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

Laszlo Romics (Lead / Corresponding author), Elizabeth Macaskill, Teresa Fernandez, Louise Simpson, Elizabeth Morrow, Vassilis Pitsinis, Sian M. 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

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

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  • Cite this

    Romics, L., Macaskill, E., Fernandez, T., Simpson, L., Morrow, E., Pitsinis, V., Tovey, S. M., 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