584 Background: Oncoplastic breast conservation surgery (O-BCS) is the norm. O-BCS improves cosmetic outcomes by restoring the shape, size, contour and symmetry of the breast and hence, quality of life. Carefully selected patients with locally advanced breast cancers (LABC) can be offered O-BCS after systemic therapy. We retrospectively evaluated our prospective dataset for oncological outcomes of patients who had O-BCS. Methods: Patients undergoing O-BCS between January 2013 and December 2023 were included. They received (neo) adjuvant chemotherapy, targeted and radiotherapy along with endocrine treatment as per standard institutional protocol and decision of Breast Cancer-Disease Management Group (BC-DMG). Clinico-pathological characteristics, type of oncoplastic procedure and follow-up details were updated from Electronic Medical Records. Data was collected and analyzed in SPSS-V29. Results: A total 1483 patients underwent O-BCS during the study period. The median age of the cohort was 45 (21- 86) years. Of 1483, 670 (45. 2%) were operated upfront and 573 (38. 6%) post-chemotherapy whereas 240 (16. 2%) had had prior excision biopsy elsewhere. Clinically, 939 (63. 3%) were early (EBC-T1/2, N0/1), 518 (34. 9%) locally advanced (LABC-T3/4, N2/3) and 26 (1. 8%) oligometastatic breast cancers. 1016 (68. 5%) were HR+, 289 (19. 5) TN and 396 (26. 7%) HER2+. Median pT in upfront versus post-chemotherapy operated patients was 3 cm (0. 1–8. 5) and 2. 7 cm (1-10) respectively. Upfront, 45. 8% patients were node positive (median-2 1-54) and post-chemotherapy 38. 3% (median-3 1-38). The median specimen volume was 432 cm 3 (56. 8–3528) in upfront and 270 cm 3 (3–2875) in post-chemotherapy operated patients. The overall margin positive rate was 5. 5% (81/1483). Of 1483, 573 (38. 6%) patients had type-1 oncoplastic parenchymal closure, 377 (25. 4%) had local dermo-glandular flaps, 344 (23. 2%) a latissimus dorsi myo-cutaneous flap, and 189 (12. 7%) bilateral reduction mammoplasty. At median follow-up of 47 months, there were 245 (16. 5%) recurrences--77 (5%) local and 211 (14%) distant--and 153 (10. 3%) deaths, and the disease-free survival (DFS) and overall survival (OS) were 84. 1% and 89. 5% respectively. The local recurrence rate in EBC was 4% and LABC 7. 4%. The 5-year DFS was 82. 1% (95%CI-79. 75%-84. 84%) and OS was 88. 5% (95%CI-86. 54%-90. 46%) across the whole cohort. On Cox regression, high clinical nodal stage (HR-1. 47, 95%CI-1. 04-2. 08, p=0. 03) and histological grade 3 (HR-1. 87, 95%CI-1-07-3. 29, p=0. 03) were predictors of poor DFS whereas type of O-BCS did not have impact on survival. Conclusions: The local recurrence rate in O-BCS was 5. 3% in our setting which is reassuring considering that 1/3 rd patients had locally advanced disease. A longer follow-up of this cohort of patients and future PROMs and QOL studies will be consolidatory.
Joshi et al. (Wed,) studied this question.