Skip to main content
Top
Published in: Annals of Surgical Oncology 10/2016

01-10-2016 | Breast Oncology

Complications of Oncoplastic Breast Surgery Involving Soft Tissue Transfer Versus Breast-Conserving Surgery: An Analysis of the NSQIP Database

Authors: Tulin D. Cil, MD, MEd, FRCSC, Erin Cordeiro, MD, MSc, FRCSC

Published in: Annals of Surgical Oncology | Issue 10/2016

Login to get access

Abstract

Background

Oncoplastic breast surgery (OBS) aims to provide breast cancer patients with optimum oncologic outcomes and excellent cosmesis. We sought to determine if there is a difference in complications associated with OBS involving soft tissue transfer compared with the traditional breast-conserving surgical (BCS) approach.

Methods

Analysis of the American College of Surgeons National Surgical Quality Improvement Program database was performed. Patients with breast cancer who underwent BCS from 2005 to 2014 were included in the study cohort, while patients undergoing concurrent high-risk non-breast surgery, male patients, and those with metastatic disease were excluded. Patients with concomitant current procedural terminology codes identifying soft tissue transfer were categorized as having OBS. Multivariable analysis was performed to determine the independent effect of OBS on postoperative morbidity.

Results

We identified 75,972 patients who underwent BCS for breast cancer between 2005 and 2014, of whom 1363 (1.8 %) underwent OBS with soft tissue transfer. Compared with the standard lumpectomy group, patients undergoing OBS were more likely to be younger, had a lower body mass index, were less likely to be smokers, and more often received neoadjuvant chemotherapy. OBS with soft tissue transfer also had a significantly longer operative time (83 vs. 59 min; p < 0.001). The multivariable analysis confirmed that soft tissue transfer OBS was not an independent predictor of overall complications (odds ratio 0.78; 95 % confidence interval 0.50–1.19).

