Retrospective multicenter analysis comparing conventional with oncoplastic breast conservation: oncologic and surgical outcome in women with high risk breast cancer from the OPBC-01/iTOP2 study
Florian FitzalMichael BolligerDaniela DunklerLouise GamboneJörg HeilFabian RiedelJana de BonifaceCharles AndréZoltán MátraiDávid PukancsikRégis Resende PaulinelliValerijus OstapenkoArvydas BurneckisAndrej OstapenkoEdvinas OstapenkoFrancesco MeaniYves HarderM BonolloA.S.M. AlbertiC. TauschBärbel PapassotiropoulosRuth HelfgottDietmar HeckHans-Jörg FehrerMarkus AckoPeter SchrenkGiacomo MontagnaElisabeth TrappGunda PristauzC. PaliczekJens‐Uwe BlohmerSamuel Padovani SteffenLászló RomicsElizabeth MorrowKadletz LorenzMartin FehrMarsha E RitterWA Weber
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Oncoplastic Surgery
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Surgical treatment of breast cancer (BC) has undergone significant changes over the past half century. Oncoplastic operations are a relatively new variant of organ-preserving surgical treatment of breast cancer. Its idea is to combine the principles of oncology and plastic surgery in order to obtain oncological safe and cosmetic acceptable results. Despite the widespread implementation of these operations, high-quality studies on the benefits of oncoplastic operations in comparison with other methods are not enough. Actual issues of breast cancer oncoplastic surgery was considered in this literature review, such as indications for surgery, classification of oncoplastic techniques, determination of positive resection margins, evaluation of recurrence and survival, postoperative complications, cosmetic result. The authors declare no conflict of interest. The authors confirm that they respect the rights of the people participated in the study, including obtaining informed consent when it is necessary, and the rules of treatment of animals when they are used in the study (Conclusion of the local Ethics Committee at Northern State Medical University of 08.04.2015, Protocol No. 02/4-15). Author Guidelines contains the detailed information.
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Oncoplastic surgery of the breast (OPS) has generated great excitement over the past years and has become an integrated component of the surgical treatment of breast cancer. Oncoplastic surgical procedures associate the best surgical oncologic principles to achieve wide tumor-free margins with the best principles of plastic surgery to optimize cosmetic outcomes. Thanks to oncoplastic techniques, the role of breast conserving surgery (BCS) has been extended to include a group of patients who would otherwise require mastectomy to achieve adequate tumor clearance. As OPS continues to gain acceptance and diffusion, an optimal and systematic approach to these techniques is becoming increasingly necessary. This article has the aim to review the essential principles and techniques associated with oncoplastic surgery, based on the data acquired through an extensive search of the PUBMED and MEDLINE database for articles published using the key words "breast cancer oncoplastic surgery". This review analyzes possible the advantages", classifications, indications, and the criteria for a proper selection of oncoplastic techniques to facilitate one's ability to master these procedures and make OPS a safe and an effective procedure.
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Quadrantectomy
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Breast cancer is the leading oncological cause of death in Mexican women over 25 years old. Given the need to improve postoperative cosmetic results in patients with breast cancer, oncoplastic surgery has been developed, which allows larger tumour resections and minor cosmetic alterations. To determine the oncological feasibility and cosmetic outcome of oncoplastic surgery at the Instituto de Enfermedades de la Mama, FUCAM, AC. A review was conducted from January 2010 to July 2013, which included patients with breast cancer diagnosis treated with conventional breast-conserving surgery or with oncoplastic surgery in the Instituto de Enfermedades de la Mama, FUCAM AC. Clinical and histopathological parameters were compared between the two groups, and a questionnaire of cosmetic satisfaction and quality of life was applied. Of the 171 patients included, 95 of them were treated with conventional breast-conserving surgery and 76 with oncoplastic surgery. Pathological tumour size was significantly larger in patients treated with oncoplastic surgery (p = 0.002). There were no differences found between the groups as regards the number of patients with positive surgical margin, the rate of complications, and cosmetic satisfaction. This study demonstrates the oncological feasibility and high cosmetic satisfaction of oncoplastic surgery with minimal psycho-social impact on patients. El cáncer de mama representa la principal causa de muerte de origen oncológico en mujeres mexicanas mayores de 25 años. Ante la necesidad de mejorar los resultados estéticos posquirúrgicos en las pacientes con cáncer de mama, se ha desarrollado la cirugía oncoplástica, la cual permite realizar cirugía conservadora en tumores de mayor tamaño con menor defecto estético. Conocer la factibilidad de la cirugía oncoplástica, su seguridad oncológica, así como el resultado estético en el Instituto de Enfermedades de la Mama, FUCAM A.C. Revisión ambispectiva desde enero del 2010 hasta julio del 2013 en pacientes con diagnóstico de cáncer de mama tratadas con cirugía conservadora convencional o con patrones oncoplásticos en el Instituto de Enfermedades de la Mama, FUCAM A.C. Se compararon entre ambos grupos parámetros clínicos e histopatológicos y se aplicó un cuestionario de satisfacción estética y de calidad de vida. Se incluyó a 171 pacientes, 95 fueron tratadas con cirugía conservadora convencional y 76 utilizando patrones oncoplásticos. El tamaño tumoral determinado por enfermedad fue significativamente mayor en las pacientes tratadas con cirugía oncoplástica (p = 0.002), sin diferencias entre ambos grupos con respecto al número de pacientes con borde quirúrgico positivo ni en la tasa de complicaciones. Ambos con un alto grado de satisfacción estética. Este estudio demuestra la factibilidad y alta satisfacción estética de la cirugía oncoplástica con un mínimo impacto psicosocial en las pacientes.
