A population-based audit of surgical practice and outcomes of oncoplastic breast conservations in Scotland - An analysis of 589 patients

Laszlo Romics (Corresponding Author), E Jane Macaskill, Teresa Fernandez, Louise Simpson, Elizabeth Morrow, Vassilis Pitsinis, Sian Tovey, Matthew Barber, Yazan Masannat, Sheila Stallard, Eva Weiler-Mithoff, Andrew Malyon, James Mansell, Esther J Campbell, Julie Doughty, J Michael Dixon

Research output: Contribution to journalArticle

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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.

Original languageEnglish
Pages (from-to)939-944
Number of pages6
JournalEuropean Journal of Surgical Oncology
Volume44
Issue number7
Early online date13 Apr 2018
DOIs
Publication statusPublished - Jul 2018

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Scotland
Breast
Population
Lobular Carcinoma
Drug Therapy
Carcinoma, Intraductal, Noninfiltrating
Survival
Disease-Free Survival
Neoplasms
Databases
Recurrence

Keywords

  • Adult
  • Aged
  • Aged, 80 and over
  • Antineoplastic Agents/therapeutic use
  • Breast Neoplasms/pathology
  • Carcinoma, Ductal, Breast/pathology
  • Carcinoma, Intraductal, Noninfiltrating/pathology
  • Carcinoma, Lobular/pathology
  • Female
  • Humans
  • Mammaplasty/methods
  • Mastectomy, Segmental/methods
  • Medical Audit
  • Middle Aged
  • Neoadjuvant Therapy
  • Neoplasm Recurrence, Local/epidemiology
  • Neoplasm, Residual
  • Postoperative Complications/epidemiology
  • Retrospective Studies
  • Risk Factors
  • Scotland
  • Surgeons
  • Surgery, Plastic
  • Young Adult

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A population-based audit of surgical practice and outcomes of oncoplastic breast conservations in Scotland - An analysis of 589 patients. / Romics, Laszlo (Corresponding Author); Macaskill, E Jane; Fernandez, Teresa; Simpson, Louise; Morrow, Elizabeth; Pitsinis, Vassilis; Tovey, Sian; Barber, Matthew; Masannat, Yazan; Stallard, Sheila; Weiler-Mithoff, Eva; Malyon, Andrew; Mansell, James; Campbell, Esther J; Doughty, Julie; Dixon, J Michael.

In: European Journal of Surgical Oncology, Vol. 44, No. 7, 07.2018, p. 939-944.

Research output: Contribution to journalArticle

Romics, L, Macaskill, EJ, Fernandez, T, Simpson, L, Morrow, E, Pitsinis, V, Tovey, S, Barber, M, Masannat, Y, Stallard, S, Weiler-Mithoff, E, Malyon, A, Mansell, J, Campbell, EJ, Doughty, J & Dixon, JM 2018, 'A population-based audit of surgical practice and outcomes of oncoplastic breast conservations in Scotland - An analysis of 589 patients', European Journal of Surgical Oncology, vol. 44, no. 7, pp. 939-944. https://doi.org/10.1016/j.ejso.2018.04.004
Romics, Laszlo ; Macaskill, E Jane ; Fernandez, Teresa ; Simpson, Louise ; Morrow, Elizabeth ; Pitsinis, Vassilis ; Tovey, Sian ; Barber, Matthew ; Masannat, Yazan ; Stallard, Sheila ; Weiler-Mithoff, Eva ; Malyon, Andrew ; Mansell, James ; Campbell, Esther J ; Doughty, Julie ; Dixon, J Michael. / A population-based audit of surgical practice and outcomes of oncoplastic breast conservations in Scotland - An analysis of 589 patients. In: European Journal of Surgical Oncology. 2018 ; Vol. 44, No. 7. pp. 939-944.
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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.",
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TY - JOUR

T1 - A population-based audit of surgical practice and outcomes of oncoplastic breast conservations in Scotland - An analysis of 589 patients

AU - Romics, Laszlo

AU - Macaskill, E Jane

AU - Fernandez, Teresa

AU - Simpson, Louise

AU - Morrow, Elizabeth

AU - Pitsinis, Vassilis

AU - Tovey, Sian

AU - Barber, Matthew

AU - Masannat, Yazan

AU - Stallard, Sheila

AU - Weiler-Mithoff, Eva

AU - Malyon, Andrew

AU - Mansell, James

AU - Campbell, Esther J

AU - Doughty, Julie

AU - Dixon, J Michael

N1 - Copyright © 2018 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.

PY - 2018/7

Y1 - 2018/7

N2 - 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.

AB - 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.

KW - Adult

KW - Aged

KW - Aged, 80 and over

KW - Antineoplastic Agents/therapeutic use

KW - Breast Neoplasms/pathology

KW - Carcinoma, Ductal, Breast/pathology

KW - Carcinoma, Intraductal, Noninfiltrating/pathology

KW - Carcinoma, Lobular/pathology

KW - Female

KW - Humans

KW - Mammaplasty/methods

KW - Mastectomy, Segmental/methods

KW - Medical Audit

KW - Middle Aged

KW - Neoadjuvant Therapy

KW - Neoplasm Recurrence, Local/epidemiology

KW - Neoplasm, Residual

KW - Postoperative Complications/epidemiology

KW - Retrospective Studies

KW - Risk Factors

KW - Scotland

KW - Surgeons

KW - Surgery, Plastic

KW - Young Adult

U2 - 10.1016/j.ejso.2018.04.004

DO - 10.1016/j.ejso.2018.04.004

M3 - Article

VL - 44

SP - 939

EP - 944

JO - European Journal of Surgical Oncology

JF - European Journal of Surgical Oncology

SN - 0748-7983

IS - 7

ER -