Less invasive mastectomy: a safe option for breast cancer patients

1 May 2015

A newer form of mastectomy was associated with survival rates comparable with more invasive techniques, and the first long-term population-based study on post-mastectomy breast reconstruction showed one operation is rarely enough, according to studies.

A literature review from 1991 to 2014 revealed that nipple-sparing mastectomy (NSM) was associated with marginally better survival rates compared with modified radical mastectomy (MRM) and skin-sparing mastectomy (SSM).

Detailed results of the meta-analysis

In a meta-analysis of 19 studies that compared the surgical techniques, Lucy De La Cruz, MD, University of Miami, and colleagues reported that:

  • Six studies found a 2.5% risk difference in overall survival (OS) rates between NSM and MRM/SSM, while
  • Three found a 4.4% risk difference between NSM and MRM/SSM in disease-free survival rates (DFS)

However,

  • Eight studies found no risk difference between the various surgical options.

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The studies compared mean OS and DFS rates for patients with NSM and MRM/SSM who were followed over <3 years, 3-5 years, and <5 years and found:

  • <3 years: 98.6% (OS) and 95.9% (DFS)
  • 3-5 years: 97% (OS) and 93.2% (DFS)
  • <5 years: 90.8% (OS) and 89.9% (DFS)

The overall mean nipple-areola recurrence rate was 1.2%, though from <3-5 years, the rate was an average of 0.6%.

"Oncological safety has been a concern due to the potential for residual glandular breast tissue to harbor future cancer," said De La Cruz.

The review also compared the outcomes of NSM between two groups of patients: those who underwent therapeutic mastectomies and those who underwent therapeutic plus prophylactic mastectomies (a combined group). There was a statistically significant difference in OS, DFS, and NAR rates between the two groups:

  • OS: 93.0% (Therapeutic) and 99.9% (Combined)
  • DFS: 84.2% (Therapeutic) and 96.2% (Combined
  • NAR: 2.6% (Therapeutic) and 0.4% (Combined)

The study noted that most women had stage I or II invasive ductal carcinoma, with stage I being the most common.

“The technique, although promising, is applicable to a small group of patients”

De La Cruz concluded that their analysis set out to prove NSM was comparable in safety to MRM/SSM, and the "small benefit" NSM showed over the other techniques should be "taken lightly," as NSM is only applicable to a small group of women.

Amanda Roberts, MD, University of Toronto, and colleagues, reported that 65% of patients required more than one operation and 39% required three or more operations. Researchers looked at several types of procedures and found the majority were either anticipated (42%) or unanticipated (37%).

According to Roberts: "As surgeons, our goal is to allow the patients to make the most informed decisions possible and [provide] them with additional information in terms of what to expect."

Julie Margenthaler, MD, Siteman Cancer Center in St. Louis, added that while NSM is still uncommon in the US, due to its advanced technique, it is an alternative for a small group of women. De La Cruz said that more research, including randomized controlled trials examining various mastectomy options, is needed.

 

Source: MedPage Today
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