Is oncoplastic breast-conserving surgery better than mastectomy with reconstruction?
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ABSTRACT:
SUBMITTER: Dai Y
PROVIDER: S-EPMC11336796 | biostudies-literature | 2024 Jul
REPOSITORIES: biostudies-literature
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Project description: Not available
| S-EPMC11002483 | biostudies-literature
Project description:BackgroundRecent evidence suggests a survival advantage after breast-conserving surgery compared with mastectomy. Previous studies have compared survival outcomes after standard breast-conserving surgery, but no studies have compared survival outcomes after oncoplastic breast-conserving surgery. The aim of this study was to compare survival outcomes after breast-conserving surgery + radiotherapy (and an oncoplastic breast-conserving surgery + radiotherapy subgroup) with those after mastectomy ± radiotherapy.MethodsPatients diagnosed with primary invasive breast cancer between 1 January 2010 and 31 December 2019 were identified from a prospectively maintained National Cancer Registry. Overall survival and breast cancer-specific survival outcomes were analysed using Kaplan-Meier analysis and Cox regression analysis adjusting for patient demographics, tumour characteristics, and treatment adjuncts.ResultsA total of 14 182 patients were eligible (8537 patients underwent standard breast-conserving surgery + radiotherapy, 360 patients underwent oncoplastic breast-conserving surgery + radiotherapy, 2953 patients underwent mastectomy + radiotherapy, and 2332 patients underwent mastectomy - radiotherapy). The median follow-up was 7.27 (range 0.2-13.6) years. Superior 10-year survival was observed after breast-conserving surgery + radiotherapy (overall survival: 81.2%; breast cancer-specific survival: 93.3%) compared with mastectomy + radiotherapy (overall survival: 63.4%; breast cancer-specific survival: 75.9%) and mastectomy - radiotherapy (overall survival: 63.1%; breast cancer-specific survival: 87.5%). Ten-year overall survival and breast cancer-specific survival after oncoplastic breast-conserving surgery + radiotherapy were 86.1% and 90.2% respectively. After adjusted analysis, breast-conserving surgery + radiotherapy was associated with superior survival outcomes compared with mastectomy + radiotherapy (overall survival: HR 1.34 (95% c.i. 1.20 to 1.51); breast cancer-specific survival: HR 1.62 (95% c.i. 1.38 to 1.90)) and mastectomy - radiotherapy (overall survival: HR 1.57 (95% c.i. 1.41 to 1.75); breast cancer-specific survival: HR 1.70 (95% c.i. 1.41 to 2.05)). Similar survival outcomes were observed amongst patients treated with oncoplastic breast-conserving surgery + radiotherapy compared with mastectomy + radiotherapy (overall survival: HR 1.72 (95% c.i. 1.62 to 2.55); breast cancer-specific survival: HR 1.74 (95% c.i. 1.06 to 2.86)) and mastectomy - radiotherapy (overall survival: HR 2.21 (95% c.i. 1.49 to 3.27); breast cancer-specific survival: HR 1.89 (95% c.i. 1.13 to 3.14)).ConclusionBreast-conserving surgery + radiotherapy and oncoplastic breast-conserving surgery + radiotherapy are associated with superior overall survival and breast cancer-specific survival compared with mastectomy ± radiotherapy. The findings should inform discussion of surgical treatment options for patients with breast cancer.
| S-EPMC11920510 | biostudies-literature
Project description:PurposeThe use of oncoplastic reconstruction for breast-conserving surgery (BCS) extends benefits beyond merely minimizing poor cosmetic results. However, the feasibility and oncological safety of oncoplastic surgery (OPS) are controversial.MethodsThis meta-analysis aimed to compare the short-term and long-term oncological outcomes of BCS alone and BCS plus OPS. Relevant studies published before July 2017 in the Embase, the Cochrane Library, PubMed, and Web of Science databases were screened and collected. The meta-analysis was performed using STATA software (Stata Corp.).ResultsA total of 3,789 patients from 11 studies were included, with 2,691 patients in the BCS-alone group and 1,098 patients in the BCS plus OPS group. The demographics were similar between both groups, and no significant difference was observed in pathological T and N stages between the two groups. Re-excision was less common (relative risk [RR], 0.66; p=0.009) and the positive-margin rate was lower, but not significantly (RR, 0.83; p=0.191), in the BCS plus OPS group than in the BCS-alone group. The local and distal recurrence rates were similar in both groups. Both disease-free survival (hazard ratio [HR], 1.19; 95% confidence interval [CI], 0.96-1.49; p=0.112) and overall survival (HR, 1.14; 95% CI, 0.76-1.69; p=0.527) did not differ between the two groups.ConclusionA combination of BCS and OPS is preferred over BCS alone for decreasing re-excisions and provides similar long-term survival as BCS alone in patients with breast cancer.
