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Pankaj Gupta Roy,1 Laura Mustata,1,2 Jesse Hu,1,3 Ben Phillips,4 Vaishali Parulekar,5 Madhu Bhattacharyya,5 Adrian Harris,6 Sileida Oliveros6 1Department of Breast Surgery, Oxford University Hospitals NHSFT, The Churchill Hospital, Oxford, UK; 2Department of Obstetrics and Gynecology, Filantropia Clinical Hospital, Bucharest, Romania; 3Department of General Surgery, National University Health System, Singapore; 4Department of Breast Pathology, Oxford University Hospitals NHSFT, The Churchill Hospital, Oxford, UK; 5Department of Breast Radiology, Oxford University Hospitals NHSFT, The Churchill Hospital, Oxford, UK; 6Department of Breast Oncology, Oxford University Hospitals NHSFT, The Churchill Hospital, Oxford, UKCorrespondence: Pankaj Gupta RoyDepartment of Breast Surgery, Oxford University Hospitals NHSFT, The Churchill Hospital, Old Road, Oxford, OX3 7LF, UKTel +44 1865220932Email pankaj.roy@ouh.nhs.ukBackground: This is a prospective cohort study of partial breast reconstruction (PBR) with a lateral chest wall perforator flap (LCWPF) to facilitate breast conservation surgery (BCS) for women undergoing surgery for breast cancer. The study was undertaken to study the clinical and cancer outcomes.Methods: Patients diagnosed with ductal carcinoma in situ (DCIS) or breast cancer who consented to undergo BCS with PBR with LCWPF were included in the study. A prospective database has been maintained to collect information on clinico-pathological features, complications, and follow-up. Patients were asked to complete an anonymised PROM questionnaire over the years. The hospital electronic records were interrogated for women who have completed 5 years follow-up to assess for development of recurrence/events.Results: A total of 105 patients underwent PBR with LCWPFs between 2011 and 2018. Of these, 74% underwent cancer resection and PBR as one operation whilst 26% underwent PBR as a two-stage approach. The median tumor size on pre-op imaging was 30 mm for the one-stage approach and 39.5 mm for the two-stage approach (p-value=0.003). The complication rates were low and the re-operation rate for close margins was 10%, with 4% eventually requiring mastectomy. Good-to-excellent esthetic outcomes were reported in more than 80% of cases by patients and clinicians. The local recurrence rate (LR) was 2%, distant recurrence rate 10.5%, disease free survival (DFS) 86%, distant disease-free survival (DDFS) 89% and overall survival (OS) 94.8% at 4.5 years median follow-up. This procedure provides an effective oncological approach, avoiding mastectomy with a good-to-excellent cosmetic outcome. The follow-up data establishes the safety of this approach.Discussion: This is the first published series of recurrence and survival data in patients undergoing PBR. We intend to continue with data collection to assess long-term outcomes beyond 10 years. The authors would recommend consideration of this technique to facilitate BCS and avoid mastectomy.Registration: Not applicable.Keywords: lateral chest wall perforator flap, breast conservation surgery, partial breast reconstruction, PBR, PROMs, breast cancer, breast cancer outcomes |
