Laszlo Romics1, E Jane Macaskill2, Teresa Fernandez3, Louise Simpson4, Elizabeth Morrow5, Vassilis Pitsinis2, Sian Tovey6, Matthew Barber7, Yazan Masannat4, Sheila Stallard8, Eva Weiler-Mithoff9, Andrew Malyon9, James Mansell10, Esther J Campbell9, Julie Doughty8, J Michael Dixon7. 1. Department of Surgery, New Victoria Hospital, Glasgow, UK; Department of Academic Surgery, University of Glasgow, UK. Electronic address: Laszlo.Romics@glasgow.ac.uk. 2. Department of Surgery, Ninewells Hospital, Dundee, UK. 3. Department of Surgery, Western General Hospital, Edinburgh, UK; Department of Surgery, Stobhill Hospital, Glasgow, UK. 4. Department of Surgery, Aberdeen Royal Infirmary, UK. 5. Department of Academic Surgery, University of Glasgow, UK. 6. Department of Surgery, University Hospital Crosshouse, UK. 7. Department of Surgery, Western General Hospital, Edinburgh, UK. 8. Department of Surgery, Gartnavel General Hospital, Glasgow, UK. 9. Canniesburn Plastic Surgical Unit, Glasgow Royal Infirmary, UK. 10. Department of Surgery, Wishaw General Hospital, UK.
Abstract
INTRODUCTION: Current evidence for oncoplastic breast conservation (OBC) is based on single institutional series. Therefore, we carried out a population-based audit of OBC practice and outcomes in Scotland. METHODS: A predefined database of patients treated with OBC was completed retrospectively in all breast units practicing OBC in Scotland. RESULTS: 589 patients were included from 11 units. Patients were diagnosed between September 2005 and March 2017. High volume units performed a mean of 19.3 OBCs per year vs. low volume units who did 11.1 (p = 0.012). 23 different surgical techniques were used. High volume units offered a wider range of techniques (8-14) than low volume units (3-6) (p = 0.004). OBC was carried out as a joint operation involving a breast and a plastic surgeon in 389 patients. Immediate contralateral symmetrisation rate was significantly higher when OBC was performed as a joint operation (70.7% vs. not joint operations: 29.8%; p < 0.001). The incomplete excision rate was 10.4% and was significantly higher after surgery for invasive lobular carcinoma (18.9%; p = 0.0292), but was significantly lower after neoadjuvant chemotherapy (3%; p = 0.031). 9.2% of patients developed major complications requiring hospital admission. Overall the complication rate was significantly lower after neoadjuvant chemotherapy (p = 0.035). The 5 year local recurrence rate was 2.7%, which was higher after OBC for DCIS (8.3%) than invasive ductal cancer (1.6%; p = 0.026). 5-year disease-free survival was 91.7%, overall survival was 93.8%, and cancer-specific survival was 96.1%. CONCLUSION: This study demonstrated that measured outcomes of OBC in a population-based multi-centre setting can be comparable to the outcomes of large volume single centre series.
INTRODUCTION: Current evidence for oncoplastic breast conservation (OBC) is based on single institutional series. Therefore, we carried out a population-based audit of OBC practice and outcomes in Scotland. METHODS: A predefined database of patients treated with OBC was completed retrospectively in all breast units practicing OBC in Scotland. RESULTS: 589 patients were included from 11 units. Patients were diagnosed between September 2005 and March 2017. High volume units performed a mean of 19.3 OBCs per year vs. low volume units who did 11.1 (p = 0.012). 23 different surgical techniques were used. High volume units offered a wider range of techniques (8-14) than low volume units (3-6) (p = 0.004). OBC was carried out as a joint operation involving a breast and a plastic surgeon in 389 patients. Immediate contralateral symmetrisation rate was significantly higher when OBC was performed as a joint operation (70.7% vs. not joint operations: 29.8%; p < 0.001). The incomplete excision rate was 10.4% and was significantly higher after surgery for invasive lobular carcinoma (18.9%; p = 0.0292), but was significantly lower after neoadjuvant chemotherapy (3%; p = 0.031). 9.2% of patients developed major complications requiring hospital admission. Overall the complication rate was significantly lower after neoadjuvant chemotherapy (p = 0.035). The 5 year local recurrence rate was 2.7%, which was higher after OBC for DCIS (8.3%) than invasive ductal cancer (1.6%; p = 0.026). 5-year disease-free survival was 91.7%, overall survival was 93.8%, and cancer-specific survival was 96.1%. CONCLUSION: This study demonstrated that measured outcomes of OBC in a population-based multi-centre setting can be comparable to the outcomes of large volume single centre series.
Authors: Alice Lee; Richard M Kwasnicki; Hasaan Khan; Yasmin Grant; Abigail Chan; Angela E E Fanshawe; Daniel R Leff Journal: BJS Open Date: 2021-11-09
Authors: Francesca Savioli; Subodh Seth; Elizabeth Morrow; Julie Doughty; Sheila Stallard; Andy Malyon; Laszlo Romics Journal: Breast Cancer (Dove Med Press) Date: 2021-05-25