- Email: [email protected]
P345 Perioperative outcomes of therapeutic breast surgery in the elderly
14th St.Gallen International Breast Cancer Conference / The Breast 24S1 (2015) S87–S150
had NSLN metastasis, while 14 patients were found to have ITC in SLN; none of them had NSLN metastasis. Multivariate analysis found that the number of SLN harboring micrometastasis is the only independent risk factor for NSLN metastasis in patients with micrometastasis (p-value = 0.008). On the contrary; Tumor size, grade and biology were not associated with NSLN metastasis. 5-year DFS in patients with macrometastasis in SLN was 94.2%, while that in patients with micrometastasis and ITC was 100% (P-value <0.001). Conclusion: NSLN metastasis in those who only have micrometastasis and ITC is rare, 5-year DFS is significantly better in this group of patients as well. It is therefore a routine practice in our unit to omit AD in patients with micrometastasis and ITC on SLN. Disclosure of Interest: No significant relationships. P343 Oncoplastic surgery for inner quadrant breast cancer: a modified dermoglandular rotation flap S. Lee1 *, J. Lee2 , Y. Jung1 , Y. Bae1 . 1 Surgery, Biomedical Research Institute, Pusan National University Hospital, Busan, Korea, 2 Surgery, Kyungpook National University Medical Center, Daegu, Korea Goals: Glandular rotation flap technique has been widely used for small defect after partial mastectomy in breast cancer patients. However, this technique is hardly performed for relatively large defect because of difficulty in obtaining a sufficient amount of tissue to fill the defect. In addition, conventional rotation flap technique for inner quadrant cancers is associated with a poor cosmetic result in spite of a small defect. To overcome these limitation in applying conventional glandular rotation flap technique for relatively large and inner quadrant defect of the breast, we introduce a modified superior-based dermoglandular rotation flap (so called fish-hook incision rotation flap). Methods: Between January 2007 and December 2012, a total of 34 female patients with breast cancer underwent breast conserving surgery with the ‘fish-hook rotational flap’. Data was collected retrospectively based on medical records, imaging findings and histopathologic results of the patients. The cosmetic results were self-estimated according to a four-point scoring system 4 weeks after radiotherapy. Results: Mean volume loss of the breast was 20.2±9.8%. Location of the tumors were as follows; upper inner quadrant (n = 13, 38.2%), lower inner quadrant (n = 21, 61.8%). The overall cosmetic satisfaction was self-estimated as follows: excellent (n = 19); good (n = 10); fair (n = 4); poor (n = 1). Conclusion: A modified superior-based dermoglandular rotation flap technique, the ‘fish-hook incision rotation flap’, is a feasible, effective oncoplastic technique that is applicable to a relatively large defect located in the inner quadrant of the breast. Also this surgical technique allows good cosmetic outcomes. Disclosure of Interest: No significant relationships. P344 An international multi-centre review of the malignancy rate of excised papillomatous breast lesions N.M. Foley1 *, Cork Papilloma Group1 , Beaumont Dublin Papilloma Group2 , Toronto Papilloma Group3 , Glasgow Papilloma Group4 , Budapest Papilloma Group5 . 1 Breast Research Centre, Cork University Hospital, Cork, Ireland, 2 Department of Surgery, Beaumont Hospital and the Royal College of Surgeons in Ireland, Dublin, Ireland, 3 Department of Surgical Oncology and Department of Laboratory Medicine and Pathobiology, University of Toronto, Ontario, Canada, 4 Department of Breast Surgery & Pathology, Victoria Infirmary, Glasgow, United Kingdom, 5 Department of Breast and Sarcoma Surgery, National Institute of Oncology, Budapest, Hungary Goals: Papillary lesions of the breast are a relatively rare, but heterogeneous group ranging from benign, to atypical and
S145
malignant. Debate exists regarding the optimal management of these lesions. In the absence of more accurate risk stratification models, traditional management guidelines recommend surgical excision, despite the majority of lesions proving to be benign. This study sought to determine the rate of malignancy in excised breast papillomas and to elucidate whether there exists a population, in which surgical excision may be unnecessary. Methods: A multicentre international retrospective review of core biopsy diagnosed breast papillomas and papillary lesions from 2009 to 2013 was performed. Institutional ethical approval was obtained. Patient demographics, histopathological and radiological findings were recorded. All data were tabulated and statistical analysis performed using Stata (version 9.2, StataCorp, LP, College Station, TX, USA). Results: 238 patients were included in the final analysis. The age profile of those with benign pathology was significantly younger than those with malignant pathology (<0.001). Atypia on core needle biopsy was significantly associated with a final pathological diagnosis of malignancy (OR = 2.73). The upgrade rate from atypia