Evaluation of Surgical Outcomes of Oncoplasty Breast Surgery in Locally Advanced Breast Cancer and Comparison with Conventional Breast Conservation Surgery.

Abstract

The purpose of this study was to compare early oncologic outcomes of oncoplastic breast surgery and conventional breast conservation surgery in patients of locally advanced breast cancer. A single-center, prospective, non-randomized study enrolled select cases of locally advanced breast cancer (TNM T3/T4, N0/1/2) who after neoadjuvant chemotherapy, were considered for breast conservation surgery with oncoplasty techniques. The specimen volume resected, the mean margins and mean closest margin obtained were noted. The re-surgery rates, complication rates, and incidence of locoregional recurrence were also noted. Variables were compared with a retrospective cohort of similar patients who had undergone conventional breast conservation surgery. Fifty-seven patients underwent OBS (group 1) and were compared with 43 cases that had undergone conventional BCS (group 2). Majority of the patients in group 1 (73%) had cT3 with N0 or N+ and a minority (17%) were with limited skin involvement (cT4 and N0/N+). Relatively larger sized, post-NACT tumors could undergo OBS(4.4 vs 2.3cm). Relatively greater proportion of tumors in central and lower quadrants were addressed by oncoplasty than traditional BCS (17/57, 29% vs 4/43, 9%, p=0.04). The mean specimen volume excised in group 1 was more than that in group 2. (187.54 vs 125.19; p=0.01). The mean of the margins were obtained more in group 1 (1.04 vs 0.69cm); p<0.01) as also the mean closest margin (0.86 vs 0.49cm; p<0.01). The incidence of close or involved margins was lesser in the OBS group (8vs 24%). Overall incidence of complications was similar in both groups (8/57, 14% vs 4/43, 9%; p=0.34 NS). The median follow-up period of group 1 is 18months (range 06-30months) while group 2 is 34months (14-44months. There was no recurrence in group 1, but there were 5 cases (11%) in group 2. Oncoplasty breast surgery offers more opportunity for breast conservation and oncologic safety than conventional breast conserving surgery.