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Reid A, Thomas R, Pieri A, Critchley A, Kalra L, Carter J, O'Donoghue JM, King E, Cain H. The impact of advanced oncoplastic surgery on breast-conserving surgery rates: A retrospective cohort study of 3,875 breast cancer procedures at a tertiary referral centre. Breast 2024; 78:103814. [PMID: 39326196 PMCID: PMC11459649 DOI: 10.1016/j.breast.2024.103814] [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: 06/20/2024] [Revised: 09/18/2024] [Accepted: 09/21/2024] [Indexed: 09/28/2024] Open
Abstract
INTRODUCTION As the treatment of breast cancer advances, the focus has shifted from solely improving oncological endpoints to a greater weight being placed on cosmetic and psychological outcomes. The advent of advanced oncoplastic techniques allows for successful breast-conserving surgery (BCS) to patients who otherwise would have required a mastectomy. The aim of this study is to ascertain if the adoption of these procedures has assisted in the reduction of mastectomies performed. METHODS A dataset of all breast cancer procedures based upon coding between April 2016 and July 2023 was evaluated, categorising procedures into: BCS, mastectomy, oncoplastic BCS and total reconstructions. R-Studio Software 4.3.1 (®) was used to explore statistical analysis and data visualisation. Registered as a clinical services evaluation study (Project ID: 14649). RESULTS During the period stated, 3875 index breast cancer procedures were recorded (sample size = 3638 patients). The BCS rate increased from 66.2 % in 2016 to 80.7 % in 2023. Using a linear regression model, the BCS rate demonstrates an increase of 2.1 % each year (coefficient = 2.12, p-value = 0.0069). Concurrently, the rate of oncoplastic BCS increased from 10.5 % to 22.9 % (coefficient = 2.14, p-value = 0.00017). Using Pearson's product-moment, a positive correlation between these two variables is seen (coefficient = 0.86, p-value = 0.0056). CONCLUSION Having reviewed 3875 index breast cancer procedures over the past eight years, the BCS rate has shown a statistically significant increase and a positive correlation with the oncoplastic BCS rate. This suggests oncoplastic surgery has helped to reduce the rates of mastectomy at the centre.
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Affiliation(s)
- Angus Reid
- Breast Unit, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP, United Kingdom.
| | - Robert Thomas
- Breast Unit, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP, United Kingdom.
| | - Andrew Pieri
- Breast Unit, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP, United Kingdom.
| | - Adam Critchley
- Breast Unit, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP, United Kingdom.
| | - Lorraine Kalra
- Breast Unit, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP, United Kingdom.
| | - Jane Carter
- Breast Unit, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP, United Kingdom.
| | - J M O'Donoghue
- Plastic Surgery Unit, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP, United Kingdom.
| | - Emily King
- Breast Unit, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP, United Kingdom.
| | - Henry Cain
- Breast Unit, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP, United Kingdom.
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Heidinger M, Loesch JM, Levy J, Maggi N, Eller RS, Schwab FD, Kurzeder C, Weber WP. Association of relative resection volume with patient-reported outcomes applying different levels of oncoplastic breast conserving surgery - A retrospective cohort study. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:108478. [PMID: 38885597 DOI: 10.1016/j.ejso.2024.108478] [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: 02/14/2024] [Revised: 05/12/2024] [Accepted: 06/10/2024] [Indexed: 06/20/2024]
Abstract
INTRODUCTION The American Society of Breast Surgeons (ASBrS) recently classified oncoplastic breast conserving surgery (OBCS) into two levels. The association of resection ratio during OBCS with patient-reported outcomes (PRO) is unclear. MATERIALS AND METHODS Patients with stage 0-III breast cancer undergoing OBCS between 01/2011-04/2023 at a Swiss university hospital, who completed at least one postoperative BREAST-Q PRO questionnaire were identified from a prospectively maintained institutional database. Outcomes included differences in PROs between patients after ASBrS level I (<20 % of breast tissue removed) versus level II surgery (20-50 %). RESULTS Of 202 eligible patients, 129 (63.9 %) underwent level I OBCS, and 73 (36.1 %) level II. Six patients (3.0 %) who underwent completion mastectomy were excluded. The median time to final PROs was 25.4 months. Patients undergoing ASBrS level II surgery were more frequently affected by delayed wound healing (p < 0.001). ASBrS level was not found to independently predict any BreastQ domain. However, delayed wound healing was shown to reduce short-term physical well-being (estimated difference -26.27, 95 % confidence interval [CI] -39.33 to -13.22, p < 0.001). Higher age was associated with improved PROs. CONCLUSION ASBrS level II surgery allows the removal of larger tumors without impairing PROs. Preventive measures for delayed wound healing and close postoperative follow-up to promptly treat wound healing disorders may avoid short-term reductions in physical well-being.
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Affiliation(s)
- Martin Heidinger
- Breast Center, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland; University of Basel, Petersplatz 1, 4001, Basel, Switzerland
| | - Julie M Loesch
- Breast Center, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland
| | - Jeremy Levy
- Breast Center, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland
| | - Nadia Maggi
- Breast Center, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland; University of Basel, Petersplatz 1, 4001, Basel, Switzerland
| | - Ruth S Eller
- Breast Center, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland; University of Basel, Petersplatz 1, 4001, Basel, Switzerland
| | - Fabienne D Schwab
- Breast Center, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland; University of Basel, Petersplatz 1, 4001, Basel, Switzerland
| | - Christian Kurzeder
- Breast Center, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland; University of Basel, Petersplatz 1, 4001, Basel, Switzerland
| | - Walter P Weber
- Breast Center, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland; University of Basel, Petersplatz 1, 4001, Basel, Switzerland.