to malignancy was 40%. The upgrade rate from benign core needle biopsy to malignancy on the final pathological sample was 14.4%, however only 3.7% had invasive cancer. Conclusion: This international dataset is one of the largest in the published literature relating to breast papillomas. The overall risk of malignancy is significantly associated with increased age and the presence of atypia on core needle biopsy. It may be possible to stratify higher risk patients according to age and core needle biopsy findings and avoid surgery on low risk patients. Disclosure of Interest: No significant relationships. P345 Perioperative outcomes of therapeutic breast surgery in the elderly C.M. Lee *, V.K.M. Tan, B.K.T. Tan, W.S. Yong, P. Madhukumar, C.Y. Wong, K.W. Ong. Surgical Oncology, National Cancer Centre Singapore, Singapore, Singapore Goals: This study aims to determine the perioperative mortality and morbidity of elderly patients who had therapeutic breast cancer surgery under general anesthesia. Parameters associated with increased surgical risk would also be identified. Methods: Patients older than 80 years of age who underwent therapeutic breast cancer surgery at the National Cancer Centre Singapore and Singapore General Hospital from 1997 to 2010 were identified. Clinicopathological data, operative details and early post operation outcomes were reviewed and analysed. Results: A total of 109 patients aged over 80 years had surgery during the study period. Ninety (82.6%) patients had at least one comorbidity, with hypertension (70.6%) being the most common preexisting condition, then dyslipidemia (29.4%) and diabetes mellitus (24.8%). Five (4.6%) had an American Society of Anesthesiology (ASA) physical classification score of I, 77 (70.6%) ASA II, 26 (23.9%) ASA III and one (0.9%) ASA IV. Ninety-seven (89%) patients had a mastectomy while 12 (11.0%) had breast conserving surgery. Eightyeight (80.7%) patients had axillary staging. The median duration of surgery was 90 minutes. Perioperative mortality was zero. Sixty-six (60.6%) patients recovered without any complications. The most common complication was that of seroma requiring aspiration (n = 35, 32.2%). Bleeding occurred in six (5.5%) patients but none required a return to the operating theatre. One patient developed an acute myocardial infarction (0.9%) while another developed deep vein thrombosis. Median length of hospital stay was three days. Conclusion: Despite the presence of co-morbidities, both curative and palliative breast surgery can be performed safely in those aged above 80 years, with low morbidity. Disclosure of Interest: No significant relationships.
had NSLN metastasis, while 14 patients were found to have ITC in SLN; none of them had NSLN metastasis. Multivariate analysis found that the number of SLN harboring micrometastasis is the only independent risk factor for NSLN metastasis in patients with micrometastasis (p-value = 0.008). On the contrary; Tumor size, grade and biology were not associated with NSLN metastasis. 5-year DFS in patients with macrometastasis in SLN was 94.2%, while that in patients with micrometastasis and ITC was 100% (P-value <0.001). Conclusion: NSLN metastasis in those who only have micrometastasis and ITC is rare, 5-year DFS is significantly better in this group of patients as well. It is therefore a routine practice in our unit to omit AD in patients with micrometastasis and ITC on SLN. Disclosure of Interest: No significant relationships. P343 Oncoplastic surgery for inner quadrant breast cancer: a modified dermoglandular rotation flap S. Lee1 *, J. Lee2 , Y. Jung1 , Y. Bae1 . 1 Surgery, Biomedical Research Institute, Pusan National University Hospital, Busan, Korea, 2 Surgery, Kyungpook National University Medical Center, Daegu, Korea Goals: Glandular rotation flap technique has been widely used for small defect after partial mastectomy in breast cancer patients. However, this technique is hardly performed for relatively large defect because of difficulty in obtaining a sufficient amount of tissue to fill the defect. In addition, conventional rotation flap technique for inner quadrant cancers is associated with a poor cosmetic result in spite of a small defect. To overcome these limitation in applying conventional glandular rotation flap technique for relatively large and inner quadrant defect of the breast, we introduce a modified superior-based dermoglandular rotation flap (so called fish-hook incision rotation flap). Methods: Between January 2007 and December 2012, a total of 34 female patients with breast cancer underwent breast conserving surgery with the ‘fish-hook rotational flap’. Data was collected retrospectively based on medical records, imaging findings and histopathologic results of the patients. The cosmetic results were self-estimated according to a four-point scoring system 4 weeks after radiotherapy. Results: Mean volume loss of the breast was 20.2±9.8%. Location of the tumors were as follows; upper inner quadrant (n = 13, 38.2%), lower inner quadrant (n = 21, 61.8%). The overall cosmetic satisfaction was self-estimated as follows: excellent (n = 19); good (n = 10); fair (n = 4); poor (n = 1). Conclusion: A modified superior-based dermoglandular rotation flap technique, the ‘fish-hook incision rotation flap’, is a feasible, effective oncoplastic technique that is applicable to a relatively large defect located in the inner quadrant of the breast. Also this surgical technique allows good cosmetic outcomes. Disclosure of Interest: No significant relationships. P344 An international multi-centre review of the malignancy rate of excised papillomatous breast lesions N.M. Foley1 *, Cork Papilloma Group1 , Beaumont Dublin Papilloma Group2 , Toronto Papilloma Group3 , Glasgow Papilloma Group4 , Budapest Papilloma Group5 . 