Oncoplastic Breast-Conserving Surgery Reduces Mastectomy and Postoperative Re-excision Rates.

BACKGROUND: 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. METHODS: 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)]. RESULTS: 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). CONCLUSIONS: 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.

Oncoplastic breast conserving surgery is associated with a lower rate of surgical site complications compared to standard breast conserving surgery.

BACKGROUND: Oncoplastic breast conserving surgery (OBCS) integrates plastic surgery techniques in the resection of breast cancer and lowers the rate of re-excision while improving breast cosmesis. The goal of this study is to compare the surgical site complication rate of OBCS with that of standard BCS. METHODS: A single institution chart review evaluated all patients undergoing BCS for treatment of breast cancer. Patients treated from January 2009 to December 2010, prior to adoption of oncoplastic techniques, were identified as the standard surgery (SS) group. Patients treated with OBCS from January 2013 to July 2015 were identified as the oncoplastic surgery (OS) group. All surgical site complications were recorded. RESULTS: Overall, 561 patients were evaluated. The SS group comprised 273 patients compared with 288 patients in the OS group. Surgical site complications occurred in 49 patients (17.9%) in the SS group compared with 23 patients (8.0%) in the OS group (p < 0.001). DISCUSSION: Overall, BCS has a low rate of significant surgical site complications. OBCS has a lower rate of surgical site complications compared to standard BCS.

A comparison of rates of lymph node metastases between patients undergoing sentinel and axillary lymphadenectomy.

BACKGROUND: Recommendations regarding credentialing for sentinel lymphadenectomy in the staging of breast cancer emphasize the need for a trial period during which novice surgeons remove both the sentinel lymph node and the axillary packet, to demonstrate acceptably low rates of both operative failure and inaccuracy. METHODS: We initiated sentinel lymph node mapping in our institution without planned axillary dissection. To establish our ability to accurately stage patients using sentinel lymphadenectomy, we compared 225 patients who underwent that procedure and 343 patients previously staged with axillary lymph node dissection. RESULTS: No differences in node positivity were found between the two groups. Among sentinel lymphadenectomy patients, no differences were found between patients in the first and second half of the institutional experience. CONCLUSIONS: We question the need for a trial period of planned axillary node dissection with sentinel lymph node mapping, and review the evidence from other investigators regarding its necessity.