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Lisboa FCAP, Giorgi LPCV, Figueiredo ACMG, Paulinelli RR, de Sousa JB. Comparative analysis of the degree of patient satisfaction after breast-conserving surgery with or without oncoplastic surgery: systematic review and meta-analysis. Front Surg 2024; 11:1396432. [PMID: 39086922 PMCID: PMC11289670 DOI: 10.3389/fsurg.2024.1396432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 05/28/2024] [Indexed: 08/02/2024] Open
Abstract
Introduction Conservative surgery is the gold standard for the treatment of single and small tumors and, combined with the concept of oncoplastic tumors, brings good aesthetic results while maintaining cancer safety. The objective was to comparatively analyze the degree of satisfaction of patients undergoing breast conserving surgery (BCS), with and without oncoplastic surgery (OPS) using level II OPS techniques. Methods Review with a search in the databases MEDLINE (by PubMed), EMBASE, Clinical Trials, Scopus, Web of Science, BVS and Oppen gray. The meta-analysis of random effects was performed using the Der Simonian-Laird method considering the odds ratio (OR) with a 95% confidence interval (95% CI). Results There was no statistically significant difference in the aesthetic outcome between women who underwent OPS and BCS (OR 0.90; 95% CI 0.62-1.30). The staging (OR 1.93; 95% CI 0.97-3.84; I 2 = 15.83%); tumor location [central (OR 1.28; 95% CI 0.06-27.49; I 2 = 17.63%); lower (OR 0.75; 95% CI 0.21-2.65; I 2 = 2.21%); superior (OR 0.67; 95% CI 0.26-1.74; I 2 = 0.00%] and tumor size (OR 8.73; 95% CI -11.82-29.28; I 2 = 93.18%) showed no association with the type of BCS performed, with or without OPS. The degree of satisfaction remains even in cases of extreme oncoplasty. Conclusion The level of patient satisfaction in relation to BCS was similar to that of the group undergoing OPS, highlighting that OPS allows the patient's satisfaction rate to be maintained even in the case of large or multicentric tumors.
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Veluponnar D, Dashtbozorg B, Guimaraes MDS, Peeters MJTFDV, de Boer LL, Ruers TJM. Resection Ratios and Tumor Eccentricity in Breast-Conserving Surgery Specimens for Surgical Accuracy Assessment. Cancers (Basel) 2024; 16:1813. [PMID: 38791892 PMCID: PMC11119905 DOI: 10.3390/cancers16101813] [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: 04/17/2024] [Revised: 04/30/2024] [Accepted: 05/02/2024] [Indexed: 05/26/2024] Open
Abstract
This study aims to evaluate several defined specimen parameters that would allow to determine the surgical accuracy of breast-conserving surgeries (BCS) in a representative population of patients. These specimen parameters could be used to compare surgical accuracy when using novel technologies for intra-operative BCS guidance in the future. Different specimen parameters were determined among 100 BCS patients, including the ratio of specimen volume to tumor volume (resection ratio) with different optimal margin widths (0 mm, 1 mm, 2 mm, and 10 mm). Furthermore, the tumor eccentricity [maximum tumor-margin distance - minimum tumor-margin distance] and the relative tumor eccentricity [tumor eccentricity ÷ pathological tumor diameter] were determined. Different patient subgroups were compared using Wilcoxon rank sum tests. When using a surgical margin width of 0 mm, 1 mm, 2 mm, and 10 mm, on average, 19.16 (IQR 44.36), 9.94 (IQR 18.09), 6.06 (IQR 9.69) and 1.35 (IQR 1.78) times the ideal resection volume was excised, respectively. The median tumor eccentricity among the entire patient population was 11.29 mm (SD = 3.99) and the median relative tumor eccentricity was 0.66 (SD = 2.22). Resection ratios based on different optimal margin widths (0 mm, 1 mm, 2 mm, and 10 mm) and the (relative) tumor eccentricity could be valuable outcome measures to evaluate the surgical accuracy of novel technologies for intra-operative BCS guidance.
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Affiliation(s)
- Dinusha Veluponnar
- Department of Surgery, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
- Department of Nanobiophysics, Faculty of Science and Technology, University of Twente, Drienerlolaan 5, 7522 NB Enschede, The Netherlands
| | - Behdad Dashtbozorg
- Department of Surgery, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | - Marcos Da Silva Guimaraes
- Department of Pathology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | - Marie-Jeanne T. F. D. Vrancken Peeters
- Department of Surgery, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
- Department of Surgery, Amsterdam University Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Lisanne L. de Boer
- Department of Surgery, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | - Theo J. M. Ruers
- Department of Surgery, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
- Department of Nanobiophysics, Faculty of Science and Technology, University of Twente, Drienerlolaan 5, 7522 NB Enschede, The Netherlands
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Torras I, Cebrecos I, Castillo H, Mension E. Evolution of breast conserving surgery-current implementation of oncoplastic techniques in breast conserving surgery: a literature review. Gland Surg 2024; 13:412-425. [PMID: 38601289 PMCID: PMC11002492 DOI: 10.21037/gs-23-454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 02/18/2024] [Indexed: 04/12/2024]
Abstract
Background and Objective De-escalation in breast cancer surgery has been a natural evolution since breast conserving surgery (BCS) was introduced in the early 1980s. From Halsted mastectomies to wide local excisions, we are facing nowadays the next trend in form of oncoplastic breast surgery. Oncoplastic breast surgery combines oncological principles with plastic surgery techniques to preserve the breast shape and appearance. The aim of this work is to review recent oncological and quality of live outcomes derived from oncoplastic techniques as well as offer a perspective about its implementation in breast cancer units. Methods A literature review was conducted to explore the landscape of oncoplastic breast surgery. Key terms related to oncoplastic techniques and breast cancer were used in searches across databases such as PubMed, Embase and Cochrane Library. Inclusion criteria focused on recent articles discussing oncological and quality of life (QoL) outcomes, as well as perspectives on the role of oncoplastic surgery. Key Content and Findings The research aims to contribute valuable insights into the efficacy and impact of oncoplastic surgery in the context of breast cancer treatment. In this new era of precision medicine, it is more than just healing patients; it is about improving their well-being. We ought to consider specific oncoplasty role in leading this paradigm shift. It is also relevant to define whether these new technical-demanding surgical options can be applied to all patients and if professional training performs adequately to current demands of personalized treatments. Conclusions The global adoption of oncoplastic BCS is recommended due to its oncological safety and improvement in QoL compared to standard procedures. Emphasizing the need for skilled surgeons in complex cases, collaboration between breast surgeons and scientific societies is urged to certify ongoing educational training in oncoplastic techniques.
