Abstract
Background
Oncoplastic breast surgery (OBS) aims to provide breast cancer patients with optimum oncologic outcomes and excellent cosmesis. We sought to determine if there is a difference in complications associated with OBS involving soft tissue transfer compared with the traditional breast-conserving surgical (BCS) approach.
Methods
Analysis of the American College of Surgeons National Surgical Quality Improvement Program database was performed. Patients with breast cancer who underwent BCS from 2005 to 2014 were included in the study cohort, while patients undergoing concurrent high-risk non-breast surgery, male patients, and those with metastatic disease were excluded. Patients with concomitant current procedural terminology codes identifying soft tissue transfer were categorized as having OBS. Multivariable analysis was performed to determine the independent effect of OBS on postoperative morbidity.
Results
We identified 75,972 patients who underwent BCS for breast cancer between 2005 and 2014, of whom 1363 (1.8 %) underwent OBS with soft tissue transfer. Compared with the standard lumpectomy group, patients undergoing OBS were more likely to be younger, had a lower body mass index, were less likely to be smokers, and more often received neoadjuvant chemotherapy. OBS with soft tissue transfer also had a significantly longer operative time (83 vs. 59 min; p < 0.001). The multivariable analysis confirmed that soft tissue transfer OBS was not an independent predictor of overall complications (odds ratio 0.78; 95 % confidence interval 0.50–1.19).
Conclusions
These data confirm that the use of OBS with soft tissue transfer for breast cancer treatment does not confer an increased risk of surgical complications, despite the longer operative time. This is important given the increasing use of oncoplastic surgery techniques within North America.
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References
Waljee JF, Hu ES, Ubel PA, Smith DM, Newman LA, Alderman AK. Effect of esthetic outcome after breast-conserving surgery on psychosocial functioning and quality of life. J Clin Oncol. 2008;26(20):3331–7.
Clough KB, Benyahi D, Nos C, Charles C, Sarfati I. Oncoplastic surgery: pushing the limits of breast-conserving surgery. Breast J. 2015;21(2):140–6.
Savalia NB, Silverstein MJ. Oncoplastic breast reconstruction: patient selection and surgical techniques. J Surg Oncol. 2016;113(8):875–82.
Losken A, Dugal CS, Styblo TM, Carlson GW. A meta-analysis comparing breast conservation therapy alone to the oncoplastic technique. Ann Plast Surg. 2014;72(2):145–9.
Piper ML, Esserman LJ, Sbitany H, Peled AW. Outcomes following oncoplastic reduction mammoplasty: a systematic review. Ann Plast Surg. 2016;76 Suppl 3:S222–6.
Tenofsky PL, Dowell P, Topalovski T, Helmer SD. Surgical, oncologic, and cosmetic differences between oncoplastic and nononcoplastic breast conserving surgery in breast cancer patients. Am J Surg. 2014;207(3):398–402.
Haloua MH, Krekel NMA, Winters HAH, Rietveld DHF, Meijer S, Bloemers FW, et al. A systematic review of oncoplastic breast-conserving surgery. Ann Surg. 2013;257(4):609–20.
Xue DQ, Qian C, Yang L, Wang XF. Risk factors for surgical site infections after breast surgery: a systematic review and meta-analysis. Eur J Surg Oncol. 2012;38(5):375–81.
Nizet J-L, Maweja S, Lakosi F, Lifrange E, Scagnol I, Seidel L, et al. Oncological and surgical outcome after oncoplastic breast surgery. Acta Chir Belg. 2015;115(1):33–41.
El-Tamer MB, Ward BM, Schifftner T, Neumayer L, Khuri S, Henderson W. Morbidity and mortality following breast cancer surgery in women: national benchmarks for standards of care. Ann Surg. 2007;245(5):665–71.
de Blacam C, Ogunleye AA, Momoh AO, Colakoglu S, Tobias AM, Sharma R, et al. High body mass index and smoking predict morbidity in breast cancer surgery. Ann Surg. 2012;255(3):551–5.
