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01-02-2012 | Breast Oncology

Do Reexcisions Impair Aesthetic Outcome in Breast Conservation Surgery? Exploratory Analysis of a Prospective Cohort Study

Authors: Joerg Heil, MD, Kathrin Breitkreuz, Michael Golatta, MD, Elena Czink, Julia Dahlkamp, Joachim Rom, MD, Florian Schuetz, MD, Maria Blumenstein, MD, Geraldine Rauch, PhD, Christof Sohn, MD

Published in: Annals of Surgical Oncology | Issue 2/2012

Abstract

Purpose

Reexcision is a clinically relevant aspect of oncological breast conservation surgery. The influence of reexcision on aesthetic outcome is described differently in the literature. Our aim was to analyze this question in a well-defined cohort with standardized study instruments.

Methods

A total of 439 patients from a prospectively followed cohort were included in this analysis. Aesthetic results were assessed by the Breast Cancer Treatment Outcome Scale (BCTOS) aesthetic status. Dates of assessments were shortly after surgical interventions and before surgery. Group comparison was performed between patients with reexcisions (80 cases; 18%) and patients without reexcision (359 cases; 82%). We considered variables of differing distribution between the two groups that could hypothetically influence BCTOS aesthetic status in a nonparametric analysis of covariance (ANCOVA).

Results

The aesthetic status of patients with reexcisions was found to be significantly worse than for patients with a single breast conservation surgery (P < 0.0001) when tested by a nonparametric ANCOVA model. Because patients with reexcisions had more noninvasive tumors (25% vs. 8%, P = 0.0001) and tumors were larger in patients with reexcision (P = 0.01), we included these variables as possible covariates in the multivariate model. The model was adjusted for the BCTOS aesthetic status before and shortly after the first surgery.

Conclusions

Our findings suggest that reexcision in breast conservation surgery impairs aesthetic outcome, at least when assessed shortly after surgery.

Clarke M, Collins R, Darby S, et al. Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of the randomised trials. Lancet. 2005;366(9503):2087–106.PubMed

Fisher B, Anderson S, Bryant J, et al. Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med. 2002;347:1233–41.PubMedCrossRef

van Dongen JA, Voogd AC, Fentiman IS, et al. Long-term results of a randomized trial comparing breast-conserving therapy with mastectomy: European Organization for Research and Treatment of Cancer 10801 trial. J Natl Cancer Inst. 2000;92:1143–50.PubMedCrossRef

Kreike B, Hart AA, van de Velde T, et al. Continuing risk of ipsilateral breast relapse after breast-conserving therapy at long-term follow-up. Int J Radiat Oncol Biol Phys. 2008;71:1014–21.PubMedCrossRef

Mannell A. Breast-conserving therapy in breast cancer patients—a 12-year experience. S Afr J Surg. 2005;43:28–30.PubMed

Aziz D, Rawlinson E, Narod SA, et al. The role of reexcision for positive margins in optimizing local disease control after breast-conserving surgery for cancer. Breast J. 2006;12:331–7.PubMedCrossRef

Cabioglu N, Hunt KK, Sahin AA, et al. Role for intraoperative margin assessment in patients undergoing breast-conserving surgery. Ann Surg Oncol. 2007;14:1458–71.PubMedCrossRef

Chagpar AB, Martin RC 2nd, Hagendoorn LJ, Chao C, McMasters KM. Lumpectomy margins are affected by tumor size and histologic subtype but not by biopsy technique. Am J Surg. 2004;188:399–402.PubMedCrossRef

Dillon MF, Hill AD, Quinn CM, McDermott EW, O’Higgins N. A pathologic assessment of adequate margin status in breast-conserving therapy. Ann Surg Oncol. 2006;13:333–9.PubMedCrossRef

10.

Kurniawan ED, Wong MH, Windle I, et al. Predictors of surgical margin status in breast-conserving surgery within a breast screening program. Ann Surg Oncol. 2008;15:2542–9.PubMedCrossRef

11.

Smitt MC, Horst K. Association of clinical and pathologic variables with lumpectomy surgical margin status after preoperative diagnosis or excisional biopsy of invasive breast cancer. Ann Surg Oncol. 2007;14:1040–4.PubMedCrossRef

12.

Margolis GJ, Goodman RL. Psychological factors in women choosing radiation therapy for breast cancer. Psychosomatics. 1984;25:464–6, 469.

13.

Curran D, van Dongen JP, Aaronson NK, et al. Quality of life of early-stage breast cancer patients treated with radical mastectomy or breast-conserving procedures: results of EORTC Trial 10801. The European Organization for Research and Treatment of Cancer (EORTC), Breast Cancer Co-operative Group (BCCG). Eur J Cancer. 1998;34:307–14.PubMedCrossRef

14.

Kiebert GM, de Haes JC, van de Velde CJ. The impact of breast-conserving treatment and mastectomy on the quality of life of early-stage breast cancer patients: a review. J Clin Oncol. 1991;9:1059–70.PubMed

15.