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Affiliation(s)
| | | | - Helena Castillo
- Department of Obstetrics and Gynecology, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Eduard Mension
- Department of Obstetrics and Gynecology, Hospital Clínic of Barcelona, Barcelona, Spain
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Huang S, Qiu P, Liang Z, Yan Z, Luo K, Huang B, Yu L, Crèvecoeur J, Winder AA, Zhang Y, Jiang H. Application of a modified lateral thoracic artery perforator flap in partial breast defects. Gland Surg 2024; 13:199-208. [PMID: 38455344 PMCID: PMC10915419 DOI: 10.21037/gs-23-529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 01/29/2024] [Indexed: 03/09/2024]
Abstract
Background Breast cancer has become the most frequently diagnosed cancer in the world. Detection at an early stage, frequently allows women to benefit from breast conserving surgery. However, some patients are not satisfied with the breast shape after breast-conserving surgery, and autologous tissue flaps are needed to fill the defect in the resection area. The modified lateral thoracic artery perforator (LTAP) flap isn't one of the commonly used flaps in breast surgery and has the advantages of a reliable blood supply, simple operation and few postoperative complications. In this study, we aimed to evaluate the feasibility and effectiveness of a modified LTAP flap for repairing partial breast defects after breast-conserving surgery. Methods In this study, we retrospectively analyzed the clinical data of 126 patients treated with LTAP flaps to repair local breast defects at Affiliated Hospital of Guangdong Medical University between January 2020 and June 2021. Data were collected on the demographic characteristics of these patients, tumor size and location, type of axillary lymph node surgery, availability of adjuvant chemotherapy and radiotherapy, and postoperative complications. Results The median weight of the tumor specimen was 185 g (range, 170-320 g), and this glandular tissue accounted for 30% to 40% of the total breast volume. The average flap size was 10.5 cm ×2.5 cm (length range, 8-15 cm, width range: 2-4 cm). The minimum follow-up time was 6 months, with an average of 10 months (range, 6-22 months). The mean operative time was 130 minutes (range: 90-180 minutes), and the mean hospital stay was 3 days (range, 2-5 days). All modified LTAP flaps survived completely without donor site complications. None of the patients required revision surgery on the postoperative breast. Conclusions The modified LTAP flap is a reliable method for repairing partial breast defects after breast-conserving surgery. It has the advantages of a simple operation, a reliable blood supply, fewer postoperative complications, and a high flap survival rate. It is especially suitable for Asian women with small breast volumes and can achieve good breast contouring effects.
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Affiliation(s)
- Shengchao Huang
- Department of General Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, China
- Department of Breast Surgery, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Pu Qiu
- Department of Breast Surgery, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Zhongzeng Liang
- Department of Breast Surgery, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Zeming Yan
- Department of Breast Surgery, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Kangwei Luo
- Department of Breast Surgery, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Baoyi Huang
- Department of Breast Surgery, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Liyan Yu
- Department of Breast Surgery, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | | | - Alec Anthony Winder
- Department of General Surgery, Townsville University Hospital, Townsville, Australia
| | - Yuanqi Zhang
- Department of Breast Surgery, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Haiping Jiang
- Department of General Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, China
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Soliani Bastos MC, Bagnoli F, Rinaldi JF, João TBF, de Oliveira VM. Dermoglandular advancement-rotation flap for conservative treatment of breast cancer - description of technique, objective and subjective assessments. Front Oncol 2023; 13:1137924. [PMID: 37207164 PMCID: PMC10189110 DOI: 10.3389/fonc.2023.1137924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 04/17/2023] [Indexed: 05/21/2023] Open
Abstract
Objective to describe and evaluate the dermoglandular advancement-rotation flap with no contralateral surgery as a technique for the conservative treatment of breast cancer when skin or a large proportion of gland requires resection. Patients/Methods 14 patients with breast tumors with a mean size of 4.2 cm and need for skin resection. The resection area is included within an isosceles triangle, with its apex located on the areola, which is the pivot for rotation of a dermoglandular flap released through a lateral extension along that triangle base. Symmetry before and after radiotherapy was objectively assessed by authors using the BCCT.core software, as well as subjectively by three experts and patients themselves using the Harvard scale. Results Experts considered the breast symmetry results to be excellent/good for 85.7% of patients in the early post-operative period and 78.6% in the late post-operative period. Excellent/good ratings provided by BCCT.core software amounted to 78.6% of cases in the early post-operative period and 92.9% in the late post-operative period. Symmetry was rated as excellent/good by 100% of patients. Conclusion Dermoglandular advancement-rotation flap technique with no contralateral surgery provides good symmetry when a large proportion of skin or gland requires resection on breast conservative cancer treatment.
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Special Techniques of Adjuvant Breast Carcinoma Radiotherapy. Cancers (Basel) 2022; 15:cancers15010298. [PMID: 36612294 PMCID: PMC9818986 DOI: 10.3390/cancers15010298] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 12/23/2022] [Accepted: 12/28/2022] [Indexed: 01/03/2023] Open
Abstract
Modern radiotherapy techniques are designed to permit reduced irradiation of healthy tissue, resulting in a diminished risk of adverse effects and shortened recovery times. Several randomized studies have demonstrated the benefits of increased dosage to the tumor bed area in combination with whole breast irradiation (WBI). Conventional WBI treatment following breast-conserving procedures, which required 5-7 weeks of daily treatments, has been reduced to 3-4 weeks when using hyperfractionated regimens. The dosage administration improves local control, albeit with poorer cosmesis. The method of accelerated partial breast irradiation (APBI) shortens the treatment period whilst reducing the irradiated volume. APBI can be delivered using intraoperative radiation, brachytherapy, or external beam radiotherapy. Currently available data support the use of external beam partial breast irradiation in selected patients. Modern radiotherapy techniques make it possible to achieve favorable cosmesis in most patients undergoing immediate breast reconstruction surgery, and studies confirm that current methods of external beam radiation allow an acceptable coverage of target volumes both in the reconstructed breast and in the regional lymphatic nodes.