| S-EPMC6158154 | biostudies-literature
Project description: Not available
| S-EPMC8554646 | biostudies-literature
Project description:BackgroundIn addition to conventional breast-conserving surgery (BCS), oncoplastic breast surgery (OBS) is an operation technique that strives simultaneously to increase oncological safety and patient's satisfaction. It is the combination of the best-proven techniques in plastic surgery with surgery for breast cancer. In a growing number of indications, OBS overcomes the limit of conventional BCS by allowing larger resection volumes while avoiding deformities. The aim of our retrospective study (2012-2014) was to compare oncological outcomes of OBS versus BCS.MethodsWe compared two groups of patients with primary non-metastatic breast tumours: group A (n = 291), where BCS was performed, versus group B (n = 52), where OBS was performed. Surgical interventions were performed in German and Swiss teaching hospital settings. The surgeon for group B had subspecialist training in OBS. We assessed outcome in term of re-excision rates, resection margin and complications.ResultsGroups were homogenous (no significant differences in terms of age, tumour size, tumour type or grade). The resection margin was larger in group B (7 mm) than in group A (3 mm). Re-excision rate of group B (8%) was significantly lower than in group A (31%). Complication rates were comparably low in groups A and B.ConclusionDespite the limits of retrospective design, our study confirms that OBS is safe and reduces the re-excision rates and the need for further surgery. OBS has the potential to improve oncological care and should be more widely adopted.
| S-EPMC6849881 | biostudies-literature
Project description:BackgroundAlthough breast-conserving surgery is oncologically safe for women with early-stage breast cancer, mastectomy rates are increasing. The objective of this study was to examine the role of breast reconstruction in the surgical management of unilateral early-stage breast cancer.MethodsA retrospective cohort study of women diagnosed with unilateral early-stage breast cancer (1998 to 2011) identified in the National Cancer Data Base was conducted. Rates of breast-conserving surgery, unilateral and bilateral mastectomy with contralateral prophylactic procedures (per 1000 early-stage breast cancer cases) were measured in relation to breast reconstruction. The association between breast reconstruction and surgical treatment was evaluated using a multinomial logistic regression, controlling for patient and disease characteristics.ResultsA total of 1,856,702 patients were included. Mastectomy rates decreased from 459 to 360 per 1000 from 1998 to 2005 (p < 0.01), increasing to 403 per 1000 in 2011 (p < 0.01). The mastectomy rates rise after 2005 reflects a 14 percent annual increase in contralateral prophylactic mastectomies (p < 0.01), as unilateral mastectomy rates did not change significantly. Each percentage point of increase in reconstruction rates was associated with a 7 percent increase in the probability of contralateral prophylactic mastectomies, with the greatest variation explained by young age(32 percent), breast reconstruction (29 percent), and stage 0 (5 percent).ConclusionsSince 2005, an increasing proportion of early-stage breast cancer patients have chosen mastectomy instead of breast-conserving surgery. This trend reflects a shift toward bilateral mastectomy with contralateral prophylactic procedures that may be facilitated by breast reconstruction availability.
