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Hasan MT, Hamouda M, Khashab MKE, Elsnhory AB, Elghamry AM, Hassan OA, Fayoud AM, Hafez AH, Al-Kafarna M, Hagrass AI, Rabea RK, Gbreel MI. Oncoplastic versus conventional breast-conserving surgery in breast cancer: a pooled analysis of 6941 female patients. Breast Cancer 2023; 30:200-214. [PMID: 36622565 PMCID: PMC9950210 DOI: 10.1007/s12282-022-01430-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 12/21/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND Breast cancer is the most prevalent cancer in women. In the past few years, surgical interventions for breast cancer have experienced massive changes from radical excision to conserving approaches. In this study, we aim to compare the two breast surgery interventions, including conventional breast-conserving surgery (CBCS) versus oncoplastic breast-conserving surgery (OPBCS). METHODS We searched on PubMed, Web of Science (WOS), Scopus, Embase, and Cochrane till 2 October 2021. All relevant randomized controlled trials (RCTs) and observational studies were included. The data were extracted and pooled using Review Manager software (RevMan 5.4). RESULTS The pooled meta-analysis of the included studies showed that OPBCS was significantly superior to CBCS in most of the outcomes. Re-excision significantly favoured CBCS (RR = 0.49, 95% CI [0.37, 0.63], P < 0.00001). However, local recurrence (RR = 0.55, 95% CI [0.27, 1.09], P = 0.09), close surgical margins (RR = 0.37, 95% CI [0.14, 1.00], P = 0.05) and end up to the risk of mastectomy (RR = 0.73, 95% CI [0.54, 97], P = 0.06) showed no significant difference between both techniques. Notably, while performing a sensitivity analysis, other outcomes as local recurrence, significantly showed favourable results towards OPBCS. In terms of safety outcomes, there was no significant difference between OPBCS and CBCS. CONCLUSION We recommend the oncoplastic approach rather than the conventional one in females with breast cancer. Re-excision rates showed better results following OPBCS.
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Affiliation(s)
- Mohammed Tarek Hasan
- Faculty of Medicine for Boys, Al-Azhar University, Cairo, Egypt
- International Medical Research Association (IMedRA), Cairo, Egypt
| | - Mohamed Hamouda
- Faculty of Medicine for Boys, Al-Azhar University, Cairo, Egypt
- International Medical Research Association (IMedRA), Cairo, Egypt
| | - Mohammad K El Khashab
- Faculty of Medicine for Boys, Al-Azhar University, Cairo, Egypt
- International Medical Research Association (IMedRA), Cairo, Egypt
| | - Ahmed Bostamy Elsnhory
- Faculty of Medicine for Boys, Al-Azhar University, Cairo, Egypt
- International Medical Research Association (IMedRA), Cairo, Egypt
| | - Abdullah Mohamed Elghamry
- Faculty of Medicine for Boys, Al-Azhar University, Cairo, Egypt
- International Medical Research Association (IMedRA), Cairo, Egypt
| | - Obada Atef Hassan
- Faculty of Medicine for Boys, Al-Azhar University, Cairo, Egypt
- International Medical Research Association (IMedRA), Cairo, Egypt
| | - Aya Mamdouh Fayoud
- Faculty of Pharmacy, Kafr El-Shaikh University, Kafr El-Shaikh, Egypt
- International Medical Research Association (IMedRA), Cairo, Egypt
| | - Abdelrahman H Hafez
- Faculty of Medicine for Boys, Al-Azhar University, Cairo, Egypt
- International Medical Research Association (IMedRA), Cairo, Egypt
| | - Mohammed Al-Kafarna
- Faculty of Pharmacy, Al-Azhar University-Gaza, Gaza Strip, Palestine
- International Medical Research Association (IMedRA), Cairo, Egypt
| | - Abdulrahman Ibrahim Hagrass
- Faculty of Medicine for Boys, Al-Azhar University, Cairo, Egypt
- International Medical Research Association (IMedRA), Cairo, Egypt
| | - Randa Kamal Rabea
- Faculty of Medicine, Ain Shams University, Cairo, Egypt
- International Medical Research Association (IMedRA), Cairo, Egypt
| | - Mohamed Ibrahim Gbreel
- Faculty of Medicine, October 6 University, Cairo Governorate, Giza, 11571, Egypt.
