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Falade I, Switalla K, Quirarte A, Baxter M, Soroudi D, Rothschild H, Abe SE, Goodwin K, Piper M, Wong J, Foster R, Mukhtar RA. Oncologic Safety of Immediate Oncoplastic Surgery Compared with Standard Breast-Conserving Surgery for Patients with Invasive Lobular Carcinoma. Ann Surg Oncol 2024:10.1245/s10434-024-15326-5. [PMID: 38713388 DOI: 10.1245/s10434-024-15326-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 04/01/2024] [Indexed: 05/08/2024]
Abstract
BACKGROUND Invasive lobular carcinoma (ILC) of the breast grows in a diffuse pattern, resulting in a high risk of positive margins at surgical resection. Oncoplastic approaches have been shown to reduce this risk, but concerns persist around the safety of immediate oncoplastic surgery for those with ILC. This study evaluated the short- and long-term oncologic outcomes of immediate oncoplastic surgery for patients with ILC. METHODS This study retrospectively analyzed an institutional database of stages I to III ILC patients who underwent breast-conserving surgery (BCS) with or without immediate oncoplastic surgery (oncoplastic closure or oncoplastic reduction mammoplasty [ORM]). The study compared positive margin rates, rates of successful BCS, and recurrence-free survival (RFS) by type of surgery. RESULTS For 494 patients the findings showed that the use of immediate ORM was associated with significantly lower odds of positive margins (odds ratio [OR], 0.34; 95 % confidence interval [CI], 0.17-0.66; p = 0.002). Both lumpectomy with oncoplastic closure and ORM were significantly associated with higher rates of successful BCS than standard lumpectomy (94.2 %, 87.8 %, and 73.9 %, respectively; p < 0.001). No difference in RFS was observed between those undergoing immediate oncoplastic surgery and those undergoing standard lumpectomy alone. CONCLUSIONS The patients with stages I to III ILC who underwent immediate oncoplastic surgery had significant benefits including lower odds of positive margins and higher rates of successful BCS, with both types of immediate oncoplastic surgery showing similar RFS compared with lumpectomy alone. This supports the oncologic safety of immediate oncoplastic surgery for diffusely growing tumors such as ILC, providing it an ideal option for patients desiring BCS.
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Affiliation(s)
- Israel Falade
- School of Medicine, University of California-San Francisco, San Francisco, CA, USA.
| | - Kayla Switalla
- University of Minnesota Medical School, Minneapolis, MN, USA
- Division of Surgical Oncology, Department of Surgery, University of California-San Francisco, San Francisco, CA, USA
| | - Astrid Quirarte
- Division of Surgical Oncology, Department of Surgery, University of California-San Francisco, San Francisco, CA, USA
| | - Molly Baxter
- Division of Surgical Oncology, Department of Surgery, University of California-San Francisco, San Francisco, CA, USA
| | - Daniel Soroudi
- School of Medicine, University of California-San Francisco, San Francisco, CA, USA
| | - Harriet Rothschild
- School of Medicine, University of California-San Francisco, San Francisco, CA, USA
| | - Shoko Emily Abe
- Division of Surgical Oncology, Department of Surgery, University of California-San Francisco, San Francisco, CA, USA
| | - Karen Goodwin
- Division of Surgical Oncology, Department of Surgery, University of California-San Francisco, San Francisco, CA, USA
| | - Merisa Piper
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of California-San Francisco, San Francisco, CA, USA
| | - Jasmine Wong
- Division of Surgical Oncology, Department of Surgery, University of California-San Francisco, San Francisco, CA, USA
| | - Robert Foster
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of California-San Francisco, San Francisco, CA, USA
| | - Rita A Mukhtar
- Division of Surgical Oncology, Department of Surgery, University of California-San Francisco, San Francisco, CA, USA
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