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Hadjittofi C, Almalki H, Mirshekar-Syahkal B, Pain S, Zechmeister K, Hussien M. Simple oncoplastic breast defect closure improves long-term cosmetic outcome of breast conserving surgery for breast cancer: A randomised controlled trial. Breast 2022; 65:104-109. [PMID: 35921797 PMCID: PMC9356147 DOI: 10.1016/j.breast.2022.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 06/30/2022] [Accepted: 07/03/2022] [Indexed: 11/20/2022] Open
Abstract
Introduction Breast conserving surgery (BCS) is associated with unsatisfactory cosmetic outcomes in up to 30% of patients, carrying psychological and quality-of-life implications. This study compares long-term cosmetic outcomes after BCS for breast cancer with v without simple oncoplastic defect closure. Methods A randomised controlled trial was performed, recruiting patients who underwent BCS over four years and randomising to the “reshaping” group (closure of excision defect with mobilised breast tissue; n = 124) and to the “control” group (no attempt at defect closure; n = 109). The estimated excision volume (EEV) was <20% of breast volume (BV) in both groups. Photography and breast retraction assessment (BRA) were recorded preoperatively. Cosmetic outcomes were blindly assessed annually for five years by BRA, panel assessment of patients, and body image questionnaire (BIQ). Results There were no significant differences between the reshaping and control groups in mean age (52.4 v 53.0; p = 0.63), body mass index (27.8 v 27.7; p = 0.80), margin re-excision (9 v 9; p = 0.78), mean BV (562.5 v 590.3 cc; p = 0.56), mean EEV (54.6 v 60.1 cc; p = 0.14), mean EEV/BV ratio (11.2 v 11.0; p = 0.84), or mean specimen weight (52.1 v 57.7 g; p = 0.24). Reshaping group patients had significantly better outcomes compared to control group patients in terms of mean BRA (0.9 v 2.8; p < 0.0001), achieving a score of “good” or “excellent” by panel assessment at 5 years (75.8% v 48%, p < 0.0001), body image questionnaire top score at 5 years (66.9% v 35.8%; p = 0.0001). Conclusions Simple oncoplastic closure of defects after breast-conserving surgery improves long-term objective and subjective cosmetic outcomes. Breast-conserving cancer surgery can lead to unsatisfactory cosmetic outcomes. Simple oncoplastic closure improves long-term cosmetic outcomes. Objective and subjective cosmetic outcomes of oncoplastic closure are correlated.
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Affiliation(s)
- Christopher Hadjittofi
- Department of Breast Surgery, Norfolk and Norwich University Hospitals, Colney Lane, Norwich, NR4 7UY, United Kingdom
| | - Hend Almalki
- Department of Breast Surgery, Norfolk and Norwich University Hospitals, Colney Lane, Norwich, NR4 7UY, United Kingdom
| | - Bahar Mirshekar-Syahkal
- Department of Breast Surgery, Norfolk and Norwich University Hospitals, Colney Lane, Norwich, NR4 7UY, United Kingdom
| | - Simon Pain
- Department of Breast Surgery, Norfolk and Norwich University Hospitals, Colney Lane, Norwich, NR4 7UY, United Kingdom
| | - Katalin Zechmeister
- Department of Breast Surgery, Norfolk and Norwich University Hospitals, Colney Lane, Norwich, NR4 7UY, United Kingdom
| | - Maged Hussien
- Department of Breast Surgery, Norfolk and Norwich University Hospitals, Colney Lane, Norwich, NR4 7UY, United Kingdom.
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Long-term quality of life and aesthetic outcomes after breast conserving surgery in patients with breast cancer. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2022; 48:1692-1698. [DOI: 10.1016/j.ejso.2022.02.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 01/23/2022] [Accepted: 02/09/2022] [Indexed: 02/06/2023]
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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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Nanda A, Hu J, Hodgkinson S, Ali S, Rainsbury R, Roy PG. Oncoplastic breast-conserving surgery for women with primary breast cancer. Cochrane Database Syst Rev 2021; 10:CD013658. [PMID: 34713449 PMCID: PMC8554646 DOI: 10.1002/14651858.cd013658.pub2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Oncoplastic breast-conserving surgery (O-BCS) involves removing the tumour in the breast and using plastic surgery techniques to reconstruct the breast. The adequacy of published evidence on the safety and efficacy of O-BCS for the treatment of breast cancer compared to other surgical options for breast cancer is still debatable. It is estimated that the local recurrence rate is similar to standard breast-conserving surgery (S-BCS) and also mastectomy, but the aesthetic and patient-reported outcomes may be improved with oncoplastic techniques. OBJECTIVES Our primary objective was to assess oncological control outcomes following O-BCS compared with other surgical options for women with breast cancer. Our secondary objective was to assess surgical complications, recall rates, need for further surgery to achieve adequate oncological resection, patient satisfaction through patient-reported outcomes, and cosmetic outcomes through objective measures or clinician-reported outcomes. SEARCH METHODS We searched the Cochrane Breast Cancer Group's Specialized Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (via OVID), Embase (via OVID), the World Health Organization's International Clinical Trials Registry Platform and ClinicalTrials.gov on 7 August 2020. We did not apply any language restrictions. SELECTION CRITERIA We selected randomised controlled trials (RCTs) and non-randomised comparative studies (cohort and case-control studies). Studies evaluated any O-BCS technique, including volume displacement techniques and partial breast volume replacement techniques compared to any other surgical treatment (partial resection or mastectomy) for the treatment of breast cancer. DATA COLLECTION AND ANALYSIS Four review authors performed data extraction and resolved disagreements. We used ROBINS-I to assess the risk of bias by outcome. We performed descriptive data analysis and meta-analysis and evaluated the quality of the evidence using GRADE criteria. The outcomes included local recurrence, breast cancer-specific disease-free survival, re-excision rates, complications, recall rates, and patient-reported outcome measures. MAIN RESULTS We included 78 non-randomised cohort studies evaluating 178,813 women. Overall, we assessed the risk of bias per outcome as being at serious risk of bias due to confounding; where studies adjusted for confounding, we deemed these at moderate risk. Comparison 1: oncoplastic breast-conserving surgery (O-BCS) versus standard-BCS (S-BCS) The evidence in the review found that O-BCS when compared to S-BCS, may make little or no difference to local recurrence; either when measured as local recurrence-free survival (hazard ratio (HR) 0.90, 95% confidence interval (CI) 0.61 to 1.34; 4 studies, 7600 participants; very low-certainty evidence) or local recurrence rate (HR 1.33, 95% CI 0.96 to 1.83; 4 studies, 2433 participants; low-certainty