Oncoplastic Breast-Conserving Surgery Reduces Mastectomy and Postoperative Re-excision Rates
Tóm tắt
Oncoplastic breast-conserving surgery (BCS) integrates partial mastectomy with plastic surgery techniques to facilitate breast cancer resection with clear surgical margins and preservation of breast cosmesis. In 2011, oncoplastic BCS was adopted as standard surgical treatment for breast cancer patients at Virginia Mason Medical Center, Seattle, WA. This single-institution retrospective review evaluates the mastectomy and postoperative re-excision rates before and after adoption of oncoplastic BCS. All patients undergoing surgical treatment of breast cancer were identified from institutional databases for the periods January 2009 through December 2010 [standard surgery group (SS)] and January 2013 through September 2014 [oncoplastic surgery group (OS)]. A total of 812 patients were evaluated; 425 patients were treated in the SS group compared with 387 patients in the OS group. The mastectomy rate in the SS group was 34 % compared with 15 % in the OS group (p < 0.001), and the average tumor size for patients undergoing BCS was 12.7 mm in the SS group compared with 15.4 mm in the OS group (p = 0.04). Despite the larger average tumor size, the postoperative re-excision rate for patients undergoing BCS in the SS group was 32 % as opposed to 18 % in the OS group (p < 0.001). Oncoplastic BCS significantly reduced the rates of mastectomy and postoperative re-excision in breast cancer patients while treating larger cancers. This study suggests that use of OS techniques can effectively treat larger cancers while maximizing breast cosmesis and minimizing the need to resort to mastectomy.
Tài liệu tham khảo
Abe O, Abe K, Asaishi K, et al. Effects of radiotherapy and surgery in early breast cancer: an overview of the randomized trials. N Engl J Med. 1995;333(22):1444–55.
Veronesi U, Cascinelli N, Mariani L, et al. Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med. 2002;347(16):1227–32.
Fisher B, Anderson S, Bryant J. Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med. 2002;347(16):1233–41.
Holmes DR, Schooler W, Smith R. Oncoplastic approaches to breast conservation. Int J Breast Cancer. 2011;2011:1–16.
Clough KB, Kaufman GJ, Nos C, Buccimazza I, Sarfati I. Improving breast cancer surgery: a classification and quadrant per quadrant atlas for oncoplastic surgery. Ann Surg Oncol. 2010;17:1375–91.
Silverstein, M. How I do it: oncoplastic breast-conservation surgery. Ann Surg Oncol. 2010;17:242–4.
Anderson SJ, Wapnir JJ, Dignam B. Prognosis after ipsilateral breast tumor recurrence and locoregional recurrences in patients treated by breast-conserving therapy in five National Surgical Adjuvant Breast and Bowel Projects protocols in node-negative breast cancer. J Clin Oncol. 2009;29:2466–73.
Scopa CD, Panagiotis AC, Tsamadas AC, Aletra C. Evaluation of margin status in lumpectomy specimens and residual breast carcinoma. Breast J. 2006;12:150–3.
Jacobs L. Positive margins: the challenge continues for breast surgeons. Ann Surg Oncol. 2008;15:1271–2.
Morrow M, Hamilton AS, Katz SJ. Why do women get mastectomy? Results from a population-based study. J Clin Oncol. 2007;25:605.
Locker GY, Sainsburgy JR, Cuzick J. Breast surgery in the “Arimidex, Tamoxifen Alone or in Combination” (ATAC) trial: American women are more likely than women from the United Kingdom to undergo mastectomy. Cancer. 2004;101(4):735–40.
Shrotria S. Techniques for improving the cosmetic outcome of breast conserving surgery. Eur J Surg Oncol. 2001;27:109–12.
Santos G, Urban C, Edelweiss MI, et al. Long-term comparison of aesthetical outcomes after oncoplastic surgery and lumpectomy in breast cancer patients. Ann Surg Oncol. 2014. doi:10.1245/s10434-014-4301-6.
Keibert GM, de Haes JC, van de Velde CJ. The impact of breast-conserving treatment and mastectomy on the quality of life of early-stage breast cancer patients: a review. J Clin Oncol. 1991;9(6):1059–70.
Waljee JF, Hu ES, Newman LA, Alderman AK. Predictors of breast asymmetry after breast-conserving operation for breast cancer. J Am Coll Surg. 2008;206(2):274–80.
Cochrane RA, Valasiadou P, Wilson ARM, Al-Ghazal SK, Macmillan RD. Cosmesis and satisfaction after breast-conserving therapy correlates with the percentage of breast volume excision. Br J Surg. 2003;90(12):1505–9.
Azu M, Abrahamse P, Katz SJ, Jagsi R, Morrow M. What is an adequate margin for breast conserving surgery? Surgeon attitudes and correlates. Ann Surg Oncol. 2010;17:558–63.
Moran MS, Schnitt SJ, Giuliano AE, et al. Society of Surgical Oncology and American Society for Radiation Oncology consensus guideline on margins for breast-conserving surgery with whole-breast irradiation in stages I and II invasive breast cancer. J Clin Oncol. 2014:32(14):1507–15.
Morrow M. Breast conservation and negative margins: how much is enough? Breast. 2009;18:84–6.
Clough KB, Ihrai T, Oden S, et al. Oncoplastic surgery for breast cancer based on tumour location and a quadrant-per-quadrant atlas. Br J Surg. 2012:99(10):1389–95.
Tenofsky PL, Dowell P, Topalovski T, Helmer SD. Surgical, oncologic, and cosmetic differences between oncoplastic and nononcoplastic breast conserving surgery in breast cancer patients. Am J Surg. 2014:207(3):398–402.