Abstract
IntroductionRecent data suggest that margins ≥2 mm after breast-conserving surgery may improve local control in invasive breast cancer (BC). By allowing large resection volumes, oncoplastic breast-conserving surgery (OBCII; Clough level II/Tübingen 5-6) may achieve better local control than conventional breast conserving surgery (BCS; Tübingen 1-2) or oncoplastic breast conservation with low resection volumes (OBCI; Clough level I/Tübingen 3-4).MethodsData from consecutive high-risk BC patients treated in 15 centers from the Oncoplastic Breast Consortium (OPBC) network, between January 2010 and December 2013, were retrospectively reviewed.ResultsA total of 3,177 women were included, 30% of whom were treated with OBC (OBCI n = 663; OBCII n = 297). The BCS/OBCI group had significantly smaller tumors and smaller resection margins compared with OBCII (pT1: 50% vs. 37%, p = 0.002; proportion with margin <1 mm: 17% vs. 6%, p < 0.001). There were significantly more re-excisions due to R1 (“ink on tumor”) in the BCS/OBCI compared with the OBCII group (11% vs. 7%, p = 0.049). Univariate and multivariable regression analysis adjusted for tumor biology, tumor size, radiotherapy, and systemic treatment demonstrated no differences in local, regional, or distant recurrence-free or overall survival between the two groups.ConclusionsLarge resection volumes in oncoplastic surgery increases the distance from cancer cells to the margin of the specimen and reduces reexcision rates significantly. With OBCII larger tumors are resected with similar local, regional and distant recurrence-free as well as overall survival rates as BCS/OBCI.
Highlights
Recent data suggest that margins C2 mm after breast-conserving surgery may improve local control in invasive breast cancer (BC)
Four institutions included 75% of all OBCII, five institutions had less than 5% of OBCII cases, and four centers had none
Compared with the breast conserving surgery (BCS)/oncoplastic breast conservation with low resection volumes (OBCI) group, patients treated with OBCII were more likely to have larger tumors and to be nodepositive
Summary
Recent data suggest that margins C2 mm after breast-conserving surgery may improve local control in invasive breast cancer (BC). The BCS/OBCI group had significantly smaller tumors and smaller resection margins compared with OBCII (pT1: 50% vs 37%, p = 0.002; proportion with margin \1 mm: 17% vs 6%, p \ 0.001). There were significantly more re-excisions due to R1 (‘‘ink on tumor’’) in the BCS/OBCI compared with the OBCII group (11% vs 7%, p = 0.049). Large resection volumes in oncoplastic surgery increases the distance from cancer cells to the margin of the specimen and reduces reexcision rates significantly. With OBCII larger tumors are resected with similar local, regional and distant recurrence-free as well as overall survival rates as BCS/OBCI
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