evidence), but the evidence is very uncertain due to most studies not controlling for confounding clinicopathological factors. O-BCS compared to S-BCS may make little to no difference to disease-free survival (HR 1.06, 95% CI 0.89 to 1.26; 7 studies, 5532 participants; low-certainty evidence). O-BCS may reduce the rate of re-excisions needed for oncological resection (risk ratio (RR) 0.76, 95% CI 0.69 to 0.85; 38 studies, 13,341 participants; very low-certainty evidence), but the evidence is very uncertain. O-BCS may increase the number of women who have at least one complication (RR 1.19, 95% CI 1.10 to 1.27; 20 studies, 118,005 participants; very low-certainty evidence) and increase the recall to biopsy rate (RR 2.39, 95% CI 1.67 to 3.42; 6 studies, 715 participants; low-certainty evidence). Meta-analysis was not possible when assessing patient-reported outcomes or cosmetic evaluation; in general, O-BCS reported a similar or more favourable result, however, the evidence is very uncertain due to risk of bias in the measurement methods. Comparison 2: oncoplastic breast-conserving surgery (O-BCS) versus mastectomy alone O-BCS may increase local recurrence-free survival compared to mastectomy but the evidence is very uncertain (HR 0.55, 95% CI 0.34 to 0.91; 2 studies, 4713 participants; very low-certainty evidence). The evidence is very uncertain about the effect of O-BCS on disease-free survival as there were only data from one study. O-BCS may reduce complications compared to mastectomy, but the evidence is very uncertain due to high risk of bias mainly resulting from confounding (RR 0.75, 95% CI 0.67 to 0.83; 4 studies, 4839 participants; very low-certainty evidence). Data on patient-reported outcome measures came from single studies; it was not possible to meta-analyse the data. Comparison 3: oncoplastic breast-conserving surgery (O-BCS) versus mastectomy with reconstruction O-BCS may make little or no difference to local recurrence-free survival (HR 1.37, 95% CI 0.72 to 2.62; 1 study, 3785 participants; very low-certainty evidence) or disease-free survival (HR 0.45, 95% CI 0.09 to 2.22; 1 study, 317 participants; very low-certainty evidence) when compared to mastectomy with reconstruction, but the evidence is very uncertain. O-BCS may reduce the complication rate compared to mastectomy with reconstruction (RR 0.49, 95% CI 0.45 to 0.54; 5 studies, 4973 participants; very low-certainty evidence) but the evidence is very uncertain due to high risk of bias from confounding and inconsistency of results. The evidence is very uncertain for patient-reported outcome measures and cosmetic evaluation. AUTHORS' CONCLUSIONS The evidence is very uncertain regarding oncological outcomes following O-BCS compared to S-BCS, though O-BCS has not been shown to be inferior. O-BCS may result in less need for a second re-excision surgery but may result in more complications and a greater recall rate than S-BCS. It seems that O-BCS may give better patient satisfaction and surgeon rating for the look of the breast, but the evidence for this is of poor quality, and due to lack of numerical data, it was not possible to pool the results of different studies. It seems O-BCS results in fewer complications compared with surgeries involving mastectomy. Based on this review, no certain conclusions can be made to help inform policymakers. The surgical decision for what operation to proceed with should be made jointly between clinician and patient after an appropriate discussion about the risks and benefits of O-BCS personalised to the patient, taking into account clinicopathological factors. This review highlighted the deficiency of well-conducted studies to evaluate efficacy, safety and patient-reported outcomes following O-BCS.
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Affiliation(s)
- Akriti Nanda
- Department of Breast Surgery, Oxford University Hospitals, Oxford, UK
| | - Jesse Hu
- Division of Breast Surgery, National University Health System, Singapore, Singapore
| | - Sarah Hodgkinson
- Editorial & Methods Department, Cochrane Central Executive, London, UK
| | - Sanah Ali
- Medical School, Oxford University, Oxford, UK
| | | | - Pankaj G Roy
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
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13
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Sakina Abidi S, Mushtaque Vohra L, Rizwan Javed M, Khan N. Oncoplastic surgery: A suitable alternative to conventional breast conserving surgery in low - Middle income countries; a retrospective cohort study. Ann Med Surg (Lond) 2021; 68:102618. [PMID: 34401126 PMCID: PMC8350174 DOI: 10.1016/j.amsu.2021.102618] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 07/26/2021] [Indexed: 11/17/2022] Open
Abstract
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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14
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Stolpner I, Heil J, Riedel F, Wallwiener M, Schäfgen B, Feißt M, Golatta M, Hennigs A. Long-Term Patient Satisfaction and Quality of Life After Breast-Conserving Therapy: A Prospective Study Using the BREAST-Q. Ann Surg Oncol 2021; 28:8742-8751. [PMID: 34279753 PMCID: PMC8591011 DOI: 10.1245/s10434-021-10377-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 05/21/2021] [Indexed: 12/24/2022]
Abstract
Background Poor patient-reported satisfaction after breast-conserving therapy (BCT) has been associated with impaired health-related quality of life (HRQOL) and subsequent depression in retrospective analysis. This prospective cohort study aimed to assess the HRQOL of patients who have undergone BCT using the BREAST-Q, and to identify clinical risk factors for lower patient satisfaction. Methods Patients with primary breast cancer undergoing BCT were asked to complete the BREAST-Q preoperatively (T1) for baseline evaluation, then 3 to 4 weeks postoperatively (T2), and finally 1 year after surgery (T3). Clinicopathologic data were extracted from the patients’ charts. Repeated measures analysis of variance (ANOVA) was used to determine significant differences in mean satisfaction and well-being levels among the test intervals. Multiple linear regression was used to evaluate risk factors for lower satisfaction. Results The study enrolled 250 patients. The lowest baseline BREAST-Q score was reported for “satisfaction with breast” (mean, 61 ± 19), but this increased postoperatively (mean, 66 ± 18) and was maintained at the 1 year follow-up evaluation (mean, 67 ± 21). “Physical well-being” decreased from T1 (mean, 82 ± 17) to T2 (mean, 28 ± 13) and did not recover much by T3 (mean, 33 ± 13), being the lowest BREAST-Q score postoperatively and in the 1-year follow-up evaluation. In multiple regression, baseline psychosocial well-being, body mass index (BMI), and type of incision were risk factors for lower “satisfaction with breasts.” Conclusion Both the aesthetic/surgery-related and psychological aspects are equally important with regard to “satisfaction with breasts” after BCT. The data could serve as the benchmark for future studies.
