk, there was no difference in overall surgical complication rates or outcomes. Supporting the argument that all oncoplastic breast reconstruction techniques should be offered to eligible patients, irrespective of age.
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Affiliation(s)
- Kerry A Gaffney
- From the Department of Surgery, Tufts Medical Center, Boston
| | | | | | - Carly Wareham
- From the Department of Surgery, Tufts Medical Center, Boston
| | | | - Salvatore Nardello
- Division of Surgical Oncology and Breast Surgery, Department of Surgery, Tufts Medical Center, Boston, MA
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Necker FN, Cholok DJ, Shaheen MS, Fischer MJ, Gifford K, El Chemaly T, Leuze CW, Scholz M, Daniel BL, Momeni A. Leveraging the Apple Ecosystem: Easy Viewing and Sharing of Three-dimensional Perforator Visualizations via iPad/iPhone-based Augmented Reality. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5940. [PMID: 38957720 PMCID: PMC11216661 DOI: 10.1097/gox.0000000000005940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 05/10/2024] [Indexed: 07/04/2024]
Abstract
We introduce a novel technique using augmented reality (AR) on smartphones and tablets, making it possible for surgeons to review perforator anatomy in three dimensions on the go. Autologous breast reconstruction with abdominal flaps remains challenging due to the highly variable anatomy of the deep inferior epigastric artery. Computed tomography angiography has mitigated some but not all challenges. Previously, volume rendering and different headsets were used to enable better three-dimensional (3D) review for surgeons. However, surgeons have been dependent on others to provide 3D imaging data. Leveraging the ubiquity of Apple devices, our approach permits surgeons to review 3D models of deep inferior epigastric artery anatomy segmented from abdominal computed tomography angiography directly on their iPhone/iPad. Segmentation can be performed in common radiology software. The models are converted to the universal scene description zipped format, which allows immediate use on Apple devices without third-party software. They can be easily shared using secure, Health Insurance Portability and Accountability Act-compliant sharing services already provided by most hospitals. Surgeons can simply open the file on their mobile device to explore the images in 3D using "object mode" natively without additional applications or can switch to AR mode to pin the model in their real-world surroundings for intuitive exploration. We believe patient-specific 3D anatomy models are a powerful tool for intuitive understanding and communication of complex perforator anatomy and would be a valuable addition in routine clinical practice and education. Using this one-click solution on existing devices that is simple to implement, we hope to streamline the adoption of AR models by plastic surgeons.
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Affiliation(s)
- Fabian N. Necker
- From the Department of Radiology, Stanford IMMERS (Incubator for Medical Mixed and Extended Reality at Stanford), Stanford University School of Medicine, Palo Alto, Calif
- Institute of Functional and Clinical Anatomy, Digital Anatomy Lab, Faculty of Medicine, Friedrich-Alexander Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Stanford University School of Medicine, Palo Alto, Calif
| | - David J. Cholok
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Stanford University School of Medicine, Palo Alto, Calif
| | - Mohammed S. Shaheen
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Stanford University School of Medicine, Palo Alto, Calif
| | - Marc J. Fischer
- From the Department of Radiology, Stanford IMMERS (Incubator for Medical Mixed and Extended Reality at Stanford), Stanford University School of Medicine, Palo Alto, Calif
| | - Kyle Gifford
- Department of Radiology, 3D and Quantitative Imaging, Stanford University School of Medicine, Stanford, Calif
| | - Trishia El Chemaly
- From the Department of Radiology, Stanford IMMERS (Incubator for Medical Mixed and Extended Reality at Stanford), Stanford University School of Medicine, Palo Alto, Calif
| | - Christoph W. Leuze
- From the Department of Radiology, Stanford IMMERS (Incubator for Medical Mixed and Extended Reality at Stanford), Stanford University School of Medicine, Palo Alto, Calif
| | - Michael Scholz
- Institute of Functional and Clinical Anatomy, Digital Anatomy Lab, Faculty of Medicine, Friedrich-Alexander Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Bruce L. Daniel
- From the Department of Radiology, Stanford IMMERS (Incubator for Medical Mixed and Extended Reality at Stanford), Stanford University School of Medicine, Palo Alto, Calif
| | - Arash Momeni
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Stanford University School of Medicine, Palo Alto, Calif
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3
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Yang AZ, Hyland CJ, Miller AS, Killelea BK, Starr BF, Broyles JM. Local practice variations and payer differences underlie state-wide disparities in oncoplastic breast surgery. J Surg Oncol 2024. [PMID: 38941173 DOI: 10.1002/jso.27755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 05/17/2024] [Accepted: 06/14/2024] [Indexed: 06/30/2024]
Abstract
BACKGROUND Little is known about disparities in oncoplastic breast surgery delivery. METHODS The Massachusetts All-Payer Claims Database was queried for patients who received lumpectomy for a diagnosis of breast cancer. Oncoplastic surgery was defined as adjacent tissue transfer, complex trunk repair, reduction mammoplasty, mastopexy, flap-based reconstruction, prosthesis insertion, or unspecified breast reconstruction after lumpectomy. RESULTS We identified 18 748 patients who underwent lumpectomy between 2016 and 2020. Among those, 3140 patients underwent immediate oncoplastic surgery and 436 patients underwent delayed oncoplastic surgery. Eighty-one percent of patients who underwent oncoplastic surgery did so in the same county as they underwent a lumpectomy. However, the relative frequency of oncoplastic surgery varied significantly among counties. In multivariable regression, public insurance status (odds ratio: 0.87, 95% confidence interval: 0.80-0.95, p = 0.002) was associated with lower odds of undergoing oncoplastic surgery, even after adjusting for macromastia, other comorbidities, and county of lumpectomy. Average payments for lumpectomy with oncoplastic surgery were more than twice as high from private insurers ($840 vs. $1942, p < 0.001). CONCLUSION Disparities in the receipt of oncoplastic surgery were related to differences in local practice patterns and the type of insurance patients held. Expanding services across counties and considering billing reform may help reduce these disparities.
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Affiliation(s)
- Alan Z Yang
- Harvard Medical School, Boston, Massachusetts, USA
| | | | | | - Brigid K Killelea
- Division of Breast Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | - Justin M Broyles
- Division of Plastic and Reconstructive Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Mathelin C, Brousse S, Schmitt M, Taris N, Uzan C, Molière S, Vaysse C. [Updated surgical indications and quality and safety indicators in the management of infiltrative breast carcinoma]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2024; 52:125-131. [PMID: 38122844 DOI: 10.1016/j.gofs.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 12/14/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVES Breast surgery is the cornerstone of breast cancer treatment. Its indications and procedures are constantly evolving. To update best practices, four questions were submitted to the Senology Commission (SC) of the Collège national des gynécologues et obstétriciens français (CNGOF), covering the indications and modalities of tumor surgery: (1) initially, (2) following neoadjuvant systemic treatment, (3) in case of local recurrence, and (4) the quality and safety of care indicators applicable to this surgery. METHODS The CNGOF SC essentially based its responses on the clinical practice recommendations and guidelines of the French Cancer Institute concerning invasive carcinomas of the breast. Exclusion criteria were carcinoma in situ, sarcoma and axillary surgery. RESULTS To define the type of breast surgery, knowledge of four parameters is essential: the patient's level of risk, the presence of metastases, the size of the breast tumor and its focality (assessed by the clinical/mammography/ultrasound tripod). (1) In the case of initial management, the 6 indications for mastectomy are patient choice (particularly in case of high risk), contraindication to radiotherapy, inflammatory cancer (T4d), surgery with positive margins (after several surgical intervention), surgery that cannot be performed as a monobloc in the case of tumors with multiple foci, and poor expected aesthetic results. All other situations should be treated conservatively. (2) The same criteria apply after neoadjuvant systemic treatment, with conservative treatment still possible whatever the size (excluding carcinomatous mastitis) and focality of the initial tumor. (3) In case of local recurrence, total mastectomy is the reference treatment, with a second conservative treatment reserved for patients with no risk factors for a second recurrence, and no poor prognostic factors, after validation in a multidisciplinary meeting. (4) Four quality and safety indicators apply to breast surgery: it must be performed after obtaining a histological diagnosis, within less than 6 weeks of mammography, in a single surgery in over 80% of cases, and followed by local radiotherapy in the case of conservative treatment. CONCLUSION The indications and modalities of breast surgery are evolving rapidly. To improve aesthetic results, oncoplastic techniques, immediate breast reconstruction, and preservation of the skin or nipple-areolar complex need to be further developed and evaluated in the long-term. These developments must necessarily be accompanied in France by a training policy for breast surgeons.
