Advanced Oncoplastic Breast Conserving Surgery: Single Institution Experience with 823 Patients

Introduction Although close radial margins after breast-conserving surgery routinely undergo re-excision, appropriate management of patients with close anterior margins remains a topic of controversy. An increasing body of literature suggests that re-excision of close anterior margins yields low rates of residual malignancy and may only be necessary in selected patients. The aim of this study was to examine the management of close anterior margins after breast conserving surgery in a single institution and to analyse the rate of residual disease in re-excised anterior margins. Methods All patients having breast conserving surgery at St Vincent’s University Hospital from January 2008 to December 2012 were reviewed retrospectively. Data collected included patient demographics, tumour characteristics, margin positivity, re-excision rates and definitive histology of the re-excision specimens. A close margin was defined as les than 2 mm. Results A total of 930 patients were included with an average age of 65 years (range 29–94 years). Of these, 121 (13%) had a close anterior margin. Further re-excison of the anterior margin was carried out in 37 patients (30.6%) and a further 16 (13.2%) proceeded to mastectomy. Residual disease was found in 18.5% (7/36) of those who underwent re-excision and 7/16 (43.75%) of those who underwent mastectomy. Overall, 11.57% (14/121) of patients with close anterior margins were subsequently found to have residual disease. Conclusion The low yield of residual disease in re-excised anterior margins specimens supports the concept that routine re-excision of close anterior margins is not necessary. Further research is required to definitively assess its influence on the risk of local recurrence.

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Oncological results of oncoplastic breast-conserving surgery: Long term follow-up of a large series at a single institution

European Journal of Surgical Oncology ◽

10.1016/j.ejso.2015.08.160 ◽

2016 ◽

Vol 42 (1) ◽

pp. 71-77 ◽

Cited By ~ 53

Author(s):

F. De Lorenzi ◽

G. Hubner ◽

N. Rotmensz ◽

V. Bagnardi ◽

P. Loschi ◽

...

Keyword(s):

Breast Conserving Surgery ◽

Large Series ◽

Single Institution ◽

Long Term Follow Up ◽

Oncological Results

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A 12-Year Single-Institution Experience with Accelerated Partial Breast Irradiation

The American Surgeon ◽

10.1177/000313481808400832 ◽

2018 ◽

Vol 84 (8) ◽

pp. 1261-1263

Author(s):

Anthony M. Scott ◽

Matthew C. Callier ◽

Madison Lashley ◽

David A. Cole ◽

Paul S. Dale

Keyword(s):

Skin Irritation ◽

Breast Conserving Surgery ◽

Accelerated Partial Breast Irradiation ◽

Partial Breast Irradiation ◽

Breast Irradiation ◽

Single Institution ◽

Recurrence Rates ◽

Breast Brachytherapy ◽

Skin Erythema ◽

American Society

Accelerated partial breast irradiation (APBI) using the implanted brachytherapy device MammoSite® was approved for routine use by the Food and Drug Administration in 2002. The American Society of Breast Surgeons MammoSite® Breast Brachytherapy Registry served as a guideline for our institution to begin offering this treatment in 2005. This report reviews our available data to provide an analysis of patient outcomes over 12 years of use at a single institution. A retrospective review was conducted of records of 150 patients who underwent APBI or attempted APBI after breast-sparing surgeries between 2006 and 2017. These charts were analyzed for documentation of patient age, cancer stage, incidence of recurrence, and posttreatment complications. Of the patients evaluated, 99 per cent (149/150) completed treatment. The median time since treatment completion is now 8.9 years. One hundred eleven patients (74%) are now greater than five years posttreatment. Ipsilateral breast recurrence was found in 2.7 per cent of patients (4/149), and 1.3 per cent of patients (2/149) developed new primary breast tumors. Acute complications, mostly skin erythema (21%), were uncommon and self-limited. Subacute effects were generally fibrosis (13%) and mild local pain (9.4%). APBI for breast cancer after breast-conserving surgery continues to be used at our institution for select patients with good outcomes. Local control and toxicity are similar to that reported in the literature. Five-year local recurrence rates compare favorably with national trials. Occasional complications included fibrosis, persistent pain, and skin irritation.

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