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

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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

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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  • Cite this

    Romics, L., Macaskill, E. J., Fernandez, T., Simpson, L., Morrow, E., Pitsinis, V., Tovey, S., Barber, M., Masannat, Y., Stallard, S., Weiler-Mithoff, E., Malyon, A., Mansell, J., Campbell, E. J., Doughty, J., & Dixon, J. M. (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, 44(7), 939-944. https://doi.org/10.1016/j.ejso.2018.04.004