Conference Coverage

Lumpectomy plus reconstruction outperforms mastectomy plus reconstruction


 

At ASBS 2017

– Lumpectomy plus oncoplastic surgery has a total cost that is comparable to lumpectomy alone and that is less than mastectomy plus reconstructive surgery, according to an analysis of nearly 40,000 women.

While the complication rate was slightly higher than lumpectomy alone, the difference disappeared in the last year of data, possibly because surgical techniques had improved. The study looked at MarketScan Commercial Claims and Encounters Database data from 2000 to 2011 and confirms findings from an earlier study that looked at data from the MD Anderson Cancer Center (Ann Surg Oncol. 2016 Oct;23[10]:3190-8).

Complication rates and costs are lower for lumpectomy, compared with mastectomy. Pradit_Ph/Thinkstock

Complication rates and costs are lower for lumpectomy, compared with mastectomy.

“The most interesting finding was that the total cost of lumpectomy plus reconstruction is only slightly higher than lumpectomy alone but much less than the total cost of mastectomy plus reconstruction,” Rosa Hwang, MD, said at the annual meeting of the American Society of Breast Surgeons. “I think, from a health care economics standpoint, everybody is interested in approaches that could offer cost savings, and I think this would be an attractive alternative to hospitals and payers.”

Lumpectomy plus oncoplastic surgery is increasingly being performed, but it still only represented about 2% of surgeries in women with invasive epithelial breast cancer, although this percentage had grown to 8.4% by 2011 and is likely higher now, according to Dr. Hwang, an associate professor of breast surgical oncology and surgical oncology at the University of Texas MD Anderson Cancer Center, Houston.

Candidates for lumpectomy plus oncoplastic surgery include those with large volume disease, multifocal/centric disease, poorly located tumors, or macromastia. “If oncoplastic reconstruction was not available, these patients would oftentimes be undergoing total mastectomy with reconstruction,” Dr. Hwang said.

The study included records from 39,518 women who underwent breast surgery with or without reconstruction. It excluded patients who received postmastectomy radiation or neoadjuvant chemotherapy.

A total of 40% underwent lumpectomy plus whole breast irradiation (BCT), 2% received BCT plus oncoplastic reconstruction (BCT+R), 30% had total mastectomy (TM), and 29% had total mastectomy plus reconstruction (TM+R).

After adjusting for age, race, comorbidity, chemotherapy, axillary surgery, and nodal positivity, the complication rate was lowest in the TM group (25%; relative risk compared with BCT+R, 0.71; 95% confidence interval, 0.64-0.78; P less than .001), followed by BCT (29%; RR, 0.80; 95% CI, 0.72-0.88; P less than .001), BCT+R (37%), and TM+R (54%; RR, 1.49; 95% CI, 1.35-1.64; P less than .001).

The rate of complications in BCT+R fell over time, so that, by 2011, it was only slightly higher than those of BCT alone (31.5% vs 29.4%). That trend is “probably just additional experience with the technique,” Dr. Hwang said.

Total costs for TM+R was $89,187, compared with $48,767 for TM, $66,217 for BCT, and $69,781 for BCT+R. The cost difference between BCT and TM+R was about $23,000.

The findings are encouraging, said Judy Boughey, MD, professor of surgery at the Mayo Clinic, Rochester, Minn., who moderated the session. However, she called for caution in interpreting the results because the population of interest made up just 2% of the overall sample. “I think you’re going to have the widest variability of confidence intervals around that group,” Dr. Boughey said. “It’s eye-opening, but I would just view it with caution.”

Dr. Hwang and Dr. Boughey reported having no financial disclosures.

Recommended Reading

Counsel women against unnecessary prophylactic mastectomies
MDedge Surgery
Survival better with breast-conserving therapy for early cancers
MDedge Surgery
VIDEO: Breast surgeons can and do provide genetic counseling to cancer patients
MDedge Surgery
VIDEO: HER2+ patients may do fine with local therapies alone
MDedge Surgery
Safe to avoid sentinel node biopsy in some breast cancer patients
MDedge Surgery
BRCA2 mutations linked to greater risk for pancreatic cancer
MDedge Surgery
NET can benefit breast cancer patients with delayed surgery
MDedge Surgery
Risk of recurrence outweighs risk of contralateral breast cancer for DCIS patients
MDedge Surgery
Multimodal breast cancer treatment linked with greater risk of lymphedema
MDedge Surgery
Study underscores aggressive approach to inflammatory breast cancer
MDedge Surgery