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Affiliation(s)
- Carole Mathelin
- Service de chirurgie, ICANS, avenue Albert-Calmette, 67200 Strasbourg, France; CHRU, avenue Molière, 67200 Strasbourg, France.
| | - Susie Brousse
- Service de chirurgie, centre Eugène-Marquis, avenue de la Bataille Flandres-Dunkerque, 35042 Rennes cedex, France.
| | - Martin Schmitt
- Service de radiothérapie, CHR Metz-Thionville, hôpital de Mercy, 1, allée du Château, 57085 Metz cedex, France.
| | - Nicolas Taris
- Service d'onco-génétique, ICANS, avenue Albert-Calmette, 67200 Strasbourg, France.
| | - Catherine Uzan
- Service de chirurgie et cancérologie gynécologique et mammaire, hôpital Pitié-Salpêtrière, Sorbonne université, AP-HP, 47-83, boulevard de l'Hôpital, 75013 Paris, France.
| | - Sébastien Molière
- Service d'imagerie de la femme, ICANS, avenue Albert-Calmette, 67200 Strasbourg, France; Service de radiologie B, CHU de Strasbourg, avenue Molière, 67200 Strasbourg, France.
| | - Charlotte Vaysse
- Service de chirurgie gynécologique oncologique, IUCT-Oncopole, CHU de Toulouse, 1, avenue Irène-Joliot-Curie, 31059 Toulouse cedex 9, France.
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Xu J, Zhu XM, Ng KC, Alhefzi MM, Avram R, Coroneos CJ. Co-surgeon versus Single-surgeon Outcomes in Free Tissue Breast Reconstruction: A Meta-analysis. J Reconstr Microsurg 2024. [PMID: 38267008 DOI: 10.1055/a-2253-6099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
BACKGROUND Autologous breast reconstruction offers superior long-term patient reported outcomes compared with implant-based reconstruction. Universal adoption of free tissue transfer has been hindered by procedural complexity and long operative time with microsurgery. In many specialties, co-surgeon (CS) approaches are reported to decrease operative time while improving surgical outcomes. This systematic review and meta-analysis synthesizes the available literature to evaluate the potential benefit of a CS approach in autologous free tissue breast reconstruction versus single-surgeon (SS). METHODS A systematic review and meta-analysis was conducted using PubMed, Embase, and MEDLINE from inception to December 2022. Published reports comparing CS to SS approaches in uni- and bilateral autologous breast reconstruction were identified. Primary outcomes included operative time, postoperative outcomes, processes of care, and financial impact. Risk of bias was assessed and outcomes were characterized with effect sizes. RESULTS Eight retrospective studies reporting on 9,425 patients were included. Compared with SS, CS approach was associated with a significantly shorter operative time (SMD -0.65, 95% confidence interval [CI] -1.01 to -0.29, p < 0.001), with the largest effect size in bilateral reconstructions (standardized mean difference [SMD] -1.02, 95% CI -1.37 to -0.67, p < 0.00001). CS was also associated with a significant decrease in length of hospitalization (SMD -0.39, 95% CI -0.71 to -0.07, p = 0.02). Odds of flap failure or surgical complications including surgical site infection, hematoma, fat necrosis, and reexploration were not significantly different. CONCLUSION CS free tissue breast reconstruction significantly shortens operative time and length of hospitalization compared with SS approaches without compromising postoperative outcomes. Further research should model processes and financial viability of its adoption in a variety of health care models.
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Affiliation(s)
- Joshua Xu
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Xi Ming Zhu
- Division of Plastic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Kimberly C Ng
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | | | - Ronen Avram
- Division of Plastic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Christopher J Coroneos
- Division of Plastic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
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Johnson L, White P, Jeevan R, Browne J, Gulliver-Clarke C, O’Donoghue J, Mohiuddin S, Hollingworth W, Fairbrother P, MacKenzie M, Holcombe C, Potter S. Long-term patient-reported outcomes of immediate breast reconstruction after mastectomy for breast cancer: population-based cohort study. Br J Surg 2023; 110:1815-1823. [PMID: 37766501 PMCID: PMC10638530 DOI: 10.1093/bjs/znad276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 06/27/2023] [Accepted: 08/10/2023] [Indexed: 09/29/2023]
Abstract
BACKGROUND Breast reconstruction is offered to improve quality of life for women after mastectomy for breast cancer, but information regarding the long-term patient-reported outcomes of different reconstruction procedures is currently lacking. The Brighter study aimed to evaluate long-term patient-reported outcomes after immediate breast reconstruction (IBR) in a population-based cohort. METHODS Women who underwent mastectomy with IBR for breast cancer in England between 1 January 2008 and 31 March 2009 were identified from National Health Service Hospital Episode Statistics. Surviving women were invited to complete the BREAST-Q, EQ-5D-5L™, and ICECAP-A at least 12 years after the index procedure. Questionnaires were scored according to developers' instructions and compared by IBR type. RESULTS Some 1236 women underwent IBR; 343 (27.8 per cent) had 2-stage expander/implant, 630 (51.0 per cent) latissimus dorsi, and 263 (21.3 per cent) abdominal flap reconstructions, with a mean(s.d.) follow-up of 13.3(0.5) years. Women who underwent abdominal flap reconstruction reported higher scores in all BREAST-Q domains than those who had other procedures. These differences remained statistically significant and clinically meaningful after adjusting for age, ethnicity, geographical region, socioeconomic status, smoking, BMI, and complications. The greatest difference was seen in scores for satisfaction with breasts; women who had abdominal flap reconstructions reported scores that were 13.17 (95 per cent c.i. 9.48 to 16.87) points; P < 0.001) higher than those among women who had two-stage expander/implant procedures. Women who underwent latissimus dorsi reconstruction reported significantly more pain/discomfort on the EQ-5D-5L™, but no other differences between procedures were seen. CONCLUSION Long-term patient-reported outcomes are significantly better following abdominal flap reconstruction than other traditional procedure types. These findings should be shared with women considering IBR to help them make informed decisions about their surgical options.
