Surgical Outcome Parameters in Breast Cancer: A Survey Comparing Oncoplastic and Non-Oncoplastic Surgeons as well as Certified with Non-Certified Breast Health Centers.

INTRODUCTION

Breast cancer surgery has evolved over the past few decades, with an increase in the number of oncoplastic surgeons and certified breast centers worldwide. However, it remains unclear whether this has led to an improvement in the overall quality of care. Oncoplastic surgery combines oncologic tumor resection with plastic-reconstructive surgical techniques, performed either by two surgeons (two-team approach) or by a single oncoplastic surgeon (one-team approach), depending on the respective training system. The one-team approach offers organizational advantages but raises concerns regarding oncological outcomes. This study compares surgical outcome parameters between oncoplastic and non-oncoplastic surgeons and between certified and non-certified breast health centers.

METHODS

A two-part questionnaire with 9 general and 16 specific questions regarding surgical treatment between 2018 and 2022 was developed to assess parameters such as the rate of R1 resections, re-operations due to complications, immediate reconstructions and the number of mastectomies. A total of 173 members of four major international professional societies, representing more than 1,000 individuals in total, responded to the questionnaire.

RESULTS

A total of 125 individuals were included in the analysis. Most respondents specialized in general surgery, and most performed oncoplastic procedures in certified breast centers. The majority of respondents reported a need for further training. Oncoplastic surgeons had the highest caseload. Non-oncoplastic surgeons had the lowest rates of mastectomy, while surgeons specializing exclusively in breast surgery had the highest rates of immediate breast reconstruction. R1 resection rates varied between surgeons and centers, and higher complication rates were observed in non-certified centers.

CONCLUSION

Our study showed that oncoplastic surgeons performed more oncoplastic procedures and immediate reconstruction after mastectomy. The use of intraoperative frozen section analysis and advances in training play a crucial role in minimizing complications or re-resection.