Introducing oncoplastic breast surgery in a community hospital

Case review

The cases of all patients who received OPBS performed by a single surgeon (H.H.) at Vernon Jubilee Hospital, a 186-bed hospital in Vernon, British Columbia, between October 2018 and October 2019 were retrospectively reviewed. We compared this cohort (post-OPBS period) with patients who received BCS performed by the same surgeon between March 2015 and January 2016 (pre-OPBS period), whose outcomes have been described previously.3 All patients were adult (> 18 yr) women with a diagnosis of invasive or in situ breast cancer. There were no exclusions. Procedures included BCS (partial mastectomy/lumpectomy with sentinel lymph node biopsy) or BCS with level 1 or 2 oncoplastic techniques the surgeon performed after completing an accredited introductory OPBS skills course. Demographic, diagnostic, perioperative, pathologic, and 6-month follow up data were analyzed. Primary outcomes included positive margin, reoperation, and completion mastectomy rates. Secondary outcomes included operative time, specimen mass, postoperative complications, and readmission rate. Statistical analysis was performed using a Student t test for continuous variables and χ² test or Mann–Whitney U tests for categorical variables where appropriate. Calculations were performed using Excel (Microsoft) and R software version 3.6.1. A p value less than 0.05 was considered statistically significant.

Cohort comparison

Our comparison includes a total of 32 breast oncology cases: 12 patients in the pre-OPBS period and 20 in the post-OPBS period. Demographic characteristics, diagnoses and staging comparisons are summarized in Table 1. The mean Charlson Comorbidity Index score for the pre-OPBS group was significantly lower.

Operative data, including frequency of oncoplastic techniques, are shown in Table 2. Operative duration was significantly longer in the group receiving OPBS. The mean tumour size was similar in the 2 cohorts. Specimen weight was significantly higher in the post-OPBS cohort. Three patients in the pre-OPBS group (25%) and 2 patients in the post-OPBS group (10%) had positive margins. Those in the pre-OPBS group were treated with completion mastectomy. One additional patient in that group with a negative but close margin for multifocal ductal carcinoma in situ underwent completion mastectomy. Both post-OPBS patients with positive margins were treated with revision partial mastectomy and repeat OPBS. The completion mastectomy rate was higher in the pre-OPBS group (33.3% v. 0%, p = 0.014). Fifteen and 20 total mastectomies were performed during the pre- and post-OPBS periods, respectively. These patients were either deemed not to be candidates for BCS or preferred to have a mastectomy. Overall, the breast conservation rate post-OPBS increased from 30% to 50% (8 of 27 v. 20 of 40, p = 0.048). One patient in each cohort had unsuccessful sentinel lymph node localization and required subsequent axillary lymph node dissections. One patient in the pre-OPBS group developed a recurrence with metastatic disease and died 6 months after surgery. No other recurrences were observed in the follow-up period in either group.

Postoperative complications are shown in Table 3. No patient in the pre-OPBS group required readmission, whereas 2 patients in the post-OPBS group required readmission for hematoma evacuation.

Conclusion

In future, we hope to complete long-term follow-up for these patients as well as examine the trends of OPBS in our centre over time. This work might help to add to research on the OPBS learning curve and its implications for surgeons newly adopting these techniques as well as their training programs and standards.