Universität zu Köln

Rezai, Mahdi, Kraemer, Stefan, Kimmig, Rainer and Kern, Peter (2015). Breast conservative surgery and local recurrence. Breast, 24. S. S100 - 8. EDINBURGH: CHURCHILL LIVINGSTONE. ISSN 1532-3080

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Abstract

Introduction: Breast conservation is a legacy of Umberto Veronesi who laid the groundwork for the preservation of the body image of women affected by breast cancer (BC) with the Milan I study in the late 70ies of the last millennium. Breast conservative surgery (BCS) has two aspects: oncological safety of tumour resection with free margins and aesthetic preservation of the breast. Determinants of local control used to be T-size, nodal status and receptor status until biologically driven concepts defined risk of recurrence on the basis of molecular portraits. We explored whether these concepts of intrinsic subtypes prove at a large scale in the context of BCS and which surgical techniques procure best oncological and aesthetic outcomes, avoiding re-excision and necessity of conversion to mastectomy. Patients and methods: We analyzed 1035 BCS patients with primary unilateral breast cancer (2004-2009) with regards to the local recurrence as a function of tumour location, surgical technique, resection volume, T-size, nodal status, grading, histopathological and intrinsic subtype and margins. Results: Five surgical techniques were applied to 944 eligible patients at a median follow-up of 5.2 years with the following frequency: Glandular rotation mammoplasty (63.8%), tumour-adapted rotation mammoplasty (20.9%), dermoglandular rotation mammoplasty (6.7%), 4.4% (lateral thoracic wall advancement), 0.7% latissimus dorsi flap (0.7%) and others (13.5%). Tumour-free margins were achieved in 88.6% of all patients at first surgery. Recurrence was independent of the surgical technique used, resection volume, T-size (in a T1/T2-cohort), nodal status (in low N-stages: NO/N1) and histopathology (inv.-ductal vs. lobular), however non-invasive subtype (DCIS), high grading (G3 vs. G1), non-luminal Her2 positive BC and triple-negative breast cancer (TNBC) were significantly associated with local recurrence. Conclusions: Five defined oncoplastic principles presented in our nomogramme (targeted breast surgery) allow the reconstruction of major segmental resection defects during breast-conserving therapy with high clinical applicability and result in favorable oncological and aesthetic outcome. Recurrence was not a function of traditional prognostic factors like T-size or nodal status (in a T1/T2, N0/N1 cohort), but of grading, intrinsic subtypes and non-invasive breast cancer components. Lobular histology, multicentricity and DCIS were predictive for breast preservation failure and conversion to mastectomy. (C) 2015 Elsevier Ltd. All rights reserved.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Rezai, Mahdi UNSPECIFIED UNSPECIFIED UNSPECIFIED Kraemer, Stefan UNSPECIFIED UNSPECIFIED UNSPECIFIED Kimmig, Rainer UNSPECIFIED UNSPECIFIED UNSPECIFIED Kern, Peter UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-387900
DOI:	10.1016/j.breast.2015.07.024
Journal or Publication Title:	Breast
Volume:	24
Page Range:	S. S100 - 8
Date:	2015
Publisher:	CHURCHILL LIVINGSTONE
Place of Publication:	EDINBURGH
ISSN:	1532-3080
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language REDUCTION MAMMAPLASTY; REGIONAL RECURRENCE; CONSERVING THERAPY; PARTIAL MASTECTOMY; INFERIOR PEDICLE; DUCTAL CARCINOMA; LONG-TERM; CANCER; MARGINS; RADIOTHERAPY Multiple languages Oncology; Obstetrics & Gynecology Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/38790