Outcomes After Oncoplastic Breast-Conserving Surgery in Breast Cancer Patients: A Systematic Literature Review
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Surgeons have increasingly performed breast-conserving surgery (BCS) utilizing oncoplastic techniques in place of standard lumpectomy for early-stage breast cancer. We assess oncologic outcomes after oncoplastic BCS for T1–T2 breast cancer.
A systematic literature review identified peer-reviewed articles in PubMed evaluating BCS with oncoplastic reconstruction. Selected studies reported on positive margin rate (PMR), re-excision rate (RR), conversion to mastectomy rate (CMR), overall survival (OS), disease-free survival (DFS), local recurrence (LR), distant recurrence (DR), complication rate, and/or cosmetic outcomes.
The search yielded 474 articles; 55 met the inclusion criteria and collectively evaluated 6011 patients with a mean age 54.6 years over a mean follow-up 50.5 months. T1 (43.8 %) and T2 (39.3 %) invasive ductal carcinoma were the most common tumor histopathologies. PMR, RR, and CMR were 10.8, 6.0, and 6.2 %, respectively, while OS, DFS, LR and DR were 95.0, 90.0, 3.2, and 8.7 %, respectively. Margin widths were heterogeneously defined in studies that included margin assessment. The PMR was not significantly different when positive margins were defined as tumor <10, <5, < 2, and <1 mm from ink margin, or tumor on ink (p = 0.162). Eleven studies reported specific margins for 1455 patients, of whom 143 (9.8 %) had positive margins, including 113 (7.8 %) with tumor on ink.
This study is the largest comprehensive literature review to date on oncoplastic BCS. Our systematic review reveals high rates of OS and DFS with low LR, DR, PMR, RR, CMR and complication rates, thereby confirming the oncologic safety of this procedure in patients with T1–T2 invasive breast cancer.
KeywordsOverall Survival Positive Margin Distant Recurrence Systematic Literature Review Oncologic Safety
Lucy De La Cruz conceptualized and designed the project, and performed data acquisition. Stephanie Blankenship performed data acquisition, data analysis and interpretation, and drafted the initial manuscript. Lucy De La Cruz, Abhishek Chatterjee, Rula Geha, Nadia Nocera, Brian Czerniecki, Julia Tchou, and Carla Fisher assisted in critical revision of the manuscript. All authors reviewed, revised and approved the final manuscript as submitted and agree to be accountable for all aspects of the work.
No external funding was secured for this study. The authors have no financial relationships or conflicts of interest to disclose that are relevant to this article.
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