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Affiliation(s)
- Leigh Johnson
- Translational Health Sciences, Bristol Medical School, Bristol, UK
| | - Paul White
- Applied Statistics Group, University of the West of England, Bristol, UK
| | - Ranjeet Jeevan
- Department of Plastic Surgery, Manchester University NHS Foundation Trust, Manchester, UK
| | - John Browne
- School of Public Health, University College Cork, Cork, Ireland
| | - Carmel Gulliver-Clarke
- Department of Breast Surgery, Western Sussex Hospitals NHS Foundation Trust, Worthing, UK
| | - Joe O’Donoghue
- Department of Plastic Surgery, Royal Victoria Infirmary, Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Syed Mohiuddin
- Translational Health Sciences, Bristol Medical School, Bristol, UK
| | | | | | | | - Chris Holcombe
- Linda McCartney Centre, Royal Liverpool and Broadgreen University Hospital, Liverpool, UK
| | - Shelley Potter
- Translational Health Sciences, Bristol Medical School, Bristol, UK
- Bristol Breast Care Centre, Southmead Hospital, Bristol, UK
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7
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Saleh GA, Batouty NM, Gamal A, Elnakib A, Hamdy O, Sharafeldeen A, Mahmoud A, Ghazal M, Yousaf J, Alhalabi M, AbouEleneen A, Tolba AE, Elmougy S, Contractor S, El-Baz A. Impact of Imaging Biomarkers and AI on Breast Cancer Management: A Brief Review. Cancers (Basel) 2023; 15:5216. [PMID: 37958390 PMCID: PMC10650187 DOI: 10.3390/cancers15215216] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 10/13/2023] [Accepted: 10/21/2023] [Indexed: 11/15/2023] Open
Abstract
Breast cancer stands out as the most frequently identified malignancy, ranking as the fifth leading cause of global cancer-related deaths. The American College of Radiology (ACR) introduced the Breast Imaging Reporting and Data System (BI-RADS) as a standard terminology facilitating communication between radiologists and clinicians; however, an update is now imperative to encompass the latest imaging modalities developed subsequent to the 5th edition of BI-RADS. Within this review article, we provide a concise history of BI-RADS, delve into advanced mammography techniques, ultrasonography (US), magnetic resonance imaging (MRI), PET/CT images, and microwave breast imaging, and subsequently furnish comprehensive, updated insights into Molecular Breast Imaging (MBI), diagnostic imaging biomarkers, and the assessment of treatment responses. This endeavor aims to enhance radiologists' proficiency in catering to the personalized needs of breast cancer patients. Lastly, we explore the augmented benefits of artificial intelligence (AI), machine learning (ML), and deep learning (DL) applications in segmenting, detecting, and diagnosing breast cancer, as well as the early prediction of the response of tumors to neoadjuvant chemotherapy (NAC). By assimilating state-of-the-art computer algorithms capable of deciphering intricate imaging data and aiding radiologists in rendering precise and effective diagnoses, AI has profoundly revolutionized the landscape of breast cancer radiology. Its vast potential holds the promise of bolstering radiologists' capabilities and ameliorating patient outcomes in the realm of breast cancer management.
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Affiliation(s)
- Gehad A. Saleh
- Diagnostic and Interventional Radiology Department, Faculty of Medicine, Mansoura University, Mansoura 35516, Egypt; (G.A.S.)
| | - Nihal M. Batouty
- Diagnostic and Interventional Radiology Department, Faculty of Medicine, Mansoura University, Mansoura 35516, Egypt; (G.A.S.)
| | - Abdelrahman Gamal
- Computer Science Department, Faculty of Computers and Information, Mansoura University, Mansoura 35516, Egypt (A.E.T.)
| | - Ahmed Elnakib
- Electrical and Computer Engineering Department, School of Engineering, Penn State Erie, The Behrend College, Erie, PA 16563, USA;
| | - Omar Hamdy
- Surgical Oncology Department, Oncology Centre, Mansoura University, Mansoura 35516, Egypt;
| | - Ahmed Sharafeldeen
- Bioengineering Department, University of Louisville, Louisville, KY 40292, USA
| | - Ali Mahmoud
- Bioengineering Department, University of Louisville, Louisville, KY 40292, USA
| | - Mohammed Ghazal
- Electrical, Computer, and Biomedical Engineering Department, Abu Dhabi University, Abu Dhabi 59911, United Arab Emirates; (M.G.)
| | - Jawad Yousaf
- Electrical, Computer, and Biomedical Engineering Department, Abu Dhabi University, Abu Dhabi 59911, United Arab Emirates; (M.G.)
| | - Marah Alhalabi
- Electrical, Computer, and Biomedical Engineering Department, Abu Dhabi University, Abu Dhabi 59911, United Arab Emirates; (M.G.)
| | - Amal AbouEleneen
- Computer Science Department, Faculty of Computers and Information, Mansoura University, Mansoura 35516, Egypt (A.E.T.)
| | - Ahmed Elsaid Tolba
- Computer Science Department, Faculty of Computers and Information, Mansoura University, Mansoura 35516, Egypt (A.E.T.)
- The Higher Institute of Engineering and Automotive Technology and Energy, New Heliopolis, Cairo 11829, Egypt
| | - Samir Elmougy
- Computer Science Department, Faculty of Computers and Information, Mansoura University, Mansoura 35516, Egypt (A.E.T.)
| | - Sohail Contractor
- Department of Radiology, University of Louisville, Louisville, KY 40202, USA
| | - Ayman El-Baz
- Bioengineering Department, University of Louisville, Louisville, KY 40292, USA
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8
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Ren JH, Wang Y, Zhang X, Cheng Q, Wang K, Liu Q, Tang R, Yang L, Gong J, Xu J, Li H. A Clinical Analysis of Prognosis and Patient-Reported Outcomes of Oncoplastic Breast-Conserving Surgery for Early Breast Cancer: A Retrospective Cohort Study. Aesthetic Plast Surg 2023:10.1007/s00266-023-03631-5. [PMID: 37821554 DOI: 10.1007/s00266-023-03631-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 08/20/2023] [Indexed: 10/13/2023]
Abstract
PURPOSE Approximately 25-30% of patients suffer from breast deformity and/or asymmetry after conventional breast-conserving surgery (CBCS). Generally, it is thought that oncoplastic breast-conserving surgery (OBCS) results in an improved cosmetic result; however, studies comparing the prognosis and aesthetic outcomes of CBCS and OBCS in early breast cancer (EBC) are inadequate. METHODS A total of 143 patients were included in this retrospective cohort study; 53 underwent OBCS and 90 underwent CBCS. The resected weight, complications, esthetic results, patient satisfaction, and recurrence rate were compared between the groups. Patient-reported outcomes (PRO) were assessed by the BREAST-Q questionnaire. RESULTS The mean age of the patients in OBCS group was 43.8 years. This was younger than that in CBCS group (49.1 years, p < 0.001). Postoperative complications (11.3% vs. 8.9%, p = 0.64) and re-excision (5.7% vs. 6.7%, p > 0.99) rates were similar. The OBCS group had higher breast satisfaction and psychosocial well-being than the CBCS group (75 vs. 63, p < 0.001 and 84 vs. 77, p = 0.05); however, sexual well-being (56 vs. 66, p = 0.05) and physical well-being (65 vs. 76, p < 0.001) were worse in OBCS. After 42.3 (range: 12.6-69.2)-month median follow-up, no difference in event-free survival (EFS) was demonstrated between the groups (p = 0.13). CONCLUSION Although OBCS has the better aesthetic outcomes and identical oncological safety in comparison with CBCS, the sexual and physical well-being in OBCS are not improved for Asian patients. Hence, choosing an appropriate procedure may be more important for the typically small to moderate-sized breasts characteristic of Asian females unlike Westerners. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- J H Ren
- Chongqing Health Center for Women and Children, Chongqing, China
- Women and Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Yuanyuan Wang
- Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Xiang Zhang
- Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Qiao Cheng
- Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Kang Wang
- Department of Oncology-Pathology, Karolinska Institute Stockholm, Stockholm, Sweden
| | - Qiang Liu
- The People's Hospital of Dazu, Chongqing, China
| | - Renxi Tang
- Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Ling Yang
- Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Junge Gong
- Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Jiawei Xu
- Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Hongyuan Li
- Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.