1 Breast Research Centre, Cork University Hospital, Cork, Ireland, 2 Department of Surgery, Beaumont Hospital and the Royal College of Surgeons in Ireland, Dublin, Ireland, 3 Department of Surgical Oncology and Department of Laboratory Medicine and Pathobiology, University of Toronto, Ontario, Canada, 4 Department of Breast Surgery & Pathology, Victoria Infirmary, Glasgow, United Kingdom, 5 Department of Breast and Sarcoma Surgery, National Institute of Oncology, Budapest, Hungary Goals: Papillary lesions of the breast are a relatively rare, but heterogeneous group ranging from benign, to atypical and
S145
malignant. Debate exists regarding the optimal management of these lesions. In the absence of more accurate risk stratification models, traditional management guidelines recommend surgical excision, despite the majority of lesions proving to be benign. This study sought to determine the rate of malignancy in excised breast papillomas and to elucidate whether there exists a population, in which surgical excision may be unnecessary. Methods: A multicentre international retrospective review of core biopsy diagnosed breast papillomas and papillary lesions from 2009 to 2013 was performed. Institutional ethical approval was obtained. Patient demographics, histopathological and radiological findings were recorded. All data were tabulated and statistical analysis performed using Stata (version 9.2, StataCorp, LP, College Station, TX, USA). Results: 238 patients were included in the final analysis. The age profile of those with benign pathology was significantly younger than those with malignant pathology (<0.001). Atypia on core needle biopsy was significantly associated with a final pathological diagnosis of malignancy (OR = 2.73). The upgrade rate from atypia to malignancy was 40%. The upgrade rate from benign core needle biopsy to malignancy on the final pathological sample was 14.4%, however only 3.7% had invasive cancer. Conclusion: This international dataset is one of the largest in the published literature relating to breast papillomas. The overall risk of malignancy is significantly associated with increased age and the presence of atypia on core needle biopsy. It may be possible to stratify higher risk patients according to age and core needle biopsy findings and avoid surgery on low risk patients. Disclosure of Interest: No significant relationships. P345 Perioperative outcomes of therapeutic breast surgery in the elderly C.M. Lee *, V.K.M. Tan, B.K.T. Tan, W.S. Yong, P. Madhukumar, C.Y. Wong, K.W. Ong. Surgical Oncology, National Cancer Centre Singapore, Singapore, Singapore Goals: This study aims to determine the perioperative mortality and morbidity of elderly patients who had therapeutic breast cancer surgery under general anesthesia. Parameters associated with increased surgical risk would also be identified. Methods: Patients older than 80 years of age who underwent therapeutic breast cancer surgery at the National Cancer Centre Singapore and Singapore General Hospital from 1997 to 2010 were identified. Clinicopathological data, operative details and early post operation outcomes were reviewed and analysed. Results: A total of 109 patients aged over 80 years had surgery during the study period. Ninety (82.6%) patients had at least one comorbidity, with hypertension (70.6%) being the most common preexisting condition, then dyslipidemia (29.4%) and diabetes mellitus (24.8%). Five (4.6%) had an American Society of Anesthesiology (ASA) physical classification score of I, 77 (70.6%) ASA II, 26 (23.9%) ASA III and one (0.9%) ASA IV. Ninety-seven (89%) patients had a mastectomy while 12 (11.0%) had breast conserving surgery. Eightyeight (80.7%) patients had axillary staging. The median duration of surgery was 90 minutes. Perioperative mortality was zero. Sixty-six (60.6%) patients recovered without any complications. The most common complication was that of seroma requiring aspiration (n = 35, 32.2%). Bleeding occurred in six (5.5%) patients but none required a return to the operating theatre. One patient developed an acute myocardial infarction (0.9%) while another developed deep vein thrombosis. Median length of hospital stay was three days. Conclusion: Despite the presence of co-morbidities, both curative and palliative breast surgery can be performed safely in those aged above 80 years, with low morbidity. Disclosure of Interest: No significant relationships.