Conclusions

These data confirm that the use of OBS with soft tissue transfer for breast cancer treatment does not confer an increased risk of surgical complications, despite the longer operative time. This is important given the increasing use of oncoplastic surgery techniques within North America.
Literature
1.
go back to reference Waljee JF, Hu ES, Ubel PA, Smith DM, Newman LA, Alderman AK. Effect of esthetic outcome after breast-conserving surgery on psychosocial functioning and quality of life. J Clin Oncol. 2008;26(20):3331–7.CrossRefPubMed Waljee JF, Hu ES, Ubel PA, Smith DM, Newman LA, Alderman AK. Effect of esthetic outcome after breast-conserving surgery on psychosocial functioning and quality of life. J Clin Oncol. 2008;26(20):3331–7.CrossRefPubMed
2.
go back to reference Clough KB, Benyahi D, Nos C, Charles C, Sarfati I. Oncoplastic surgery: pushing the limits of breast-conserving surgery. Breast J. 2015;21(2):140–6.CrossRefPubMed Clough KB, Benyahi D, Nos C, Charles C, Sarfati I. Oncoplastic surgery: pushing the limits of breast-conserving surgery. Breast J. 2015;21(2):140–6.CrossRefPubMed
3.
go back to reference Savalia NB, Silverstein MJ. Oncoplastic breast reconstruction: patient selection and surgical techniques. J Surg Oncol. 2016;113(8):875–82.CrossRefPubMed Savalia NB, Silverstein MJ. Oncoplastic breast reconstruction: patient selection and surgical techniques. J Surg Oncol. 2016;113(8):875–82.CrossRefPubMed
4.
go back to reference Losken A, Dugal CS, Styblo TM, Carlson GW. A meta-analysis comparing breast conservation therapy alone to the oncoplastic technique. Ann Plast Surg. 2014;72(2):145–9.CrossRefPubMed Losken A, Dugal CS, Styblo TM, Carlson GW. A meta-analysis comparing breast conservation therapy alone to the oncoplastic technique. Ann Plast Surg. 2014;72(2):145–9.CrossRefPubMed
5.
go back to reference Piper ML, Esserman LJ, Sbitany H, Peled AW. Outcomes following oncoplastic reduction mammoplasty: a systematic review. Ann Plast Surg. 2016;76 Suppl 3:S222–6.CrossRefPubMed Piper ML, Esserman LJ, Sbitany H, Peled AW. Outcomes following oncoplastic reduction mammoplasty: a systematic review. Ann Plast Surg. 2016;76 Suppl 3:S222–6.CrossRefPubMed
6.
go back to reference Tenofsky PL, Dowell P, Topalovski T, Helmer SD. Surgical, oncologic, and cosmetic differences between oncoplastic and nononcoplastic breast conserving surgery in breast cancer patients. Am J Surg. 2014;207(3):398–402.CrossRefPubMed Tenofsky PL, Dowell P, Topalovski T, Helmer SD. Surgical, oncologic, and cosmetic differences between oncoplastic and nononcoplastic breast conserving surgery in breast cancer patients. Am J Surg. 2014;207(3):398–402.CrossRefPubMed
7.
go back to reference Haloua MH, Krekel NMA, Winters HAH, Rietveld DHF, Meijer S, Bloemers FW, et al. A systematic review of oncoplastic breast-conserving surgery. Ann Surg. 2013;257(4):609–20.CrossRefPubMed Haloua MH, Krekel NMA, Winters HAH, Rietveld DHF, Meijer S, Bloemers FW, et al. A systematic review of oncoplastic breast-conserving surgery. Ann Surg. 2013;257(4):609–20.CrossRefPubMed
8.
go back to reference Xue DQ, Qian C, Yang L, Wang XF. Risk factors for surgical site infections after breast surgery: a systematic review and meta-analysis. Eur J Surg Oncol. 2012;38(5):375–81.CrossRefPubMed Xue DQ, Qian C, Yang L, Wang XF. Risk factors for surgical site infections after breast surgery: a systematic review and meta-analysis. Eur J Surg Oncol. 2012;38(5):375–81.CrossRefPubMed
9.
go back to reference Nizet J-L, Maweja S, Lakosi F, Lifrange E, Scagnol I, Seidel L, et al. Oncological and surgical outcome after oncoplastic breast surgery. Acta Chir Belg. 2015;115(1):33–41.CrossRef Nizet J-L, Maweja S, Lakosi F, Lifrange E, Scagnol I, Seidel L, et al. Oncological and surgical outcome after oncoplastic breast surgery. Acta Chir Belg. 2015;115(1):33–41.CrossRef
10.