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9
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Corpuz GS, Premaratne ID, Toyoda Y, Ning Y, Kurlansky PA, Rohde CH. Correlating state-specific and national trends in breast reconstruction after Medicaid expansion: A decade-long update on the Affordable Care Act's impact. J Plast Reconstr Aesthet Surg 2023; 85:344-351. [PMID: 37543023 DOI: 10.1016/j.bjps.2023.07.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 07/13/2023] [Accepted: 07/16/2023] [Indexed: 08/07/2023]
Abstract
While disparities in access to reconstruction persist, a comprehensive analysis comparing state-based outcomes and national patterns in breast reconstruction as a result of Medicaid expansion has never been examined. In this study, we investigated how breast reconstruction rates changed as a result of Medicaid expansion and compared these state-based findings to national counterparts. Patient data from the Healthcare Cost and Utilization Project among states that chose to expand Medicaid were compared with those from states that did not expand. The difference-in-differences estimate of expansion to nonexpansion states was 7.05 (p = 0.10) for implant-based reconstruction, -11.56 (p = 0.01) for autologous reconstruction, and -7.08 (p = 0.18) for overall reconstruction. Comparing rates of nonexpansion states to national trends yielded estimates of -0.06 (p = 0.04), 0.06 (p = 0.01), and 0.004 (p = 0.90) for implant-based, autologous, and overall breast reconstruction, respectively. Similarly, comparing rates of expansion states to national trends yielded estimates of 0.02 (p = 0.38), -0.05 (p = 0.03), and -0.02 (p = 0.44) for implant-based, autologous, and overall breast reconstruction, respectively. In this study on national health policy, Medicaid expansion was associated with a significant increase in autologous rates while state-specific trends alone did not appear to predict the national outcomes of sweeping legislative changes that were differentially applied among states.
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Affiliation(s)
- George S Corpuz
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, NY, United States; Division of Plastic and Reconstructive Surgery, Department of Surgery, Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, NY, United States
| | - Ishani D Premaratne
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, NY, United States; Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Southern California, Los Angeles, CA, United States
| | - Yoshiko Toyoda
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, NY, United States; Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA, United States
| | - Yuming Ning
- Center for Innovation and Outcomes Research, Department of Surgery, Columbia University Medical Center, New York, NY, United States
| | - Paul A Kurlansky
- Center for Innovation and Outcomes Research, Department of Surgery, Columbia University Medical Center, New York, NY, United States
| | - Christine H Rohde
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, NY, United States.
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10
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Araújo Pereira Lisboa FC, Paulinelli RR, Campos Veras LP, Jubé Ribeiro LF, Pádua Oliveira LF, Sousa Rahal RM, Sousa AG, Freitas-Júnior R, Batista de Sousa J. Aesthetic results were more satisfactory after oncoplastic surgery than after total breast reconstruction according to patients and surgeons. Breast 2023; 71:47-53. [PMID: 37487426 PMCID: PMC10374858 DOI: 10.1016/j.breast.2023.07.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 07/09/2023] [Accepted: 07/11/2023] [Indexed: 07/26/2023] Open
Abstract
INTRODUCTION Patient satisfaction after breast cancer surgery has an impact on body image, sexual function, self-esteem, and quality of life and may differ from the perception of the attending physician. This study aimed to compare the aesthetic outcomes and satisfaction with conservative oncoplastic surgeries, mastectomies, and total breast reconstruction. METHODS We included 760 women diagnosed with invasive breast carcinoma or phyllodes tumors who returned at least 6 months after surgery or radiotherapy at two public hospitals and a private clinic between 2014 and 2022. Data was collected prospectively from patients and retrospectively from their medical records using a specific form after obtaining their informed consent. Aesthetic outcomes and quality of life were assessed using the BREAST-Q©, Harris Scale, and BCCT.core software. Data were evaluated using the SPSS statistical software. Statistical significance was set at p < 0.05. This study was approved by the hospital ethics committees. RESULTS A total of 405 (53.29%) partial and 355 (46.71%) total reconstructions were included. Patients who underwent partial reconstruction were older and had higher body mass index. Patients who underwent total reconstruction had larger tumors with advanced clinical and pathological stages. Clinical and surgical complications occurred more frequently in the total reconstruction group. A greater number of reparative surgeries and lipofilling procedures were required for total reconstruction. According to the BREAST-Q, the partial reconstruction group showed significantly higher levels of women's satisfaction with their breasts, the surgical outcomes, psychosocial and sexual well-being, provision of information, and the reconstructive surgeon. Only physical well-being was slightly higher in the total reconstruction group. In most cases, the results were rated good or excellent. Physicians considered partial reconstructions to have better results than total reconstructions, although this difference was not perceived by the BCCT.core software. CONCLUSION Women who underwent partial breast reconstruction had higher levels of satisfaction in several domains, lower frequency of complications, and required fewer surgeries to complete their reconstruction than women who underwent total reconstruction. Physicians were also more satisfied with the results of partial reconstructions.
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Affiliation(s)
| | - Régis Resende Paulinelli
- Mastology Program, Department of Gynecology and Obstetrics, Federal University of Goiás, Goiânia, Goiás, Brazil; Breast and Gynecology Unit, Araújo Jorge Cancer Hospital, Goiás Cancer Combat Association, Brazil
| | | | | | | | - Rosemar Macedo Sousa Rahal
- Mastology Program, Department of Gynecology and Obstetrics, Federal University of Goiás, Goiânia, Goiás, Brazil
| | | | - Ruffo Freitas-Júnior
- Mastology Program, Department of Gynecology and Obstetrics, Federal University of Goiás, Goiânia, Goiás, Brazil; Breast and Gynecology Unit, Araújo Jorge Cancer Hospital, Goiás Cancer Combat Association, Brazil
| | - João Batista de Sousa
- Faculty of Medicine, University of Brasília - UnB, Distrito Federal, Brasília, Brazil
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11
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Pelorca RJF, de Oliveira-Junior I, da Costa Vieira RA. Oncoplastic surgery for Paget's disease of the breast. Front Oncol 2023; 13:1151932. [PMID: 37265790 PMCID: PMC10231681 DOI: 10.3389/fonc.2023.1151932] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 05/02/2023] [Indexed: 06/03/2023] Open
Abstract
Introduction Paget's disease of the breast (PDB) is a rare nipple entity associated with multifocality. Due to its location, resection of the entire nipple-areolar complex is necessary. Historically central quadrantectomy and mastectomy have the surgical treatments of choice. The feasibility of oncoplastic breast surgery (OBS) for PDB is unknown. Methods This was a retrospective study performed in a Brazilian oncological hospital. We evaluated the factors related to the performance of OBS in PDB. In addition, the impact of OBS on local recurrence and survival was analysed. Comparisons were made between groups using the chi-square test, Mann-Whitney U test, and Kaplan-Meier method. To assess the impact factor of the variables on the performance of OBS, logistic regression was performed. Results Eighty-five patients were evaluated. OBS was performed in 69.4% (n=59), and of these, 16 (27.2%) were symmetrized with contralateral surgery. Mastectomy without reconstruction was performed in 28.3% of the patients. The primary procedure performed was mastectomy with reconstruction (n=38; 44.7%), and the preferential technique for immediate reconstruction was skin-sparing mastectomy with prosthesis; for late reconstruction, the preferred technique was using the latissimus dorsi. Breast conserving-surgery was performed in 27.0% (n=23), primarily using the plug-flap technique (OBS). Age was associated with the use of OBS; as patients aged 40-49 exhibited a higher rate of OBS (p = 0.002; odds ratio 3.22). OBS did not influence local recurrence (p=1.000), overall survival (p=0.185), or cancer-specific survival (p=0.418). Conclusion OBS improves options related to surgical treatment in PDB without affecting local recurrence or survival rates.
