The role of oncoplastic breast surgery in the management of breast cancer treated with primary chemotherapy.

The purpose of this study was to evaluate the benefit of Oncoplastic Breast Conserving Surgery (BCS) compared to standard BCS after primary CT, in terms of oncologic safety and cosmetic outcomes. The development of new drugs has led to greater use of primary chemotherapy (CT) for bulky breast cancer (BC) and has allowed wider indications for conservative surgery. We identified 259 patients consecutively treated with BCS for primary BC from January 2002 to November 2010. All patients had undergone Oncoplastic Breast Surgery (OBS) or standard BCS after primary CT. Mastectomy rates, and oncological and cosmetic outcomes were compared. A total of 45 OBS and 214 standard BCS were analyzed. The median tumor size was 40 mm in the two groups (p = 0.66). The median operative specimen volumes were larger in the OBS group than in the standard group (respectively, 180 cm3 and 98 cm3, p < 0.0001). Re-excision (9% vs. 2%) and mastectomy (24% vs. 18%) rates were similar (p = 0.22 and p = 0.30) in the standard BCS group and in the OBS group respectively. At a median follow-up of 46 months, local relapse (p = 0.23) and distant relapse (p = 0.35) rates were similar. OBS allows excision of larger volumes of residual tumor after primary CT. OBS outcomes results were similar to those of standard BCS. Oncoplastic Breast Conserving Surgery (BCS) after primary chemotherapy allows wider breast resection than standard BCS. Survival and relapse probabilities are similar in both groups.

Mazouni C ，Naveau A ，Kane A ，Dunant A ，Garbay JR ，Leymarie N ，Sarfati B ，Delaloge S ，Rimareix F ... -  《-》

Oncologic safety of breast-conserving surgery compared to mastectomy in patients receiving neoadjuvant chemotherapy for locally advanced breast cancer.

Breast-conserving surgery (BCS) in patients with large tumors shrunk by neoadjuvant chemotherapy (NCT) remains controversial. We investigated oncologic outcomes of BCS in patients receiving NCT to treat locally advanced breast cancer (LABC). We reviewed 1,994 patients who underwent surgery with/without NCT. Patients were categorized into three groups according to treatment methods: initial BCS, BCS after NCT (NCT-BCS), and mastectomy after NCT (NCT-MX). Their characteristics and outcomes were analyzed. The NCT-BCS group had earlier stage cancer, more hormone receptor-negative and triple-negative breast cancers (TNBC) than the NCT-MX group. However, outcomes did not differ statistically between the two groups. BCS patients receiving NCT were younger, and had more advanced, hormone receptor-negative, HER2-positive, and TNBC breast cancers than BCS patients without NCT. Patients with pathological complete remission (pCR) in the NCT-BCS group had better survival outcomes than non-pCR patients and the initial BCS group. By multivariate analysis in patients receiving NCT, final stage and TNBC were associated with poor overall survival (stage III: P = 0.008; TNBC: P = 0.01), however surgery type was not (P = 0.20). BCS after NCT is a safe option for LABC that responded well to NCT. Shrinking tumors with NCT allows more opportunities to apply BCS without compromising outcomes.

Cho JH ，Park JM ，Park HS ，Park S ，Kim SI ，Park BW ... -  《-》

Short term safety of oncoplastic breast conserving surgery for larger tumors.

Oncoplastic surgery (OPS) replaces lumpectomy as standard technique in breast conserving surgery (BCS). OPS has shown to give good cosmetic results, but is it as safe as standard lumpectomy? We conducted a retrospective cohort study to determine postoperative complications, resection margins and re-excision rates for OPS compared to standard lumpectomy. Based on data from the 'Netherlands Cancer Registry' and medical records we scored patient, treatment and follow-up related variables. All consecutive patients, with an initially breast conserving operation for primary breast cancer, performed between January 2010 and December 2014 in a dedicated breast center were eligible. Breast surgeons performed the operations. Invasive and in situ tumors were included. Postoperative complications within 30 days after surgery and the need for additional treatment were classified using the Clavien Dindo classification. Involved margin rates and subsequent re-excision were compared. We included 828 women with 842 breast cancers, who had a standard lumpectomy (62.7%) or oncoplastic resection (37.3%). OPS was performed more often for larger tumors (17.5 mm vs 13.6 mm, p = 0.002) and for tumors in the caudal half of the breast (33.1% vs 16.9%, p < 0.001). There was no significant difference in postoperative complications. Positive surgical margins were similar (OPS 22.6%, lumpectomy 18.2%, p = 0.119), as were re-excision rates (p = 0.337). Oncoplastic breast surgery can be safely applied in larger tumors, resulting in comparable postoperative complications, resection margins and re-excision rates compared to standard lumpectomy.