Nano MT, Gill PG, Kollias J, Bochner MA, Malycha P, Winefield HR. Psychological impact and cosmetic outcome of surgical breast cancer strategies. ANZ J Surg. 2005;75:940–7.PubMedCrossRef

16.

Noguchi M, Saito Y, Nishijima H, et al. The psychological and cosmetic aspects of breast conserving therapy compared with radical mastectomy. Surg Today. 1993;23:598–602.PubMedCrossRef

17.

Wang HT, Barone CM, Steigelman MB, et al. Aesthetic outcomes in breast conservation therapy. Aesthet Surg J. 2008;28:165–70.PubMedCrossRef

18.

Heil J, Holl S, Golatta M, et al. Aesthetic and functional results after breast conserving surgery as correlates of quality of life measured by a German version of the Breast Cancer Treatment Outcome Scale (BCTOS). Breast. 2010;19:470–4.PubMedCrossRef

19.

Heil J, Czink E, Golatta M, et al. Change of aesthetic and functional outcome over time and their relationship to quality of life after breast conserving therapy. Eur J Surg Oncol. 2011;37:116–21.PubMedCrossRef

20.

Wazer DE, DiPetrillo T, Schmidt-Ullrich R, et al. Factors influencing cosmetic outcome and complication risk after conservative surgery and radiotherapy for early-stage breast carcinoma. J Clin Oncol. 1992;10:356–63.PubMed

21.

Fedorcik GG, Sachs R, Goldfarb MA. Oncologic and aesthetic results following breast-conserving therapy with 0.5 cm margins in 100 consecutive patients. Breast J. 2006;12:208–11.PubMedCrossRef

22.

Waljee JF, Hu ES, Newman LA, Alderman AK. Predictors of breast asymmetry after breast-conserving operation for breast cancer. J Am Coll Surg. 2008;206:274–80.PubMedCrossRef

23.

Cochrane RA, Valasiadou P, Wilson AR, Al-Ghazal SK, Macmillan RD. Cosmesis and satisfaction after breast-conserving surgery correlates with the percentage of breast volume excised. Br J Surg. 2003;90:1505–9.PubMedCrossRef

24.

Heil J, Dahlkamp J, Golatta M, et al. Aesthetics in breast conserving therapy: do objectively measured results match patients’ evaluations? Ann Surg Oncol. 2011;18:134–8.PubMedCrossRef

25.

Al-Ghazal SK, Fallowfield L, Blamey RW. Patient evaluation of cosmetic outcome after conserving surgery for treatment of primary breast cancer. Eur J Surg Oncol. 1999;25:344–6.PubMedCrossRef

26.

Al-Ghazal SK, Blamey RW. Cosmetic assessment of breast-conserving surgery for primary breast cancer. Breast. 1999;8:162–8.PubMedCrossRef

27.

Stanton AL, Krishnan L, Collins CA. Form or function? Part 1. Subjective cosmetic and functional correlates of quality of life in women treated with breast-conserving surgical procedures and radiotherapy. Cancer. 2001;91:2273–81.

28.

Knoke JD. Nonparametric analysis of covariance for comparing change in randomized studies with baseline values subject to error. Biometrics. 1991;47:523–33.PubMedCrossRef

29.

Cardoso MJ, Cardoso J, Santos AC, et al. Factors determining esthetic outcome after breast cancer conservative treatment. Breast J. 2007;13:140–6.PubMedCrossRef

30.

Al-Ghazal SK, Blamey RW, Stewart J, Morgan AA. The cosmetic outcome in early breast cancer treated with breast conservation. Eur J Surg Oncol. 1999;25:566–70.PubMedCrossRef

31.

Lindsey I, Serpell JW, Johnson WR, Rodger A. Cosmesis following complete local excision of breast cancer. Aust N Z J Surg. 1997;67:428–32.PubMedCrossRef

32.

Taylor ME, Perez CA, Halverson KJ, et al. Factors influencing cosmetic results after conservation therapy for breast cancer. Int J Radiat Oncol Biol Phys. 1995;31:753–64.PubMedCrossRef

Title: Do Reexcisions Impair Aesthetic Outcome in Breast Conservation Surgery? Exploratory Analysis of a Prospective Cohort Study
Authors: Joerg Heil, MD
Kathrin Breitkreuz
Michael Golatta, MD
Elena Czink
Julia Dahlkamp
Joachim Rom, MD
Florian Schuetz, MD
Maria Blumenstein, MD
Geraldine Rauch, PhD
Christof Sohn, MD
Publication date: 01-02-2012
Publisher: Springer-Verlag
Published in: Annals of Surgical Oncology / Issue 2/2012
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-011-1947-1

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Springer Medicine

Do Reexcisions Impair Aesthetic Outcome in Breast Conservation Surgery? Exploratory Analysis of a Prospective Cohort Study

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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