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.
- Breast conservation therapy
- Breast reconstruction
- Breast surgery
- Postoperative complications
- Breast Neoplasms/pathology
- Middle Aged
- Antineoplastic Agents/therapeutic use
- Medical Audit
- Mastectomy, Segmental/methods
- Neoplasm, Residual
- Young Adult
- Postoperative Complications/epidemiology
- Aged, 80 and over
- Neoadjuvant Therapy
- Retrospective Studies
- Carcinoma, Intraductal, Noninfiltrating/pathology
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Lobular/pathology
- Risk Factors
- Neoplasm Recurrence, Local/epidemiology
- Surgery, Plastic