Messaggi chiave
- A partire dalla coorte prospettica UMBRELLA, è stata condotta un’analisi volta a confrontare gli esiti clinici e gli esiti riferiti dalle pazienti dopo chirurgia mammaria conservativa tradizionale (C-BCS) e BCS oncoplastica (OP-BCS).
- In totale, 1628 (84,9%) pazienti sono state sottoposte a C-BCS e 290 (15,1%) a OP-BCS. Margini di resezione liberi sono stati ottenuti nell’84,2 e 86,2% dei casi, rispettivamente, con tassi di reintervento per l’ampliamento dei margini a distanza di <3 mesi dalla chirurgia iniziale pari al 5,3 e 4,8% e un intervallo mediano prima dell’avvio della terapia sistemica adiuvante di 66 e 63 giorni. Nell’immediato postoperatorio, la OP-BCS è stata associata a punteggi medi significativamente inferiori in termini di funzionamento fisico e immagine corporea e a maggior dolore e sintomi mammari rispetto alla C-BCS. I punteggi relativi all’immagine corporea sono rimasti significativamente meno favorevoli con la OP-BCS fino a 24 mesi dopo l’intervento.
- Gli autori concludono che la chirurgia oncoplastica, pur consentendo di attuare interventi conservativi in modo sicuro, può portare a esiti a lungo termine meno soddisfacenti in termini di percezione dell’immagine corporea rispetto alla C-BCS. Si tratta di risultati importanti per guidare la comunicazione con la paziente e facilitare la condivisione dei processi decisionali.
Abstract
Background
- Oncoplastic breast conserving surgery (OP-BCS) is becoming increasingly popular to avoid mastectomy or optimize cosmetic outcomes of breast conserving surgery (BCS).
- Few studies have compared clinical outcomes and patient-reported outcomes (PROs) of OP-BCS to conventional BCS (C-BCS).
- This study aims to compare clinical outcomes and short and long-term PROs after OP-BCS and C-BCS in a large prospective breast cancer cohort.
Methods
- Women in the prospective, multicenter UMBRELLA-breast cancer cohort who underwent OP-BCS or C-BCS were included.
- Clinical outcomes and PROs (measured by EORTC QLQ-C30/BR23) up to 24 months postoperatively were evaluated.
- Mixed-model analysis was performed to assess differences in PROs over time between groups.
Results
- 1628 (84.9%) patients received C-BCS and 290 (15.1%) OP-BCS.
- After C-BCS and OP-BCS, free resection margins were obtained in 84.2% (n = 1370) and 86.2% (n = 250), respectively, reoperation for re-exision of margins <3 months occurred in 5.3% (n = 86) and 4.8% (n = 14), median time interval from surgery until adjuvant systemic therapy was 66 and 63 days, and 36 and 41 days until radiotherapy.
- Shortly postoperative, OP-BCS was associated with statistically significant lower mean scores for physical functioning (83.6 vs 87.2) and body image (82.8 vs 89.4) and more pain (19.8 vs 26.5) and breast symptoms (22.7 vs 30.3) than C-BCS.
- Body image scores remained significantly less favorable after OP-BSC than C-BCS up to 24 months postoperatively (87.8 vs 92.2).
Conclusions
- Oncoplastic surgery safely enables BCS, but may lead to less favorable long-term body image compared to C-BCS.
- These findings are important for patient education and shared decision-making.