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The Quasi-purchase system of research outcome is a research funds' system based upon research outcome. The thesis analyses the characteristics of research outcomes' honour under the quasi-purchase system of research outcome. It researches the evaluation of the follow-up impact of the honoured outcome. And make a greater impact on the honoured outcome for incentives and penalties for false results of the proposal.
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Breast conserving surgery (BCS) followed by radiotherapy is the standard of care for most patients with early breast cancers; however, the aesthetic outcomes of this procedure is not always desirable. Oncoplastic breast surgery is an innovative approach that aims at the safe and effective treatment of the cancerous lesion while achieving the best possible aesthetic outcome. The aim of this study was to evaluate and compare oncoplastic and non-oncoplastic procedures.A retrospective observational study was conducted on a group of patients who underwent oncoplastic or non-oncoplastic breast surgery at the Breast Unit of the University of Rome Tor Vergata.Out of 211 patients, 154 (73%) underwent non-oncoplastic surgery, while 61 (27%) underwent an oncoplastic procedure. The percentage of patients requiring re-excision was twice greater for women in the non-oncoplastic group: 12.9% vs. 6.5% in the oncoplastic group. The rate of complications was higher in the oncoplastic group compared to the non-oncoplastic one (4.9% vs. 1.3%). The size of the tumor, the number of the patients receiving post-operative radiation, the interval between surgery and radiotherapy and follow-up were similar between the two groups.Oncoplastic surgery represents a valid alternative to breast conserving surgery for patients with breast cancer, with only minimal differences in long-term complications and similar results in terms of local recurrence and number of metastasis.
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ObjectiveTo assess different techniques of oncoplastic breast-conserving surgery, according to breast shape, protrusion, size, and symmetry.BackgroundOncoplastic surgery has emerged as a new approach to allow wide excision for breast-conserving surgery without compromising the natural shape of the breast. It is based on integration of plastic surgery techniques for immediate breast reshaping after wide excision for breast cancer.Patients and methodsThis prospective study was carried out on 35 patients; all patients had breast tumor and were being managed at Menoufia University Hospitals by different modalities of oncoplastic breast surgery during the period from April 2012 to December 2013. The appropriate oncoplastic technique was selected for every patient taking into consideration the location and size of the mass and breast size and ptosis.ResultsSeven patients underwent simple oncoplastic procedures with volume displacement techniques, 20 patients underwent more advanced oncoplastic techniques of volume replacement with local dermoglandular flaps, and eight patients required reconstruction with distant pedicle musculocutaneous flaps. All our patients had negative clear specimen margins. Only three complications were encountered: one case of skin necrosis in the skin envelope after skin-sparing mastectomy and two cases of traumatic fat necrosis with the inverted-T technique.ConclusionThis study showed that creative use of reconstructive techniques can yield excellent results, fulfilling all patient and surgeon expectations with a minimum rate of morbidity. Younger women with a small-size breast will benefit from a simple oncoplastic technique with volume displacement procedures. Women with large ptotic breasts need more complex mammoplastic techniques with or without flaps.Oncoplastic surgery should be the standard approach to breast cancer treatment whenever feasible.
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