go back to reference El-Tamer MB, Ward BM, Schifftner T, Neumayer L, Khuri S, Henderson W. Morbidity and mortality following breast cancer surgery in women: national benchmarks for standards of care. Ann Surg. 2007;245(5):665–71.CrossRefPubMedPubMedCentral El-Tamer MB, Ward BM, Schifftner T, Neumayer L, Khuri S, Henderson W. Morbidity and mortality following breast cancer surgery in women: national benchmarks for standards of care. Ann Surg. 2007;245(5):665–71.CrossRefPubMedPubMedCentral
11.
go back to reference de Blacam C, Ogunleye AA, Momoh AO, Colakoglu S, Tobias AM, Sharma R, et al. High body mass index and smoking predict morbidity in breast cancer surgery. Ann Surg. 2012;255(3):551–5.CrossRefPubMed de Blacam C, Ogunleye AA, Momoh AO, Colakoglu S, Tobias AM, Sharma R, et al. High body mass index and smoking predict morbidity in breast cancer surgery. Ann Surg. 2012;255(3):551–5.CrossRefPubMed
12.
go back to reference Hernanz F, Regaño S, Vega A, Gómez Fleitas M. Reduction mammaplasty: an advantageous option for breast conserving surgery in large-breasted patients. Surg Oncol. 2010;19(4):e95–e102.CrossRefPubMed Hernanz F, Regaño S, Vega A, Gómez Fleitas M. Reduction mammaplasty: an advantageous option for breast conserving surgery in large-breasted patients. Surg Oncol. 2010;19(4):e95–e102.CrossRefPubMed
13.
go back to reference Clough KB, Lewis JS, Couturaud B, Fitoussi A, Nos C, Falcou M-C. Oncoplastic techniques allow extensive resections for breast-conserving therapy of breast carcinomas. Ann Surg. 2003;237(1):26.CrossRefPubMedPubMedCentral Clough KB, Lewis JS, Couturaud B, Fitoussi A, Nos C, Falcou M-C. Oncoplastic techniques allow extensive resections for breast-conserving therapy of breast carcinomas. Ann Surg. 2003;237(1):26.CrossRefPubMedPubMedCentral
14.
go back to reference Giacalone PL, Roger P, Dubon O, El Gareh N, Rihaoui S, Taourel P, et al.. Comparative study of the accuracy of breast resection in oncoplastic surgery and quadrantectomy in breast cancer. Ann Surg Oncol. 2007;14(2): 605-14.CrossRefPubMed Giacalone PL, Roger P, Dubon O, El Gareh N, Rihaoui S, Taourel P, et al.. Comparative study of the accuracy of breast resection in oncoplastic surgery and quadrantectomy in breast cancer. Ann Surg Oncol. 2007;14(2): 605-14.CrossRefPubMed
15.
go back to reference Gulcelik MA, Dogan L, Camlibel M, Karaman N, Kuru B, Alagol H, et al. Early complications of a reduction mammoplasty technique in the treatment of macromastia with or without breast cancer. Clin Breast Cancer. 2011;11(6):395–9.CrossRefPubMed Gulcelik MA, Dogan L, Camlibel M, Karaman N, Kuru B, Alagol H, et al. Early complications of a reduction mammoplasty technique in the treatment of macromastia with or without breast cancer. Clin Breast Cancer. 2011;11(6):395–9.CrossRefPubMed
16.
go back to reference Meretoja TJ, Svarvar C, Jahkola TA. Outcome of oncoplastic breast surgery in 90 prospective patients. Am J Surg. 2010;200(2):224–8.CrossRefPubMed Meretoja TJ, Svarvar C, Jahkola TA. Outcome of oncoplastic breast surgery in 90 prospective patients. Am J Surg. 2010;200(2):224–8.CrossRefPubMed
17.
go back to reference Rietjens M, Urban CA, Rey PC, Mazzarol G, Maisonneuve P, Garusi C, et al. Long-term oncological results of breast conservative treatment with oncoplastic surgery. Breast. 2007;16(4):387–95.CrossRefPubMed Rietjens M, Urban CA, Rey PC, Mazzarol G, Maisonneuve P, Garusi C, et al. Long-term oncological results of breast conservative treatment with oncoplastic surgery. Breast. 2007;16(4):387–95.CrossRefPubMed
18.
go back to reference Law M, Yang S, Wang H, Babb JS, Johnson G, Cha S, et al. Glioma grading: sensitivity, specificity, and predictive values of perfusion MR imaging and proton MR spectroscopic imaging compared with conventional MR imaging. AJNR Am J Neuroradiol. 2003;24(10):1989–98.PubMed Law M, Yang S, Wang H, Babb JS, Johnson G, Cha S, et al. Glioma grading: sensitivity, specificity, and predictive values of perfusion MR imaging and proton MR spectroscopic imaging compared with conventional MR imaging. AJNR Am J Neuroradiol. 2003;24(10):1989–98.PubMed
