The Impact Of Oncoplastic Reduction On Initiation Of Adjuvant Radiation And Need For Re-excision: A Database Evaluation
Jennifer K. Shah, N/A, Kelsey Lipman, MD, Rachel Pedreira, MD, Nathan Makarewicz, BA, Rahim Nazerali, MD.
Stanford University, Palo Alto, CA, USA.
PURPOSE: Partial breast reconstruction with oncoplastic reduction can provide breast cancer patients with improved aesthetic outcomes following breast conservation therapy. This study evaluates the implications of simultaneous oncoplastic reduction with lumpectomy on complication rates, time to adjuvant radiation therapy, and rates of margin re-excision compared to lumpectomy alone.
METHODS: The Clinformatics® Data Mart Database is a national deidentified commercial claims data warehouse. From 2003-2020, adult female patients were queried with International Classification of Disease (ICD-9 and ICD-10) codes to identify patients with a breast cancer diagnosis. Among those, common procedural terminology (CPT) codes were used to identify those who underwent lumpectomy alone versus lumpectomy with oncoplastic reduction. Patient demographics, complications, adjuvant oncologic therapies, and need for re-excision were recorded. Patients who were not continuously enrolled for at least six months before and after the index procedure were excluded. Chi squared and multivariable regression tests were used for statistical analysis.
RESULTS: Of 53,165 patients meeting criteria (mean age 61.4 ± 11.6 years), 1,552 (2.9%) underwent oncoplastic reduction. Diagnoses of most non-surgical complications (seroma, wound dehiscence, postoperative infection, fat necrosis, tissue necrosis, and non-specified complications of surgical care) were significantly higher in the oncoplastic reduction group, as were rates of some complications requiring surgical intervention (hematoma, seroma, and tissue debridement). However, undergoing oncoplastic reduction did not have an impact on time to adjuvant radiation (p=0.187) and protected against positive margins requiring repeat lumpectomy or completion mastectomy (p less than 0.001).
CONCLUSION: In patients undergoing breast conservation therapy, simultaneous oncoplastic reduction decreased occurrence of positive margins and did not impact time to adjuvant radiation therapy, despite increased rates of surgical and non-surgical complications.
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