Cohort study comparing volume replacement oncoplastic breast surgery with standard wide local excision for breast cancer.

Abstract

Background: Volume replacement oncoplastic breast surgery (VR-OPS) allows breast conservation for women who would otherwise undergo mastectomy or compromise cosmetic outcomes with wide local excision (WLE). VR-OPS remains understudied in the literature. The aim of this study was to compare 7-year outcomes of VR-OPS vs. WLE.

Methods: This is a single-centre retrospective chart review compared VR-OPS (2012-2016) to WLE (2013-2014), analysing clinicopathological, treatment, surgical, and follow-up data.

Results: Eighty patients underwent WLE and 79 VR-OPS. No differences in smoking status, cancer type, or grade were observed between the groups. Women in the VR-OPS group were significantly younger, more likely to be node positive, and had larger tumours. Consequently, they received more neo-adjuvant chemotherapy and axillary surgery. VR-OPS resulted in significantly more clear margins [relative risk (RR) =0.3638; 95% confidence interval (CI): 0.1621 to 0.8162; P=0.01], translating to a decreased need for mastectomy (RR =0.2250; 95% CI: 0.0502 to 1.0089; P=0.06). There was also a significant decrease in the need for further breast surgery for symmetrisation after VR-OPS (RR =0.1266; 95% CI: 0.0162 to 0.9887; P=0.04). Although VR-OPS had slightly more post-op complications (RR =1.8228; 95% CI: 0.8982 to 3.6993; P=0.09), this was not statistically significant. Importantly there was no difference in long-term oncological outcomes specifically local-recurrence (RR =0.7949; 95% CI: 0.1152 to 5.484; P=0.81) and overall-survival (RR =0.6551; 95% CI: 0.2633 to 1.6302; P=0.36).

Conclusions: This study observed no significant differences in long-term local recurrence and survival between the VR-OPS and WLE groups. VR-OPS represents an oncologically safe surgical option especially for larger tumours.