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Erschienen in:
14.11.2022 | Original Paper
Oncoplastic breast surgery in elderly primary breast cancer: time to serve more surgically?
Erschienen in: European Journal of Plastic Surgery | Ausgabe 2/2023
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Background
Over 30% of breast cancers in the UK are diagnosed in elderly women (age ≥ 70). Women in this age group are less likely to undergo primary surgery for breast cancer, and those who are treated with surgery are more likely to receive a mastectomy. Compared to simple wide local excision, oncoplastic breast surgery (OBS) can reduce re-operation rates, including in larger cancers, and yet maintain/improve breast aesthetics. Despite these advantages, older women are largely underrepresented in the available literature.
Methods
To explore the utility of OBS in women aged ≥ 70 years in a well-established surgical practice, a retrospective review of patients undergoing breast-conserving surgery was performed. Tumour characteristics, operative variables and adjuvant treatment details of elderly patients were compared with the younger cohort.
Results
A total of 325 patients underwent breast-conserving surgery during the study period including 60 who underwent OBS (22.64%). In fit/operable elderly women, despite greater cancer size, OBS was minimal (n = 1/52, 1.96%), likely due to multi-factorial reasons such as the multidisciplinary team’s subconscious age bias or assumptions against qualitatively escalated surgery. In contrast, more patients (n = 6/52, 11.76%) were deemed fit for cytotoxic chemotherapy.
Conclusions
Whilst OBS-related benefits certainly should be weighed against the increased risks of a longer operative time and recovery, balanced considerations should be made when considering the escalation of systemic adjuvant treatments and related side-effects vis-à-vis de-escalation of surgery and relation to physical and psychological considerations.
Level of Evidence: Level IV, Risk / Prognostic Study.