19.
go back to reference Rusby JE, Paramanathan N, Laws SAM, Rainsbury RM. Immediate latissimus dorsi miniflap volume replacement for partial mastectomy: use of intra-operative frozen sections to confirm negative margins. Am J Surg. 2008;196(4):512–8.CrossRefPubMed Rusby JE, Paramanathan N, Laws SAM, Rainsbury RM. Immediate latissimus dorsi miniflap volume replacement for partial mastectomy: use of intra-operative frozen sections to confirm negative margins. Am J Surg. 2008;196(4):512–8.CrossRefPubMed
20.
go back to reference Holmes DR, Silverstein MJ. Triangle resection with crescent mastopexy: an oncoplastic breast surgical technique for managing inferior pole lesions. Ann Surg Oncol. 2012;19(10):3289–91.CrossRefPubMed Holmes DR, Silverstein MJ. Triangle resection with crescent mastopexy: an oncoplastic breast surgical technique for managing inferior pole lesions. Ann Surg Oncol. 2012;19(10):3289–91.CrossRefPubMed
21.
go back to reference Osman F, Saleh F, Jackson TD, Corrigan MA, Cil T. Increased postoperative complications in bilateral mastectomy patients compared to unilateral mastectomy: an analysis of the NSQIP database. Ann Surg Oncol. 2013;20(10):3212–7.CrossRefPubMed Osman F, Saleh F, Jackson TD, Corrigan MA, Cil T. Increased postoperative complications in bilateral mastectomy patients compared to unilateral mastectomy: an analysis of the NSQIP database. Ann Surg Oncol. 2013;20(10):3212–7.CrossRefPubMed
22.
go back to reference Khan NA, Quan H, Bugar JM, Lemaire JB, Brant R, Ghali WA. Association of postoperative complications with hospital costs and length of stay in a tertiary care center. J Gen Intern Med. 2006;21(2):177–80.CrossRefPubMedPubMedCentral Khan NA, Quan H, Bugar JM, Lemaire JB, Brant R, Ghali WA. Association of postoperative complications with hospital costs and length of stay in a tertiary care center. J Gen Intern Med. 2006;21(2):177–80.CrossRefPubMedPubMedCentral
23.
go back to reference Dimick JB, Chen SL, Taheri PA, Henderson WG, Khuri SF, Campbell DA. Hospital costs associated with surgical complications: a report from the private-sector National Surgical Quality Improvement Program. J Am Coll Surg. 2004;199(4):531–7.CrossRefPubMed Dimick JB, Chen SL, Taheri PA, Henderson WG, Khuri SF, Campbell DA. Hospital costs associated with surgical complications: a report from the private-sector National Surgical Quality Improvement Program. J Am Coll Surg. 2004;199(4):531–7.CrossRefPubMed
24.
go back to reference Lohrisch C, Paltiel C, Gelmon K, Speers C, Taylor S, Barnett J, et al. Impact on survival of time from definitive surgery to initiation of adjuvant chemotherapy for early-stage breast cancer. J Clin Oncol. 2006;24(30):4888–94.CrossRefPubMed Lohrisch C, Paltiel C, Gelmon K, Speers C, Taylor S, Barnett J, et al. Impact on survival of time from definitive surgery to initiation of adjuvant chemotherapy for early-stage breast cancer. J Clin Oncol. 2006;24(30):4888–94.CrossRefPubMed
25.
go back to reference Chavez-MacGregor M, Clarke CA, Lichtensztajn DY, Giordano SH. Delayed initiation of adjuvant chemotherapy among patients with breast cancer. JAMA Oncol. 2016;2(3):322–9.CrossRefPubMed Chavez-MacGregor M, Clarke CA, Lichtensztajn DY, Giordano SH. Delayed initiation of adjuvant chemotherapy among patients with breast cancer. JAMA Oncol. 2016;2(3):322–9.CrossRefPubMed
Metadata
Title
Complications of Oncoplastic Breast Surgery Involving Soft Tissue Transfer Versus Breast-Conserving Surgery: An Analysis of the NSQIP Database
Authors
Tulin D. Cil, MD, MEd, FRCSC
Erin Cordeiro, MD, MSc, FRCSC
Publication date
01-10-2016
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 10/2016
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-016-5477-8

Other articles of this Issue 10/2016

Annals of Surgical Oncology 10/2016 Go to the issue