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Affiliation(s)
- Rafael José Fábio Pelorca
- Programa de Pós-Graduação em Tocoginecologia, Faculdade de Medicina de Botucatu, Botucatu, SP, Brazil
| | - Idam de Oliveira-Junior
- Programa de Pós-Graduação em Tocoginecologia, Faculdade de Medicina de Botucatu, Botucatu, SP, Brazil
- Programa de Pós-Graduação em Oncologia, Barretos Cancer Hospital, Barretos, SP, Brazil
- Departamento de Mastologia e Reconstrução Mamária, Barretos Cancer Hospital, Barretos, SP, Brazil
| | - René Aloisio da Costa Vieira
- Programa de Pós-Graduação em Tocoginecologia, Faculdade de Medicina de Botucatu, Botucatu, SP, Brazil
- Programa de Pós-Graduação em Oncologia, Barretos Cancer Hospital, Barretos, SP, Brazil
- Departamento de Cirurgia Oncológica, Divisão de Mastologia, Hospital de Câncer de Muriaé, Muriaé, MG, Brazil
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12
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Radparvar J, Piplani C, Chatterjee A, Nardello SM. Oncoplastic Surgery in the Large-Breasted Breast Cancer gene Patient: A Staged Step to Enable Nipple Sparing Mastectomy. Am Surg 2023; 89:2049-2051. [PMID: 34053225 DOI: 10.1177/00031348211023454] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Patients with macromastia and/or moderate-severe ptosis who desire mastectomy are typically offered skin sparing mastectomies. Recent technical advances have broadened the inclusion criteria to allow for nipple sparing mastectomy (NSM) in this population; however, they have been limited to patients with unifocal disease. We report on the multidisciplinary approach used to offer a NSM to a patient with multicentric triple-negative breast cancer and symptomatic macromastia with severe ptosis in the setting of positive genetic testing. We discuss the combination of a staged oncoplastic approach with neoadjuvant and adjuvant chemotherapy, as well as the foundations of these approaches. We encourage further research and inclusion of patients such as ours in the criteria for NSM.
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Affiliation(s)
| | - Charoo Piplani
- Clara Swain Mission Hospital, Bareilly, Uttar Pradesh, India
| | - Abhishek Chatterjee
- Tufts Medical Center Community Care, Stoneham, MA, USA
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Tufts Medical Center, Boston, MA, USA
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13
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Karamchandani MM, Jonczyk MM, De La Cruz Ku G, Gaffney KA, Wareham C, Nardello S, Persing SM, Homsy C, Chatterjee A. The adoption of oncoplastic surgery: Is there a learning curve? J Surg Oncol 2023. [PMID: 37092965 DOI: 10.1002/jso.27294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 04/12/2023] [Accepted: 04/16/2023] [Indexed: 04/25/2023]
Abstract
INTRODUCTION Oncoplastic surgery (OPS) is a form of breast conservation surgery involving partial mastectomy followed by volume displacement or replacement surgery. As the field of OPS is growing, we sought to determine if there was a learning curve to this surgery. METHODS A retrospective chart review was conducted of all patients who underwent OPS over a 6-year period with a single surgeon formally trained in both Plastic Surgery and Breast Oncology. Cumulative summation analysis (CUSUM) was performed on mean operative time to generate the learning curve and learning curve phases. Outcomes were compared between phases to determine significance. RESULTS Mean operative time decreased significantly across the 6-year period, generating three distinct learning curve phases: Learner phase (cases 1-23), Competence phase (24-73), and Mastery phase (74 and greater). The overall positive margin rate was 10.9% and there was no significant difference in rates between phases (p = 0.49). Overall complication rates, reoperation rates, and locoregional recurrence remained the same across all phases (p = 0.16; p = 0.65; p = 0.41). The rate of partial nipple loss decreased between phases (p = 0.02). CONCLUSION As with many complex operations, there does appear to be a learning curve with OPS, as the operative time and the rates of partial nipple loss decreased over time.
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Affiliation(s)
| | - Michael M Jonczyk
- Department of Surgery, Lahey Hospital & Medical Center, Burlington, Massachusetts, USA
| | - Gabriel De La Cruz Ku
- Department of Surgery, UMass Memorial Medical Center, Worcester, Massachusetts, USA
- Universidad Cientifica del Sur, Lima, Peru
| | - Kerry A Gaffney
- Department of Surgery, Tufts Medical Center, Boston, Massachusetts, USA
| | - Carly Wareham
- Department of Surgery, Tufts Medical Center, Boston, Massachusetts, USA
| | - Salvatore Nardello
- Department of Surgery, Division of Surgical Oncology, Tufts Medical Center, Boston, Massachusetts, USA
| | - Sarah M Persing
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Tufts Medical Center, Boston, Massachusetts, USA
- Department of Surgery, Division of Surgical Oncology, Tufts Medical Center, Boston, Massachusetts, USA
| | - Christopher Homsy
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Tufts Medical Center, Boston, Massachusetts, USA
| | - Abhishek Chatterjee
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Tufts Medical Center, Boston, Massachusetts, USA
- Department of Surgery, Division of Surgical Oncology, Tufts Medical Center, Boston, Massachusetts, USA
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14
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Faulkner HR, Losken A. Modern Approaches to Oncoplastic Surgical Treatment. Clin Plast Surg 2023; 50:211-221. [PMID: 36813399 DOI: 10.1016/j.cps.2022.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Partial breast reconstruction using oncoplastic techniques is performed at the time of lumpectomy and includes volume replacement techniques such as flaps and volume displacement techniques such as reduction and mastopexy. These techniques are used to preserve breast shape, contour, size, symmetry, inframammary fold position, and position of the nipple-areolar complex. Newer techniques such as auto-augmentation flaps and perforator flaps continue to broaden options and newer radiation therapy protocols will hopefully reduce side effects. Options for the oncoplastic approach now include higher risk patients as there is a larger repository of data on the safety and efficacy of this technique.
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Affiliation(s)
- Heather R Faulkner
- Emory Division of Plastic and Reconstructive Surgery, 550 Peachtree Street Northeast, Suite 9000, Atlanta GA 30308, USA
| | - Albert Losken
- Emory Division of Plastic and Reconstructive Surgery, 550 Peachtree Street Northeast, Suite 9000, Atlanta GA 30308, USA.
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15
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Jonczyk MM, Homsy C, Naber S, Chatterjee A. Examining a decade of racial disparity in partial mastectomy and oncoplastic surgery. J Surg Oncol 2023; 127:541-549. [PMID: 36507913 DOI: 10.1002/jso.27173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 10/25/2022] [Accepted: 12/01/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND OBJECTIVES Understanding racial disparity is crucial to addressing health equity and access to care. Our study aims to examine racial differences in breast conserving surgery (BCS) utilization rates and determine how these rates have changed over time. METHODS This retrospective cohort analysis utilized the NSQIP database to identify women diagnosed with breast cancer who underwent BCS procedures between 2008 and 2019. Racial utilization trends were analyzed using a Cochran-Armitage test and Index of Disparity analysis. RESULTS In the 12-year period, 202 492 women underwent a breast cancer surgery, of which 47% underwent BCS. Within the BCS subgroup, oncoplastic surgery utilization increased from 3% to 10%, leading to a declining proportion of partial mastectomies: 97% to 90.0% (both p < 0.01). The racial index of disparity for overall BCS patients decreased from 7% to 6%, remained unchanged (1%) for partial mastectomies, and significantly decreased in oncoplastics (23%-7.6%). CONCLUSION BCS represents a mainstay option for early-staged breast cancer interventions, this study demonstrate promising progress in decreasing the index of disparity among races and persistent racial inequalities.