Wijgman DJ ，Ten Wolde B ，van Groesen NR ，Keemers-Gels ME ，van den Wildenberg FJ ，Strobbe LJ ... -  《-》

Preoperative chemotherapy for T2 breast cancer is associated with improved surgical outcome.

The aim of this study is to compare the clinical outcome in T2 breast cancer patients who underwent preoperative chemotherapy (PC) and who did not. The study also tried to define a subgroup of patients, who are more beneficial after PC in terms of lower re-excision rates, better cosmetic results and local recurrence free survival. 251 consecutive patients treated for nonmetastatic T2 invasive breast cancer were analyzed retrospectively. Of those; 141 underwent primary surgery (PS) followed by chemotherapy, whereas 110 were treated with combination of PC and surgery. The patients who were treated with PC had a significantly higher incidence of negative margins and lower rate of re-excision (5% vs. 16%, p = 0.02). Of all patients attempted breast conserving surgery (BCS), patients in the PC group were more likely to undergo BCS as their definitive operation compared to patients with PS group (BCS rates; PC group: 99% vs. PS group: 92%, p = 0.05). Multifocal disease (OR: 7, 95% Cl, 2.7-18.4, p = 0.0001) and PC (OR = 0.2; 95% CI, 0.06-0.72, p = 0.01) were factors associated with margin positivity in patients treated with BCS. There was no statistically significant difference in 5 year local-recurrence free survival rates between 2 groups. Our study shows that PC significantly decreases the re-excision in patients undergoing BCS with primary T2 breast tumors. This data suggests that any patient with a tumor greater than 2 cm might be considered for PC to increase BCS success with final negative margins.

Karanlik H ，Ozgur I ，Cabioglu N ，Sen F ，Erturk K ，Kilic B ，Onder S ，Deniz M ，Yavuz E ，Aydiner A ... -  《-》

Oncological advantages of oncoplastic breast-conserving surgery in treatment of early breast cancer.

The standard approach to breast-conserving surgery is wide local excision of the tumor and radiotherapy. However, a significant number of patients require further surgery to obtain oncologically clear margins, and may obtain a poor cosmetic result following adjuvant radiotherapy. Oncoplastic techniques may result in improved cosmesis, but few studies have investigated the oncological advantage of this approach. The aim of this retrospective study was to compare tumor clearance and the need for further margin excision following standard wide local excision (group A, 121 patients), and oncoplastic breast-conserving surgery (group B, 37 patients). These techniques included therapeutic mammoplasty, sub-axillary fat pad rotation mammoplasty, thoraco-epigastric flap, and central flap. Compared to standard surgery (group A), oncoplastic techniques (group B) can be employed for significantly larger tumors (17.6 mm versus 23.9 mm, p = 0.002). Oncoplastic breast-conserving surgery results in higher mean specimen weights (58.1 g versus 231.1 g, p < 0.0001), higher specimen volumes (112.3 cm(3) versus 484.5 cm(3) , p < 0.0001), and wider clear margins (6.1 mm versus 14.3 mm, p < 0.0001), resulting in lower rates of further surgery (28.9% versus 5.4%, p = 0.002). There was no statistical increase in complication rates following oncoplastic surgery. Oncoplastic breast-conserving surgery is more successful than standard wide local excision in treating larger tumors and obtaining wider radial margins, thus reducing the need for further margin excision, which delays adjuvant therapy. There was no increase in postoperative complication rate using an oncoplastic approach.

Down SK ，Jha PK ，Burger A ，Hussien MI ... -  《-》