“Unplanned breast-conserving surgery after systemic therapy in locally
advanced breast cancer: the results of level II oncoplastic techniques”
BACKGROUND: In patients with breast cancer for whom neoadjuvant
chemotherapy (NAC) is planned, it is recommended to mark the primary
tumor before treatment (planned surgery). However, surgeons may have to
perform breast-conserving surgery on patients whose tumors are not
marked (unplanned surgery). This study focused on the results obtained
with planned and unplanned level II oncoplastic surgery (OPS) techniques
applied to patients after NAC. METHODS: Patient groups who underwent
planned, unplanned OPS and mastectomy after NAC were compared. Surgical
margin status, re-operation and re-excision requirements, ipsilateral
breast tumor recurrence (IBTR) and axillary recurrence rates recorded.
Long-term local recurrence-free survival (LRFS), disease-free survival
and overall survival were evaluated. RESULTS: There was no significant
difference between the planned and unplanned OPS groups in terms of
surgical margin status, re-excision requirement, and mastectomy rates.
During an average follow-up period of 43 months, 5.3% and 4% of the
patients in the planned OPS group developed IBTR and axillary
recurrence, respectively, whereas these rates were 6.6% and 5.3% in
the unplanned OPS group. In the mastectomy group, the rates of IBTR and
axillary recurrence were found to be 4.1% and 3.8%, respectively.
There was no significant difference between the three groups in terms of
IBTR (p: 0.06) and axillary recurrence (p: 0.08) rates. CONCLUSION:
Breast conserving surgery can be applied using level II OPS techniques
with the post-NAC radiological examination and marking even if primary
tumor marking is not done in the pre-NAC period.