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Affiliation(s)
- Michael M Jonczyk
- Department of General Surgery, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA.,Department of Surgery, Tufts Medical Center, Boston, Massachusetts, USA
| | - Christopher Homsy
- Department of Surgery, Tufts Medical Center, Boston, Massachusetts, USA
| | - Stephen Naber
- Department of Pathology and Laboratory Medicine, Tufts Medical Center, Boston, Massachusetts, USA
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16
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Karamchandani MM, De La Cruz Ku G, Gaffney KA, Wareham C, Persing SM, Homsy C, Nardello S, Chatterjee A. Single Versus Dual Surgeon Approaches to Oncoplastic Surgery: A Comparison of Outcomes. J Surg Res 2023; 283:1064-1072. [PMID: 36914997 DOI: 10.1016/j.jss.2022.11.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 11/20/2022] [Accepted: 11/21/2022] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Oncoplastic surgery (OPS) is traditionally performed using a dual surgeon (DS) approach that involves both a breast surgeon and a plastic surgeon. It is also performed using a single surgeon (SS) approach with a surgeon trained in both breast surgical oncology and plastic surgery. We sought to determine if outcomes differed between SS versus DS OPS approaches. METHODS A retrospective chart review was conducted of all OPS performed in a single health system over a 6-y period by either an SS or a DS approach. Primary outcomes were rates of positive margins and the overall complication rate; secondary outcomes were loco-regional recurrence, disease-free survival, and overall survival. RESULTS A total of 217 patients were identified; 117 were SS cases and 100 were DS cases. Baseline preoperative patient characteristics were similar between the two groups as there was no difference in mean Charlson Comorbidity Index scores (P = 0.07). There was no difference in tumor stage (P = 0.09) or nodal status (P = 0.31). Rates of positive margins were not significantly different (10.9% (SS) versus 9% (DS); P = 0.81), nor were rates of complications (11.1% (SS) versus 15% (DS); P = 0.42). Rates of locoregional recurrence were also not significantly different (1.7% (SS) versus 0% (DS); P = 0.5). Disease-free survival and overall survival were not significantly different at 1-y, 3-y, and 5-y time points (P = 0.20 and P = 0.23, respectively) although follow-up time was not sufficient for definitive analysis regarding survival. CONCLUSIONS Both SS and DS approaches to OPS have similar outcomes with regards to positive margin rates and surgical complication rates and are comparably safe.
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Affiliation(s)
| | - Gabriel De La Cruz Ku
- Department of Surgery, UMass Memorial Medical Center, Worcester, Massachusetts; Universidad Cientifica del Sur, Lima, Peru
| | - Kerry A Gaffney
- Department of Surgery, Tufts Medical Center, Boston, Massachusetts
| | - Carly Wareham
- Department of Surgery, Tufts Medical Center, Boston, Massachusetts
| | - Sarah M Persing
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Tufts Medical Center, Boston, Massachusetts; Division of Surgical Oncology, Department of Surgery, Tufts Medical Center, Boston, Massachusetts
| | - Christopher Homsy
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Tufts Medical Center, Boston, Massachusetts
| | - Salvatore Nardello
- Division of Surgical Oncology, Department of Surgery, Tufts Medical Center, Boston, Massachusetts
| | - Abhishek Chatterjee
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Tufts Medical Center, Boston, Massachusetts; Division of Surgical Oncology, Department of Surgery, Tufts Medical Center, Boston, Massachusetts.
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17
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Bloom JA, Foroutanjazi S, Erlichman Z, Beqiraj Z, Jonczyk MM, Persing SM, Chatterjee A. The Use of Hemostatic Agents to Decrease Bleeding Complications in Breast Cancer Surgery. Am Surg 2023; 89:395-400. [PMID: 34176297 DOI: 10.1177/00031348211029866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Following breast cancer surgery, patients often require adjuvant radiation and chemotherapy for locoregional and systemic disease control. These procedures may result in postoperative complications, which may delay adjuvant therapy. To potentially decrease these complications, hemostatic agents may be used. This study evaluated the rate of postoperative bleeding complications and duration of Jackson-Pratt (JP) drain use in oncologic breast surgery with and without hemostatic agents. METHODS After obtaining institutional review board approval, a retrospective chart review was performed. Patients who underwent oncoplastic breast surgery, mastectomy with or without expander/implant-based reconstruction, and subsequent reconstruction with expander to implant exchange were included. Data collected included indication for surgery, type of operation, use of hemostatic agent, specifically fibrin sealant (FS, EVICEL®, Ethicon, USA) or combination powder (CP, HEMOBLAST™ Bellows, biom'up, France), length of follow-up, time to JP drain removal, and post-operative complications (seroma, hematoma, or operating room (OR) takeback). This was a consecutive experience where initially no hemostatic agent was used, followed by use of FS, and then CP. RESULTS The use of a hemostatic agent resulted in fewer bleeding complications and significantly decreased time until JP drain removal. Although not significant, subgroup analysis demonstrated that this was more pronounced in the CP group. JP drain duration was decreased among all procedures for CP compared to FS. CONCLUSIONS The use of hemostatic agents in oncologic breast surgery may result in decreased postoperative complications and significantly reduce time to JP drain removal.
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Affiliation(s)
- Joshua A Bloom
- Department of Surgery, 1867Tufts Medical Center, Boston, MA, USA
| | | | | | - Zhaneta Beqiraj
- Department of Surgery, 1867Tufts Medical Center, Boston, MA, USA
| | | | - Sarah M Persing
- Division of Plastic and Reconstructive Surgery, Department of Surgery, 5116University of Southern California, Los Angeles, CA, USA
| | - Abhishek Chatterjee
- Division of Plastic and Reconstructive Surgery, Department of Surgery, 1867Tufts Medical Center, Boston, MA, USA
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18
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Bloom JA, Shah SA, Long EA, Chatterjee A, Lee BT. Post-Mastectomy Tissue Expander Placement Followed by Radiation Therapy: A Cost-Effectiveness Analysis of Staged Autologous Versus Implant-Based Unilateral Reconstruction. Ann Surg Oncol 2023; 30:1075-1083. [PMID: 36348205 DOI: 10.1245/s10434-022-12619-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 06/17/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND There is no preferred approach to breast reconstruction for patients with locally advanced breast cancer (LABC) who require post-mastectomy radiation therapy (PMRT). Staged implant and autologous reconstruction both have unique risks and benefits. No previous study has compared their cost-effectiveness with utility scores. METHODS A literature review determined the probabilities and outcomes for mastectomy and staged implant or autologous reconstruction. Utility scores were used to calculate the quality-adjusted life years (QALYs) associated with successful surgery and postoperative complications. Medicare billing codes were used to assess costs. A decision analysis tree was constructed with rollback and incremental cost-effectiveness ratio (ICER) analyses. Sensitivity analyses were performed to validate results and account for uncertainty. RESULTS Mastectomy with staged deep inferior epigastric perforator (DIEP) flap reconstruction is costlier ($14,104.80 vs $3216.93), but more effective (QALYs, 29.96 vs 24.87). This resulted in an ICER of 2141.00, favoring autologous reconstruction. One-way sensitivity analysis showed that autologous reconstruction was more cost-effective if less than $257,444.13. Monte Carlo analysis showed a confidence of 99.99% that DIEP flap reconstruction is more cost-effective. CONCLUSIONS For patients with LABC who require PMRT, staged autologous reconstruction is significantly more cost-effective than reconstruction with implants. Despite the decreased morbidity, staged implant reconstruction has greater rates of complication.