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Affiliation(s)
- Ilona Stolpner
- Department of Gynecology and Obstetrics, University of Heidelberg, Heidelberg, Germany
| | - Jörg Heil
- Department of Gynecology and Obstetrics, University of Heidelberg, Heidelberg, Germany
| | - Fabian Riedel
- Department of Gynecology and Obstetrics, University of Heidelberg, Heidelberg, Germany
| | - Markus Wallwiener
- Department of Gynecology and Obstetrics, University of Heidelberg, Heidelberg, Germany
| | - Benedikt Schäfgen
- Department of Gynecology and Obstetrics, University of Heidelberg, Heidelberg, Germany
| | - Manuel Feißt
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Michael Golatta
- Department of Gynecology and Obstetrics, University of Heidelberg, Heidelberg, Germany
| | - André Hennigs
- Department of Gynecology and Obstetrics, University of Heidelberg, Heidelberg, Germany.
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15
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Araújo RS, Leone CV, Dotto PG, Ferreira LM, Veiga DF. Publications, by different surgical specialties, on patient-reported outcomes of oncoplastic surgery. Rev Assoc Med Bras (1992) 2021; 67:1069-1074. [DOI: 10.1590/1806-9282.20210186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 05/23/2021] [Indexed: 11/21/2022] Open
Affiliation(s)
| | | | | | - Lydia Masako Ferreira
- Universidade Federal de São Paulo, Brazil; Universidade Federal de São Paulo, Brazil
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16
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Shaitelman SF, Jeruss JS, Pusic AL. Oncoplastic Surgery in the Management of Breast Cancer. J Clin Oncol 2020; 38:2246-2253. [PMID: 32442070 DOI: 10.1200/jco.19.02795] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Simona F Shaitelman
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Andrea L Pusic
- Division of Plastic Surgery, Brigham and Women's Hospital, Boston, MA
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17
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Acea-Nebril B, Cereijo-Garea C, García-Novoa A, Bouzon-Alejandro A, Mosquera-Oses J. Breast-Q 15 prospective study: oncoplastic breast reduction improve quality of live for women with macromastia. Breast J 2020; 26:1890-1892. [PMID: 32291860 DOI: 10.1111/tbj.13836] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 03/17/2020] [Accepted: 03/26/2020] [Indexed: 11/26/2022]
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18
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Krishna KL, Srinath BS, Santosh D, Velusamy S, Divyamala KP, Sariya Mohammadi J, Kurpad V, Kulkarni S, Yaji P, Goud S, Dhanireddy S, Ram J. A comparative study of perioperative techniques to attain negative margins and spare healthy breast tissue in breast conserving surgery. Breast Dis 2020; 39:127-135. [PMID: 32831188 DOI: 10.3233/bd-200443] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND AND AIM Traditionally lumpectomy as a part of breast-conserving surgery (BCS) is performed by palpation-guided method leading to positive margins and large excision volumes. There is no evidence suggesting that wide margin excisions decrease intra-breast tumour recurrence. Various perioperative techniques are used for margin assessment. We aimed to compare three commonly used techniques, i.e., ultrasound-guided surgery, palpation-guided surgery and cavity shaving for attaining negative margins and estimating the extent of healthy breast tissue resection. METHOD A prospective comparative study was performed on 90 patients who underwent breast conservation surgery for early breast cancer between August 2018 and June 2019. Tumour excision with a minimum of 1 cm margin was done either using ultrasound, palpation or cavity shaving. Histopathological evaluation was done to assess the margin status and excess amount of resected normal breast tissue. Calculated resection ratio (CRR) defining the excess amount of the resected breast tissue was achieved by dividing the total resection volume (TRV) by optimal resection volume (ORV). The time taken for excision was also recorded. RESULTS Histopathology of all 90 patients (30 in each group) revealed a negative resection margin in 93.3% of 30 patients in palpation-guided surgery group and 100% in both ultrasound-guided surgery and cavity shaving groups. Two patients (6.7%) from the cavity shaving group had positive margins on initial lumpectomy but shave margins were negative. TRV was significantly less in the ultrasound-guided surgery group compared to the palpation-guided surgery group and cavity shaving group (76.9 cm3, 94.7 cm3 and 126.3 cm3 respectively; p < 0.0051). CRR was 1.2 in ultrasound group compared to 1.9 in palpation group and 2.1 in cavity shave group which was also statistically significant (p < 0.0001).Excision time was significantly less (p < 0.001) in palpation-guided surgery group (13.8 min) compared to cavity shaving group (15.1 min) and ultrasound-guided group (19.4 min). CONCLUSION Ultrasound-guided surgery is more accurate in attaining negative margins with the removal of least amount of healthy breast tissue compared to palpation-guided surgery and cavity shaving.
