Outcomes Of Ipsilateral Breast Tumor Recurrence (IBTR) After Breast Conserving Surgery (BCS): Repeat Lumpectomy As An Alternative To Salvage Mastectomy
*Ayat ElSherif, *Chirag Shah, *Erinn Downs-Kelly, *Alia AlHareb, *Chao Tu, Zahraa Al-Hilli
Cleveland Clinic Foundation- Main Campus, Cleveland, OH
Background: The role of repeat lumpectomy in patients with ipsilateral breast tumor recurrence (IBTR) after breast conserving surgery (BCS) remains controversial. This study aimed to report our institutional experience with IBTR as well as examine recurrence and survival outcomes after repeat lumpectomy and salvage mastectomy. Methods: Patients treated at our institution between 2013-2019 for IBTR after BCS were identified. Patient demographics, tumor characteristics, details of surgery (including post-operative complications) and details of radiation therapy at first cancer diagnosis and recurrence were collected. Repeat lumpectomy was compared to salvage mastectomy using Chi-square, Fisher’s exact and Wilcoxon rank sum tests. Disease free survival (DFS) and overall survival (OS) were estimated using Kaplan-Meier method and compared between two surgery groups using log-rank test. Results: 116 recurrences after BCS were identified in 113 patients. 72% of patients underwent salvage mastectomy (n=84) and 28% underwent repeat lumpectomy (n=32). Patients undergoing salvage mastectomy were younger in age at initial cancer diagnosis (Median age 57 vs 68, p= 0.008), had higher nuclear grade at recurrence (54% vs 25%, p= 0.01) and longer time to IBTR (Median time to IBTR 8.5 years vs 4.5 years, p= 0.03). At a median follow up of 1.7 years (range 0.9- 3.37 years), the overall incidence of a second recurrence was 9 % overall (5% (n=4) in the salvage mastectomy group versus 16%(n=5) in the repeat lumpectomy group, p=0.112). There was no significant difference in DFS (p=0.09) or OS (p=0.84) between repeat lumpectomy and salvage mastectomy.Conclusion: Repeat lumpectomy could be considered in a select group of patients as an alternative to salvage mastectomy with lower rates of postoperative complications and equivalent survival outcomes.
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