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Affiliation(s)
- Joshua A Bloom
- Department of Surgery, Tufts Medical Center, Boston, MA, USA
| | | | - Emily A Long
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Abhishek Chatterjee
- Division of Plastic and Reconstructive Surgery, Tufts Medical Center, Boston, MA, USA
| | - Bernard T Lee
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA.
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19
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Vieira RADC, Bailão-Junior A, de Oliveira-Junior I. Does breast oncoplastic surgery improve quality of life? Front Oncol 2023; 12:1099125. [PMID: 36713564 PMCID: PMC9877289 DOI: 10.3389/fonc.2022.1099125] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 12/28/2022] [Indexed: 01/15/2023] Open
Abstract
Breast Oncoplastic Surgery (OS) has established itself as a safe procedure associated with the treatment of breast cancer, but the term is broad, encompassing procedures associated with breast-conserving surgeries (BCS), conservative mastectomies and fat grafting. Surgeons believe that OS is associated with an increase in quality of life (QOL), but the diversity of QOL questionnaires and therapeutic modalities makes it difficult to assess from the patient's perspective. To answer this question, we performed a search for systematic reviews on QOL associated with different COM procedures, and in their absence, we selected case-control studies, discussing the main results. We observed that: (1) Patients undergoing BCS or breast reconstruction have improved QoL compared to those undergoing mastectomy; (2) In patients undergoing BCS, OS has not yet shown an improvement in QOL, a fact possibly influenced by patient selection bias; (3) In patients undergoing mastectomy with reconstruction, the QoL results are superior when the reconstruction is performed with autologous flaps and when the areola is preserved; (4) Prepectoral implants improves QOL in relation to subpectoral implant-based breast reconstruction; (5) ADM do not improves QOL; (6) In patients undergoing prophylactic mastectomy, satisfaction is high with the indication, but the patient must be informed about the potential complications associated with the procedure; (7) Satisfaction is high after performing fat grafting. It is observed that, in general, OS increases QOL, and when evaluating the procedures, any preservation or repair, or the use of autologous tissues, increases QOL, justifying OS.
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Affiliation(s)
- René Aloisio da Costa Vieira
- Programa de Pós-Graduação em Tocoginecologia, Faculdade de Medicina de Botucatu, Botucatu/SP, Brazil,Programa de Pós-Graduação em Oncologia, Hospital de Câncer de Barretos, Barretos/SP, Brazil,Departamento de Cirurgia Oncológica, Divisão de Mastologia, Hospital de Câncer de Muriaé, Muriaé/MG, Brazil,Active Member of European Organisation for Research and Treatment (EORTC) Quality of life Group, Brussels, Belgium,*Correspondence: René Aloisio da Costa Vieira,
| | - Antônio Bailão-Junior
- Programa de Pós-Graduação em Tocoginecologia, Faculdade de Medicina de Botucatu, Botucatu/SP, Brazil,Departamento de Mastologia e Reconstrução Mamária, Hospital de Câncer de Barretos, Barretos/SP, Brazil
| | - Idam de Oliveira-Junior
- Programa de Pós-Graduação em Tocoginecologia, Faculdade de Medicina de Botucatu, Botucatu/SP, Brazil,Programa de Pós-Graduação em Oncologia, Hospital de Câncer de Barretos, Barretos/SP, Brazil,Departamento de Mastologia e Reconstrução Mamária, Hospital de Câncer de Barretos, Barretos/SP, Brazil
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20
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Thestrup Hansen S, Piil K, Bak Hansen L, Ledertoug KM, Hølge-Hazelton B, Schmidt VJ. Electronic patient-reported outcome measures to enable systematic follow-up in treatment and care of women diagnosed with breast cancer: a feasibility study protocol. BMJ Open 2022; 12:e065110. [PMID: 36385030 PMCID: PMC9670949 DOI: 10.1136/bmjopen-2022-065110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION The use of patient-reported outcome measures (PROMs) in clinical practice has the potential to promote person-centred care and improve patients' health-related quality of life. We aimed to develop an intervention centred around electronic PROMs (ePROMs) for systematic follow-up in patients diagnosed with breast cancer and to evaluate its feasibility. METHODS AND ANALYSIS We developed a nurse-oriented and surgeon-oriented intervention in PROMs, including (1) an education programme for nurses and surgeons; (2) administration of BREAST-Q as proactive ePROMs during follow-up in patients diagnosed with breast cancer and (3) feedback to nurses and surgeons on PROM scores and a guidance manual for healthcare practitioners. Subsequently, we designed a non-controlled feasibility evaluation on the outcomes acceptability, demand, implementation, practicality and integration. The feasibility evaluation includes qualitative ethnographic studies exploring the user perspectives of patients, nurses and surgeons and quantitative studies to explore the characteristics of the patient population regarding demographic background, response rates and response patterns. The feasibility study was initiated in September 2021, will continue until 2024 and will include approximately 900 patients. EPROMs are collected at the following assessment time points: baseline (after diagnosis, before surgery), 1-year follow-up and 3-year endpoint. ETHICS AND DISSEMINATION The study will be conducted according to the General Data Protection Regulation and the fifth version of the Helsinki Declaration. The National Committee on Health Research Ethics approved the study according to the law of the Committee § 1, part 4. All data will be anonymised before its publication. The results of the feasibility study will be published in peer-reviewed, international journals.
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Affiliation(s)
- Stine Thestrup Hansen
- Department of Plastic and Breast Surgery, Zealand University Hospital, Roskilde, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Karin Piil
- Department of Oncology, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Lone Bak Hansen
- Department of Plastic and Breast Surgery, Zealand University Hospital, Roskilde, Denmark
- Department of Clinical Medicine, University of Copenhagen, København, Denmark
| | - Karen Marie Ledertoug
- Department of Plastic and Breast Surgery, Zealand University Hospital, Roskilde, Denmark
- Copenhagen Emergency Medical Services, Capital Region of Denmark, Ballerup, Denmark
| | - Bibi Hølge-Hazelton
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
- Research Support Unit, Zealand University Hospital, Roskilde, Denmark
| | - Volker Jürgen Schmidt
- Department of Plastic and Breast Surgery, Zealand University Hospital, Roskilde, Denmark
- Department of Clinical Medicine, University of Copenhagen, København, Denmark
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21
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De la Cruz Ku G, Karamchandani M, Chambergo-Michilot D, Narvaez-Rojas AR, Jonczyk M, Príncipe-Meneses FS, Posawatz D, Nardello S, Chatterjee A. Does Breast-Conserving Surgery with Radiotherapy have a Better Survival than Mastectomy? A Meta-Analysis of More than 1,500,000 Patients. Ann Surg Oncol 2022; 29:6163-6188. [PMID: 35876923 DOI: 10.1245/s10434-022-12133-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 05/25/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND There have been conflicting studies reporting on survival advantages between breast-conserving surgery with radiotherapy (BCS) in comparison with mastectomy. Our aim was to compare the efficacy of BCS and mastectomy in terms of overall survival (OS) comparing all past published studies. METHODS We performed a comprehensive review of literature through October 2021 in PubMed, Scopus, and EMBASE. The studies included were randomized controlled trials (RCTs) and cohorts that compare BCS versus mastectomy. We excluded studies that included male sex, stage 0, distant metastasis at diagnosis, bilateral synchronous cancer, neoadjuvant radiation/chemotherapy, and articles with incomplete data. We performed a meta-analysis following the random-effect model with the inverse variance method. RESULTS From 18,997 publications, a total of 30 studies were included in the final analysis: 6 studies were randomized trials, and 24 were retrospective cohorts. A total of 1,802,128 patients with a follow-up ranging from 4 to 20 years were included, and 1,075,563 and 744,565 underwent BCS and mastectomy, respectively. Among the population, BCS is associated with improved OS compared with mastectomy [relative risk (RR) 0.64, 95% confidence interval (CI) 0.55-0.74]. This effect was similar when analysis was performed in cohorts and multi-institutional databases (RR 0.57, 95% CI 0.49-0.67). Furthermore, the benefit of BCS was stronger in patients who had less than 10 years of follow-up (RR 0.54, 95% CI 0.46-0.64). CONCLUSIONS Patients who underwent BCS had better OS compared with mastectomy. Such results depicting survival advantage, especially using such a large sample of patients, may need to be included in the shared surgical decision making when discussing breast cancer treatment with patients.
