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Oncoplastic Breast Surgery: A Meta-Analysis of 2,512 Patient Outcomes
Sunishka Wimalawansa, MD, MBA;
William C. Rigano, MD;
R. Michael Johnson, MD
Wright State University / Miami Valley Hospital; Dayton, OH
2013-02-01
Presenter: Sunishka Wimalawansa, MD, MBA
Affidavit:
We have not presented or published this data anywhere else.
Dr. Wimalawansa performed the entire meta-analysis and abstract write-up.
Director Name: R. Michael Johnson, MD
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Breast (Aesthetic and Recon.)
Breast conserving therapy (BCT) was developed to preserve the female form in breast cancer treatment; however, reports indicate high cosmetic failure rates. Oncoplastic surgery (OPS) was developed as a BCT adjunct to maximize cosmetic outcome; however, questions remain about its oncologic safety. Several studies analyzed OPS outcomes, but no large randomized studies have been published.
A PubMed search identified 197 abstracts with 35 pertinent studies. 2,512 patients underwent OPS; control BCT groups enrolled 680 patients. Not all parameters were reported in all studies; results were weighted for reporting subsets.
Close/positive margins occurred in 11.7% of OPS versus 21.1% of BCT (statistically significant in matched groups); BCT literature reports positive margin rates between 20-55%. Average OPS follow-up was 44.4 months with 5-year survival, metastasis-free survival, and local recurrence rates of 94.1%, 88.6%, and 5.7%; BCT rates (per NEJM, 1995) were 92.9%, 87.9%, and 7.7% (stage I and II disease only). Intermediate-term (1 to 5 year) OPS survival, metastasis, and local recurrence rates were 98.3%, 4%, and 2%, respectively.
OPS selection criteria typically involved larger tumors and unfavorable locations. Mean OPS tumors measured 24.4 mm (larger than matched BCT controls). 45% of OPS cases were stage II; 6.7% were stage III. DCIS, a known risk factor for multicentricity and positive margins, represented 16.7%. Despite this, OPS cosmesis was rated satisfactory by 90.1% of treatment teams and 93.4% of patients (BCT literature reports 70-80%).
Large multicenter randomized prospective trials are needed, but this meta-analysis confirms the oncologic safety and superior cosmesis of OPS.