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Affiliation(s)
- Kanyadhara Lohita Krishna
- Department of Surgical Oncology, Sri Shankara Cancer Hospital and Research Centre, Basavangudi, Bangalore, Karnataka, India
| | - B S Srinath
- Department of Surgical Oncology, Sri Shankara Cancer Hospital and Research Centre, Basavangudi, Bangalore, Karnataka, India
| | - Divya Santosh
- Department of Breast Radiology, Sri Shankara Cancer Hospital and Research Centre, Basavangudi, Bangalore, Karnataka, India
| | - Shanthi Velusamy
- Department of Pathology, Sri Shankara Cancer Hospital and Research Centre, Basavangudi, Bangalore, Karnataka, India
| | - K P Divyamala
- Department of Pathology, Sri Shankara Cancer Hospital and Research Centre, Basavangudi, Bangalore, Karnataka, India
| | - J Sariya Mohammadi
- Department of Surgical Oncology, Sri Shankara Cancer Hospital and Research Centre, Basavangudi, Bangalore, Karnataka, India
| | - Vishnu Kurpad
- Department of Surgical Oncology, Sri Shankara Cancer Hospital and Research Centre, Basavangudi, Bangalore, Karnataka, India
| | - Sanjeev Kulkarni
- Department of Surgical Oncology, Sri Shankara Cancer Hospital and Research Centre, Basavangudi, Bangalore, Karnataka, India
| | - Prabhat Yaji
- Department of Surgical Oncology, Sri Shankara Cancer Hospital and Research Centre, Basavangudi, Bangalore, Karnataka, India
| | - Sandeep Goud
- Department of Surgical Oncology, Sri Shankara Cancer Hospital and Research Centre, Basavangudi, Bangalore, Karnataka, India
| | - Subhashini Dhanireddy
- Department of Surgical Oncology, Sri Shankara Cancer Hospital and Research Centre, Basavangudi, Bangalore, Karnataka, India
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19
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Stolpner I, Heil J, Hennigs A. ASO Author Reflections: The BREAST-Q BCT Module and Its Use in Clinical Practice. Ann Surg Oncol 2019; 26:788-789. [PMID: 31617118 DOI: 10.1245/s10434-019-07939-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Indexed: 11/18/2022]
Affiliation(s)
- Ilona Stolpner
- Department of Gynecology and Obstetrics, University of Heidelberg, Heidelberg, Germany
| | - Jörg Heil
- Department of Gynecology and Obstetrics, University of Heidelberg, Heidelberg, Germany
| | - André Hennigs
- Department of Gynecology and Obstetrics, University of Heidelberg, Heidelberg, Germany.
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20
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Flanagan MR, Zabor EC, Romanoff A, Fuzesi S, Stempel M, Mehrara BJ, Morrow M, Pusic AL, Gemignani ML. A Comparison of Patient-Reported Outcomes After Breast-Conserving Surgery and Mastectomy with Implant Breast Reconstruction. Ann Surg Oncol 2019; 26:3133-3140. [PMID: 31342397 DOI: 10.1245/s10434-019-07548-9] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Indexed: 01/02/2023]
Abstract
BACKGROUND Many factors influence decisions regarding choice of breast-conserving surgery (BCS) versus mastectomy with reconstruction for early invasive breast cancer. The purpose of this study was to compare patient satisfaction following BCS and mastectomy with implant reconstruction (M-iR) utilizing the BREAST-Q patient-reported outcome measure. METHODS Women with stage I or II breast cancer undergoing BCS or M-iR who completed a BREAST-Q from 2010 to 2016 were identified by retrospective review of a prospective database. Baseline characteristics were compared, and linear mixed models were used to analyze associations with BREAST-Q scores over time. RESULTS Our study group was composed of 3233 women; 2026 (63%) had BCS, 123 (3.8%) had nipple-sparing mastectomy, and 1084 (34%) had skin-sparing or total mastectomy. Median time from surgery to BREAST-Q was 205 days for BCS and 639 days for M-iR (p < 0.001). Regardless of type of surgery, breast satisfaction scores decreased significantly over time (p < 0.001), whereas psychosocial (p = 0.001) and sexual (p = 0.004) well-being scores increased significantly over time. BCS was associated with significantly higher scores over time compared with M-iR across all subscales (all p < 0.001). Radiation was significantly associated with decreased scores over time across all subscales (all p < 0.05). CONCLUSIONS Breast satisfaction and quality-of-life scores were higher for BCS compared with M-iR in early-stage invasive breast cancer. These findings may help in counseling women who have a choice for surgical treatment. Breast satisfaction scores decreased over time in all women, highlighting the need for further evaluation with longer follow-up.
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Affiliation(s)
- Meghan R Flanagan
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Emily C Zabor
- Biostatistics Service, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Anya Romanoff
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sarah Fuzesi
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Michelle Stempel
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Babak J Mehrara
- Plastic and Reconstructive Surgical Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Monica Morrow
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Andrea L Pusic
- Plastic and Reconstructive Surgery Division, Brigham and Women's Hospital, Boston, MA, USA
| | - Mary L Gemignani
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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21
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Tagliaferri L, Lancellotta V, Zinicola T, Gentileschi S, Sollena P, Garganese G, Guinot JL, Rembielak A, Soror T, Autorino R, Cammelli S, Gambacorta MA, Aristei C, Valentini V, Kovacs G. Cosmetic assessment in brachytherapy (interventional radiotherapy) for breast cancer: A multidisciplinary review. Brachytherapy 2019; 18:635-644. [PMID: 31171462 DOI: 10.1016/j.brachy.2019.03.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Revised: 03/18/2019] [Accepted: 03/25/2019] [Indexed: 01/24/2023]
Abstract
PURPOSE This review was to focus on breast brachytherapy cosmetic assessment methods state of the art and to define the advantages and disadvantages related to. METHODS AND MATERIALS We conducted a literature review of the major experience on breast brachytherapy cosmetic assessment methods in several databases (PubMed, Scopus, and Google Scholar databases). To identify the relevant works, a task force screened citations at title and abstract level to identify potentially relevant paper. An expert board reviewed and approved the text. The assessment systems were classified into three main groups: (1) the Oncological Toxicity Scales, (2) the Independent Patients Perspective Measures, (3) the Patient-Related Outcome Measures. Each cosmetic assessment method was evaluated following six parameters: (1) anatomical site, (2) advantages, (3) disadvantages, (4) subjective/objective, (5) quantitative/qualitative, (6) computers or pictures needs. RESULTS Eleven assessment methods were selected. Three methods were classified as Oncological Toxicity Scale, six in the Independent Patients Perspective Measures classification, and two as Patient-Related Outcome Measures. Six methods are subjective, while eight are objective. Four systems are classified as quantitative, four as qualitative while three both. Five systems need informatics support. Moreover, each method was discussed individually reporting the main characteristics and peculiarities. CONCLUSIONS Cosmesis is one major end point for the patient who has a malignancy of low lethal potential. In modern personalized medicine, there is a need for standardized cosmetic outcome assessments to analyze and compare the results of treatments. No gold standard methods currently exist. The result of this review is to summarize the various cosmesis methods, defining the strengths and weaknesses of each one and giving a line in research and clinical practice.
