Single Versus Dual Surgeon Approaches to Oncoplastic Surgery: A Comparison of Outcomes

• Published in: The Journal of surgical research 2023-03, Vol.283, p.1064-1072
• Main Authors: Karamchandani, Manish M., De La Cruz Ku, Gabriel, Gaffney, Kerry A., Wareham, Carly, Persing, Sarah M., Homsy, Christopher, Nardello, Salvatore, Chatterjee, Abhishek
• Format: Article
• Language: English
• Subjects: Breast conserving surgery; Breast Neoplasms - surgery; Dual surgeon oncoplastic surgery; Female; Humans; Mammaplasty; Margins of Excision; Mastectomy, Segmental; Neoplasm Recurrence, Local - epidemiology; Oncoplastic surgery; Partial mastectomy; Retrospective Studies; Single surgeon oncoplastic surgery; Surgeons
• ISSN: 0022-4804; 1095-8673
• DOI: 10.1016/j.jss.2022.11.067

Oncoplastic surgery (OPS) is traditionally performed using a dual surgeon (DS) approach that involves both a breast surgeon and a plastic surgeon. It is also performed using a single surgeon (SS) approach with a surgeon trained in both breast surgical oncology and plastic surgery. We sought to determine if outcomes differed between SS versus DS OPS approaches. A retrospective chart review was conducted of all OPS performed in a single health system over a 6-y period by either an SS or a DS approach. Primary outcomes were rates of positive margins and the overall complication rate; secondary outcomes were loco-regional recurrence, disease-free survival, and overall survival. A total of 217 patients were identified; 117 were SS cases and 100 were DS cases. Baseline preoperative patient characteristics were similar between the two groups as there was no difference in mean Charlson Comorbidity Index scores (P = 0.07). There was no difference in tumor stage (P = 0.09) or nodal status (P = 0.31). Rates of positive margins were not significantly different (10.9% (SS) versus 9% (DS); P = 0.81), nor were rates of complications (11.1% (SS) versus 15% (DS); P = 0.42). Rates of locoregional recurrence were also not significantly different (1.7% (SS) versus 0% (DS); P = 0.5). Disease-free survival and overall survival were not significantly different at 1-y, 3-y, and 5-y time points (P = 0.20 and P = 0.23, respectively) although follow-up time was not sufficient for definitive analysis regarding survival. Both SS and DS approaches to OPS have similar outcomes with regards to positive margin rates and surgical complication rates and are comparably safe.