Hernanz F, Regaño S, Vega A, Gómez Fleitas M. Reduction mammaplasty: an advantageous option for breast conserving surgery in large-breasted patients. Surg Oncol. 2010;19(4):e95–e102.
Clough KB, Lewis JS, Couturaud B, Fitoussi A, Nos C, Falcou M-C. Oncoplastic techniques allow extensive resections for breast-conserving therapy of breast carcinomas. Ann Surg. 2003;237(1):26.
Giacalone PL, Roger P, Dubon O, El Gareh N, Rihaoui S, Taourel P, et al.. Comparative study of the accuracy of breast resection in oncoplastic surgery and quadrantectomy in breast cancer. Ann Surg Oncol. 2007;14(2): 605-14.
Gulcelik MA, Dogan L, Camlibel M, Karaman N, Kuru B, Alagol H, et al. Early complications of a reduction mammoplasty technique in the treatment of macromastia with or without breast cancer. Clin Breast Cancer. 2011;11(6):395–9.
Meretoja TJ, Svarvar C, Jahkola TA. Outcome of oncoplastic breast surgery in 90 prospective patients. Am J Surg. 2010;200(2):224–8.
Rietjens M, Urban CA, Rey PC, Mazzarol G, Maisonneuve P, Garusi C, et al. Long-term oncological results of breast conservative treatment with oncoplastic surgery. Breast. 2007;16(4):387–95.
Law M, Yang S, Wang H, Babb JS, Johnson G, Cha S, et al. Glioma grading: sensitivity, specificity, and predictive values of perfusion MR imaging and proton MR spectroscopic imaging compared with conventional MR imaging. AJNR Am J Neuroradiol. 2003;24(10):1989–98.
Rusby JE, Paramanathan N, Laws SAM, Rainsbury RM. Immediate latissimus dorsi miniflap volume replacement for partial mastectomy: use of intra-operative frozen sections to confirm negative margins. Am J Surg. 2008;196(4):512–8.
Holmes DR, Silverstein MJ. Triangle resection with crescent mastopexy: an oncoplastic breast surgical technique for managing inferior pole lesions. Ann Surg Oncol. 2012;19(10):3289–91.
Osman F, Saleh F, Jackson TD, Corrigan MA, Cil T. Increased postoperative complications in bilateral mastectomy patients compared to unilateral mastectomy: an analysis of the NSQIP database. Ann Surg Oncol. 2013;20(10):3212–7.
Khan NA, Quan H, Bugar JM, Lemaire JB, Brant R, Ghali WA. Association of postoperative complications with hospital costs and length of stay in a tertiary care center. J Gen Intern Med. 2006;21(2):177–80.
Dimick JB, Chen SL, Taheri PA, Henderson WG, Khuri SF, Campbell DA. Hospital costs associated with surgical complications: a report from the private-sector National Surgical Quality Improvement Program. J Am Coll Surg. 2004;199(4):531–7.
Lohrisch C, Paltiel C, Gelmon K, Speers C, Taylor S, Barnett J, et al. Impact on survival of time from definitive surgery to initiation of adjuvant chemotherapy for early-stage breast cancer. J Clin Oncol. 2006;24(30):4888–94.
Chavez-MacGregor M, Clarke CA, Lichtensztajn DY, Giordano SH. Delayed initiation of adjuvant chemotherapy among patients with breast cancer. JAMA Oncol. 2016;2(3):322–9.
Disclosures
Neither Dr. Cil nor Dr. Cordeiro have any relevant financial disclosures. No external sources of funding were used for this study.
Disclaimer
The ACS-NSQIP and the hospitals participating in the NSQIP are the source of the data used herein; they have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors.
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Cil, T.D., Cordeiro, E. Complications of Oncoplastic Breast Surgery Involving Soft Tissue Transfer Versus Breast-Conserving Surgery: An Analysis of the NSQIP Database. Ann Surg Oncol 23, 3266–3271 (2016). https://doi.org/10.1245/s10434-016-5477-8
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DOI: https://doi.org/10.1245/s10434-016-5477-8