| S-EPMC4744797 | biostudies-literature
Project description:Oncoplastic breast-conserving surgery (OBCS) avoids mastectomy for larger tumors, but patient-reported outcomes are unknown.The BREAST-Q questionnaire was distributed to 333 women following therapeutic mammaplasty or latissimus dorsi (LD) miniflap since 1991 [tumor diameter, 32.5 (5-100) mm). QScore software generated scores/100 for breast appearance, physical, emotional, and sexual wellbeing. Outcomes following therapeutic mammaplasty and LD miniflap were compared and qualitative data analyzed to identify common themes relating to satisfaction.One hundred fifty (45%) women responded [mammaplasty versus LD miniflap, 52% versus 42%; age, 52 (30-83) years; follow-up, 84 (4-281) months). Eighty-nine percent rated OBCS better than mastectomy, > 80% recommending it to others. Mean outcome scores for breast appearance, physical, and emotional wellbeing were high and persisted beyond 15 years. Therapeutic mammaplasty patients were significantly more satisfied than those undergoing LD miniflap with the shape (P < 0.05), the size (P < 0.005), and the natural feel of the treated breast (P = 0.01). They demonstrated similar scores for physical and emotional wellbeing and a lower score for sexual wellbeing than LD miniflap patients. More LD miniflap patients reported back/shoulder symptoms and were more likely to report upper back pain (P < 0.05), but very few (< 5%) were concerned about donor-site appearance. Overall satisfaction with surgical outcomes was high in both OBCS groups (82% "excellent/very good") but greatest after therapeutic mammaplasty (P < 0.005).Patients report long-lasting satisfaction after OBCS and outcomes that compare very favorably with those reported following mastectomy and immediate autologous reconstruction.
| S-EPMC5548581 | biostudies-other
Project description: Not available
| S-EPMC11002492 | biostudies-literature
Project description:IntroductionBreast cancer is the most common cancer among women. The surgical treatment of breast cancer has transitioned progressively from radical mastectomy to breast-conserving surgery. In this meta-analysis, we are aiming to compare oncoplastic breast-conserving surgery (OS) with conventional breast-conserving surgery (BCS) in terms of efficacy and safety.MethodsWe searched Medline, Web of Science, Embase, Cochrane databases, Clinicaltrial.gov, and CNKI until April 30, 2024. Data from cohort studies and randomized controlled trials (RCTs) were included. Outcomes included primary outcomes (re-excision, local recurrence, positive surgical margin, mastectomy), secondary outcomes and safety outcomes. The Cochrane Risk of Bias Assessment Tool and Newcastle-Ottawa Scale were used to evaluate the quality of outcomes.ResultsOur study included 52 studies containing 46,835 patients. Primary outcomes comprise re-excision, local recurrence, positive surgical margin, and mastectomy, there were significant differences favoring OS over BCS (RR 0.68 [0.56, 0.82], RR 0.62 [0.47, 0.82], RR 0.76 [0.59, 0.98], RR 0.66 [0.44, 0.98] respectively), indicating superior efficacy of OS. Additionally, OS demonstrated significant aesthetic benefits (RR 1.17 [1.03, 1.33] and RR 1.34 [1.18, 1.52]). While total complications were significantly fewer in the OS group (RR 0.70 [0.53, 0.94]), the differences in specific complications were not significant. Furthermore, subgroup analyses were conducted based on nationality, sample size, quality, and type.ConclusionOS demonstrates either superior or at least comparable outcomes across various aspects when compared to BCS.
| S-EPMC11364001 | biostudies-literature
Project description:BackgroundThere is no consensus regarding the impact of oncoplastic surgery (OPS) on rates of re-excision and conversion to mastectomy following breast-conserving surgery (BCS). Here these two outcomes after BCS and OPS were compared in a nationwide population-based setting.MethodsIn Denmark, all OPS is registered and categorized into volume displacement, volume reduction or volume replacement. Patients who underwent BCS or OPS between 2012 and 2018 were selected from the Danish Breast Cancer Group database. Multivariable analyses were performed to adjust for confounders, and propensity score matching to limit potential confounding by indication bias.ResultsA total of 13 185 patients (72·5 per cent) underwent BCS and 5003 (27·5 per cent) OPS. Volume displacement was used in 4171 patients (83·4 per cent), volume reduction in 679 (13·6 per cent) and volume replacement in 153 (3·1 per cent). Re-excision rates were 15·6 and 14·1 per cent after BCS and OPS respectively. After adjusting for confounders, patients were less likely to have a re-excision following OPS than BCS (odds ratio (OR) 0·80, 95 per cent c.i. 0·72 to 0·88), specifically after volume displacement and reduction. The rate of conversion to mastectomy was similar after OPS and BCS (3·2 versus 3·7 per cent; P = 0·105), but with a lower risk in adjusted analysis (OR 0·69, 0·58 to 0·84), specifically after volume displacement and reduction procedures. Findings were similar after propensity score matching.ConclusionA modest decrease in re-excision rate and less frequent conversion to mastectomy were observed after OPS compared with BCS.
| S-EPMC7689836 | biostudies-literature