Breast-conserving Oncoplastic Surgery Stratification - Morbidity Retrospective Analysis and its Association with Procedure Complexity Level

Abstract

Introduction: Breast-conserving oncoplastic surgery (BCOS), in association with radiotherapy, is the state of the art in the surgical treatment of breast cancer. In this study we aim to systematize and validate a novel, four level complexity classification system, for BCOS and associate it with surgical morbidity. Methods: A retrospective observational study of consecutive female patients that underwent a BCOS between August 2022 and January 2024 at our breast center was conducted. Descriptive statistics were used to summarize the main sample characteristics. The primary outcome was surgical morbidity, associated with the novel four level complexity classification category of surgery performed, computed through a logistic regression model. Results: 304 patients underwent the procedures of interest of this study. Level 1, 2 3 and 4 of complexity surgeries were performed in 28, 121, 114 and 41 patients, respectively. A total of 95 patients had complications, including infection, seroma, hematoma, dehiscence or other complications. A total of 28 patients required reinterventions after definitive diagnosis. The odds of complications increased according to the surgery level of complexity, independently of risk factors for complications and factors linked to the surgery type selection, even when considering only clinically relevant complications. Conclusions: We concluded that there is an association between the morbidity, and the level of complexity of BCOS performed, with the most complex techniques being associated with higher rates of overall complications and need for reintervention, validating the need for a new surgery´s stratifying system, to improve patients' quality of life.