Expanded indications for breast-conserving surgery with oncoplastic approaches compared to conventional approaches: a single-center retrospective comparative cohort study

Wenjie Zhou; Xiaoli Wang; Jiqiao Yang; Alejandro Martin Sanchez; Qiuwen Tan; Xiaoqin Yang

doi:10.21037/gs-23-371

Expanded indications for breast-conserving surgery with oncoplastic approaches compared to conventional approaches: a single-center retrospective comparative cohort study

Gland Surg. 2023 Nov 24;12(11):1594-1609. doi: 10.21037/gs-23-371. Epub 2023 Nov 17.

Authors

Wenjie Zhou^#^{1

2

3}, Xiaoli Wang^#^{1

2}, Jiqiao Yang^{1

2}, Alejandro Martin Sanchez⁴, Qiuwen Tan^{1

2}, Xiaoqin Yang^{1

2}

Affiliations

¹ Division of Breast Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China.
² Breast Center, West China Hospital, Sichuan University, Chengdu, China.
³ Department of General Surgery, Chengdu Shang Jin Nan Fu Hospital, West China Hospital, Sichuan University, Chengdu, China.
⁴ Multidisciplinary Breast Center, Fondazione Policlinico Universitario Agostino Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy.

^# Contributed equally.

Abstract

Background: Oncoplastic breast-conserving surgery (OPBS) is the evolution of conventional breast-conserving surgery (CBCS); however, data from studies comparing patients who received two surgical procedures are limited. A comparison of differences in terms of the patient characteristics, tumor-nipple distance, volume of resected breast tissue, tumor volume and postoperative breast appearance between patients undergoing OPBS and CBCS was carried out in this study, enhancing the evidence base for OPBS by widening indications and improving patient satisfaction.

Methods: From January 2020 to April 2022, the Breast Center of West China Hospital conducted a retrospective comparative study involving 106 patients. Preoperative characteristics of patients were recorded, and the tumor-nipple distance, the volume of resected breast tissue, tumor volume and patient-reported esthetic outcomes measured by the Harris cosmetic scale were compared between patients who underwent OPBS and CBCS.

Results: Each group had a median follow-up time of 2 months, ranging from 1 week to 6 months. The tumor-nipple distance was significantly shorter in patients receiving OPBS than in those receiving CBCS (2.98±1.42 vs. 3.85±1.78 cm, P=0.006). The rate of positive margin evaluated by intraoperative frozen section biopsy was significantly lower in OPBS group than in CBCS group (2/43, 4.65% vs. 11/63, 17.46%; P=0.048). The maximum diameter of resected tissue (7.80±2.29 vs. 6.75±1.87 cm, P=0.011) and volume of resected tissue (74.20±42.77 vs. 45.52±30.99 cm³, P<0.001) were signiﬁcantly larger with OPBS. The tumor size, tumor volume (either clinically measured by ultrasound or pathologically measured), tumor location, and reoperation rate due to positive margins did not differ signiﬁcantly between groups. Moreover, insigniﬁcant differences existed regarding patient satisfaction between two groups (87.30% vs. 81.40%).

Conclusions: The OPBS strategy allowed extensive resections and expanded indications with equivalent cosmetic satisfaction and favorable oncological safety.

Keywords: Oncoplastic breast-conserving surgery (OPBS); aesthetics; breast cancer; indication; patient satisfaction.