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Affiliation(s)
- Luca Tagliaferri
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Roma, Italia
| | - Valentina Lancellotta
- Department of Surgery and Biomedical Sciences, Radiation Oncology Section, University of Perugia and Perugia General Hospital, Perugia, Italia
| | - Tiziano Zinicola
- Università Cattolica del Sacro Cuore, Istituto di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Roma, Italia.
| | - Stefano Gentileschi
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Dipartimento di Chirurgia Plastica e Ricostruttiva, Centro di Trattamento Chirurgico del Linfedema, Roma, Italia
| | - Pietro Sollena
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Dermatologia, Roma, Italia
| | - Giorgia Garganese
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Dipartimento Scienze della Salute della Donna e del Bambino, Roma, Italia
| | - José L Guinot
- Department of Radiation Oncology, Foundation Instituto Valenciano de Oncologia (I.V.O.), València, Spain
| | - Agata Rembielak
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester and Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Tamer Soror
- Department of Clinical Radiation Oncology, Ernst von Bergmann Medical Center, Academic Teaching Hospital of Humboldt University Berlin (Charité), Berlin, Germany; National Cancer Institute (NCI), Radiation Oncology Department, Cairo University, Cairo, Egypt
| | - Rosa Autorino
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Roma, Italia
| | - Silvia Cammelli
- Radiation Oncology Unit, Department of Experimental, Diagnostic and Specialty Medicine - DIMES, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italia
| | - Maria A Gambacorta
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Roma, Italia; Università Cattolica del Sacro Cuore, Istituto di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Roma, Italia
| | - Cynthia Aristei
- Department of Surgery and Biomedical Sciences, Radiation Oncology Section, University of Perugia and Perugia General Hospital, Perugia, Italia
| | - Vincenzo Valentini
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Roma, Italia; Università Cattolica del Sacro Cuore, Istituto di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Roma, Italia
| | - György Kovacs
- Interdisciplinary Brachytherapy Unit, UKSH CL, Lübeck, Germany
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22
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Strach MC, Prasanna T, Kirova YM, Alran S, O'Toole S, Beith JM, Poortmans P, McNeil CM, Carroll S. Optimise not compromise: The importance of a multidisciplinary breast cancer patient pathway in the era of oncoplastic and reconstructive surgery. Crit Rev Oncol Hematol 2018; 134:10-21. [PMID: 30771869 DOI: 10.1016/j.critrevonc.2018.11.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Revised: 08/25/2018] [Accepted: 11/23/2018] [Indexed: 12/18/2022] Open
Abstract
Modern breast cancer care is a complex multidisciplinary undertaking in which the integrated function of multiple constituent parts is critical, and where changes to one therapeutic component may profoundly influence the delivery and outcomes of another. Oncoplastic and reconstructive breast surgery has evolved in the era of longer survival rates for women with breast cancer and aims to enhance oncological and cosmetic outcomes. However, concurrently there has been an expansion in the indications for post-mastectomy radiation therapy (Abdulkarim et al., 2011; Early Breast Cancer Trialists' Collaborative Group (EBCTCG), 2014; Poortmans et al., 2015; Wang et al., 2011), the recognition of several biologically distinct breast cancer subtypes (Perou et al., 2000; Sørlie et al., 2001, 2003; Cheang et al., 2008, 2009; Sotiriou et al., 2003; Millar et al., 2011; Blows et al., 2010; Schnitt, 2010; Haque et al., 2012; Dai et al., 2015) and the development of recommendations for prophylactic surgery for high-risk women, including BRCA-mutation carriers (James et al., 2006; Domchek et al., 2010). Primary systemic therapy is increasingly utilised yet has varying efficacy depending on tumour biology (Cortazar et al., 2014). In this paper we review the evidence which informs the multidisciplinary team opinion in the era of oncoplastic and reconstructive breast surgery. We aim to describe an optimal multidisciplinary approach which balances competing risks of multimodal therapies to optimise oncological and cosmetic outcomes.
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Affiliation(s)
- Madeleine C Strach
- Department of Medical Oncology, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia; Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.
| | - Thiru Prasanna
- Department of Medical Oncology, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia; Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Youlia M Kirova
- Department of Radiation Oncology, Institut Curie, Paris, France
| | - Severine Alran
- Department of Surgical Oncology, Groupe Hospitalier Paris St Joseph, France
| | - Sandra O'Toole
- Garvan Institute of Medical Research, Darlinghurst, New South Wales, Australia; Sydney Medical School, University of Sydney, New South Wales, Australia; Australian Clinical Labs, Bella Vista, New South Wales, Australia
| | - Jane M Beith
- Department of Medical Oncology, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia; Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia; Sydney Medical School, University of Sydney, New South Wales, Australia
| | | | - Catriona M McNeil
- Department of Medical Oncology, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia; Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia; Sydney Medical School, University of Sydney, New South Wales, Australia
| | - Susan Carroll
- Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia; Sydney Medical School, University of Sydney, New South Wales, Australia; Department of Radiation Oncology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
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