- International Medical Research Association (IMedRA), Cairo, Egypt.
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Weinzierl A, Schmauss D, Harder Y. [The Significance of Oncoplastic Breast Reconstruction After Tumorectomy in Surgical Breast Cancer Therapy]. HANDCHIR MIKROCHIR P 2022; 54:305-313. [PMID: 35944535 DOI: 10.1055/a-1773-0968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Breast-conserving therapy (BCT), meaning tumorectomy in combination with systemic therapy and locoregional radiation therapy has become the preferred method to treat early-stage breast cancer. With excellent long-term recurrence-free and overall survival rates, breast surgeons today must deliver du- rable and aesthetically appealing results that guarantee a good quality of life to meet the high patient expectations. Oncoplas- tic breast surgery (OPBS) is an innovative approach to improve the overall results of BCT. Often carried out by a team of a plastic surgeon and an oncologic breast surgeon, OPBS can actively prevent breast deformities without compromising oncological safety. In the following, an overview of the principles and techniques of oncoplastic breast surgery will be given due to its ever-increasing significance and its advantages and dis- advantages will be discussed in the context of reconstructive breast surgery.
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Affiliation(s)
- Andrea Weinzierl
- Institut für Klinisch-Experimentelle Chirurgie, Universität des Saarlandes, Homburg/Saar, Deutschland
| | - Daniel Schmauss
- Klinik für Plastische, Rekonstruktive und Ästhetische Chirurgie, Ospedale Regionale di Lugano (ORL), Ente Ospedaliero Cantonale (EOC), Lugano, Schweiz.,Fakultät der Biomedizinischen Wissenschaften, Università della Svizzera Italiana, Lugano, Schweiz
| | - Yves Harder
- Klinik für Plastische, Rekonstruktive und Ästhetische Chirurgie, Ospedale Regionale di Lugano (ORL), Ente Ospedaliero Cantonale (EOC), Lugano, Schweiz.,Fakultät der Biomedizinischen Wissenschaften, Università della Svizzera Italiana, Lugano, Schweiz
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Level II Oncoplastic Surgery as an Alternative Option to Mastectomy with Immediate Breast Reconstruction in the Neoadjuvant Setting: A Multidisciplinary Single Center Experience. Cancers (Basel) 2022; 14:cancers14051275. [PMID: 35267583 PMCID: PMC8909600 DOI: 10.3390/cancers14051275] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 02/19/2022] [Accepted: 02/25/2022] [Indexed: 02/05/2023] Open
Abstract
Oncoplastic surgery level II techniques (OPSII) are used in patients with operable breast cancer. There is no evidence regarding their safety and efficacy after neoadjuvant chemotherapy (NAC). The aim of this study was to compare the oncological and aesthetic outcomes of this technique compared with those observed in mastectomy with immediate breast reconstruction (MIBR), in post-NAC patients undergoing surgery between January 2016 and March 2021. Local disease-free survival (L-DFS), regional disease-free survival (R-DFS), distant disease-free survival (D-DFS), and overall survival (OS) were compared; the aesthetic results and quality of life (QoL) were evaluated using BREAST-Q. A total of 297 patients were included, 87 of whom underwent OPSII and 210 of whom underwent MIBR. After a median follow-up of 39.5 months, local recurrence had occurred in 3 patients in the OPSII group (3.4%), and in 13 patients in the MIBR group (6.1%) (p = 0.408). The three-year L-DFS rates were 95.1% for OPSII and 96.2% for MIBR (p = 0.286). The three-year R-DFS rates were 100% and 96.4%, respectively (p = 0.559). The three-year D-DFS rate were 90.7% and 89.7% (p = 0.849). The three-year OS rates were 95.7% and 95% (p = 0.394). BREAST-Q highlighted significant advantages in physical well-being for OPSII. No difference was shown for satisfaction with breasts (p = 0.656) or psychosocial well-being (p = 0.444). OPSII is safe and effective after NAC. It allows oncological and aesthetic outcomes with a high QoL, and is a safe alternative for locally advanced tumors which are partial responders to NAC.
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