Oncoplastic breast-conserving surgery in breast cancer treatment Systematic review of the literature

BACKGROUND: Oncoplastic breast-conserving surgery (OPBS) is a rapidly emerging field. Various oncoplastic techniques have been proposed and are increasingly adopted to facilitate breast conservation and preserve breast aesthetics. This systematic review seeks to assess the oncological and cosmetic outcomes of OPBS. MATERIALS AND METHODS: A systematic review of the literature was conducted using specific inclusion and exclusion criteria, for articles published up to July 31th, 2015. Relevant studies were identified using computerized bibliographic searches of MEDLINE database. The keywords that were used in various combinations were: "Oncoplastic surgery", "oncological results", "cosmetic results", "cosmesis", "immediate reconstruction" and "breast conserving surgery". RESULTS: A total of 106 articles were identified for potential inclusion and reviewed in detail. No randomized controlled trials were identified This study was initially designed to identify and review after a strict selection process, published articles with the highest level of evidence on OPBS. Systematic reviews and metanalyses were not included in this systematic review for methodological reasons. Ten prospective studies fulfilled strict inclusion criteria and were included Local relapse using OPBS did not exceed 7%. Tumor free margins were retrieved in 86% of cases. Good cosmetic results were obtained in 86% of patients. Most studies showed significant weaknesses, including absence of robust design and methodological limitations, influencing negatively generalizability. CONCLUSIONS: This systematic review proves that current evidence supporting efficacy of OPBS in based on poorly designed and underpowered studies. Further studies and particularly RCTs, are required to assess oncological safety and cosmetic results of OPBS, reporting evidence on long-term oncological results, cosmetic outcomes and survival rates of patients treated with this technique.