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Affiliation(s)
- Gabriel De la Cruz Ku
- Department of General Surgery, University of Massachusetts, Worcester, MA, USA.,Universidad Científica del Sur, Lima, Peru
| | | | | | | | | | | | - David Posawatz
- Department of General Surgery, Tufts Medical Center, Boston, MA, USA
| | | | - Abhishek Chatterjee
- Division of Surgical Oncology, Tufts Medical Center, Boston, MA, USA. .,Division of Plastic and Reconstructive Surgery, Division of Surgical Oncology, Tufts Medical Center, Boston, MA, USA.
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22
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Karadeniz Cakmak G. Innovative Standards in Oncoplastic Breast Conserving Surgery: From Radical Mastectomy to Extreme Oncoplasty. Breast Care (Basel) 2022; 16:559-573. [PMID: 35087359 DOI: 10.1159/000518992] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 08/11/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Oncoplastic breast conserving surgery (OBCS), which is the current procedure of choice for eligible BC patients, describes a philosophy that prioritizes oncologic and cosmetic outcomes. However, knowledge gaps regarding training, acceptance, and practice preclude standardization and make it difficult to design algorithmic guidelines to optimize individualized management in the era of precision medicine. SUMMARY The harmony between patient expectations and oncologic goals creates the state of the art of OBCS. Nevertheless, to achieve these goals, multidisciplinary approach is a must. Surgical decisions require a comprehensive evaluation including patient factors, tumor biology, genetics, technical considerations, and adjunct therapies. Moreover, the quality-of-life (QOL) issues should be considered as the highest level of priority with a shared decision making instituted on realistic discussions with the patient. KEY MESSAGES The standardization in OBCS should be initiated via defining a breast surgeon who should gain theorical and practical competence on techniques via national or international educational programs. The algorithmic patient assessment with appropriate documentation before and after surgery should be established. A simple and safe global lexicon should be designed regarding techniques to be proposed and quality metrics to be considered. Additionally, international multicenter prospective trials should be instituted to overcome knowledge gaps. It is evident that OBCS is the perfect union of science with art. Nevertheless, at the very end, the question is not the nature of the surgeon/artist who would be the extremist, the innovator, or the conservative, but the patient's satisfaction, prognosis, and QOL that conclude the cascade of state of the art of OBCS.
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23
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A Systematic Review of Health State Utility Values in the Plastic Surgery Literature. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3944. [PMID: 34849317 PMCID: PMC8615317 DOI: 10.1097/gox.0000000000003944] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 09/15/2021] [Indexed: 01/23/2023]
Abstract
Cost-utility analyses assess health gains acquired by interventions by incorporating weighted health state utility values (HSUVs). HSUVs are important in plastic and reconstructive surgery (PRS) because they include qualitative metrics when comparing operative techniques or interventions. We systematically reviewed the literature to identify the extent and quality of existing original utilities research within PRS. Methods A systematic review of articles with original PRS utility data was conducted in accordance with the Preferred Reporting Items for a Systematic Review and Meta-Analysis guidelines. Subspecialty, survey sample size, and respondent characteristics were extracted. For each HSUV, the utility measure [direct (standard gamble, time trade off, visual analog scale) and/or indirect], mean utility score, and measure of variance were recorded. Similar HSUVs were pooled into weighted averages based on sample size if they were derived from the same utility measure. Results In total, 348 HSUVs for 194 disease states were derived from 56 studies within seven PRS subspecialties. Utility studies were most common in breast (n = 17, 30.4%) and hand/upper extremity (n = 15, 26.8%), and direct measurements were most frequent [visual analog scale (55.4%), standard gamble (46.4%), time trade off (57.1%)]. Studies surveying the general public had more respondents (n = 165, IQR 103-299) than those that surveyed patients (n = 61, IQR 48-79) or healthcare professionals (n = 42, IQR 10-109). HSUVs for 18 health states were aggregated. Conclusions The HSUV literature within PRS is scant and heterogeneous. Researchers should become familiar with these outcomes, as integrating utility and cost data will help illustrate that the impact of certain interventions are cost-effective when we consider patient quality of life.
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24
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Savage JA. Response to letter to the editor regarding: "Long-term outcomes of latissimus dorsi flap breast reconstructions: A single-center observational cohort study with up to 12 years of follow up". J Plast Reconstr Aesthet Surg 2021; 75:893-939. [PMID: 34844883 DOI: 10.1016/j.bjps.2021.11.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 11/08/2021] [Indexed: 10/19/2022]
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25
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Chatterjee A. Editorial on Oncoplastic Breast-Conserving Surgery for Synchronous Multicentric and Multifocal Tumors: Is It Oncologically Safe? A Retrospective Matched-Cohort Analysis. Ann Surg Oncol 2021; 29:23-24. [PMID: 34625878 DOI: 10.1245/s10434-021-10919-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 09/29/2021] [Indexed: 11/18/2022]
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26
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De Lorenzi F, Borelli F, Pagan E, Bagnardi V, Peradze N, Jereczek-Fossa BA, Leonardi C, Mazzarol G, Favia G, Corso G, Montagna E, Rietjens M, Veronesi P. Oncoplastic Breast-Conserving Surgery for Synchronous Multicentric and Multifocal Tumors: Is It Oncologically Safe? A Retrospective Matched-Cohort Analysis. Ann Surg Oncol 2021; 29:427-436. [PMID: 34613536 PMCID: PMC8677637 DOI: 10.1245/s10434-021-10800-w] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 08/15/2021] [Indexed: 11/30/2022]
Abstract
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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Affiliation(s)
- Francesca De Lorenzi
- Department of Plastic and Reconstructive Surgery, European Institute of Oncology, IRCCS, Milan, Italy
| | - Francesco Borelli
- Department of Plastic and Reconstructive Surgery, European Institute of Oncology, IRCCS, Milan, Italy.
| | - Eleonora Pagan
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milan, Italy
| | - Vincenzo Bagnardi
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milan, Italy
| | - Nickolas Peradze
- Department of Breast Surgery, European Institute of Oncology, IRCCS, Milan, Italy
| | | | - Cristina Leonardi
- Division of Radiotherapy, European Institute of Oncology, IRCCS, University of Milan, Milan, Italy
| | - Giovanni Mazzarol
- Department of Pathology and Laboratory Medicine, European Institute of Oncology, IRCCS, Milan, Italy
| | - Giorgio Favia
- Department of Plastic and Reconstructive Surgery, European Institute of Oncology, IRCCS, Milan, Italy
| | - Giovanni Corso
- Department of Breast Surgery, European Institute of Oncology, IRCCS, Milan, Italy
| | - Emilia Montagna
- Medical Senology, European Institute of Oncology, IRCCS, Milan, Italy
| | - Mario Rietjens
- Department of Plastic and Reconstructive Surgery, European Institute of Oncology, IRCCS, Milan, Italy
| | - Paolo Veronesi
- Department of Breast Surgery, European Institute of Oncology, IRCCS, Milan, Italy
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