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Knowledge gaps in oncoplastic breast surgery - 04/08/20

Doi : 10.1016/S1470-2045(20)30084-X 
Walter P Weber, MD a, c, , Monica Morrow, MD f, Jana de Boniface, MD g, h, Andrea Pusic, ProfMD i, Giacomo Montagna, MD a, d, f, Elisabeth A Kappos, MD a, c, Mathilde Ritter, MD a, c, Martin Haug, MD a, c, Christian Kurzeder, MD a, d, Ramon Saccilotto, MD b, Alexandra Schulz, MSc b, John Benson, MD j, k, Florian Fitzal, MD l, Zoltan Matrai, MD m, Jane Shaw, BA e, Marie-Jeanne Vrancken Peeters, ProfMD n, Shelley Potter, PhD o, p, Joerg Heil, MD q
on behalf of the

Oncoplastic Breast Consortium

  Contributing members of the Oncoplastic Breast Consortium can be found in the appendix
Eduardo González, Mona Elzayat, Rupert Koller, Michael Gnant, Fabricio Brenelli, Regis Resende Paulinelli, Vappu Zobel, Sarianna Joukainen, Ulla Karhunen-Enckell, Susanna Kauhanen, Jean-Marc Piat, Vesna Bjelic-Radisic, Andree Faridi, Christoph Heitmann, Juergen Hoffmann, Ulrich Kneser, Sherko Kümmel, Thorsten Kühn, Michalis Kontos, Ekaterini Christina Tampaki, Mitchel Barry, Tanir M Allweis, Moshe Carmon, Tal Hadar, Giuseppe Catanuto, Carlos A Garcia-Etienne, Oreste D Gentilini, Susan Knox, Barbara Klein, Linetta Koppert, Pedro F Gouveia, Tor Svensjö, Heiner C Bucher, Silvia Ess, Ursula Ganz-Blättler, Andreas Günthert, Nik Hauser, Nancy Hynes, Michael Knauer, Marlen Pfeiffer, Christoph Rochlitz, Christoph Tausch, Yves Harder, Frank Zimmermann, Fabienne D Schwab, Veronica D’Amico, Savas D Soysal, Liliana Castrezana Lopez, Ilario Fulco, Lars G Hemkens, Visnu Lohsiriwat, Bahadir M Gulluoglu, Guldeniz Karadeniz, Hasan Karanlik, Atakan Sezer, Mehmet Ali Gulcelik, Mustafa Emiroglu, Tibor Kovacs, Tim Rattay, Laszlo Romics, Raghavan Vidya, Lynda Wyld, Mahmoud El-Tamer, Virgilio Sacchini

a Breast Center, University Hospital Basel and University of Basel, Basel, Switzerland 
b Department of Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland 
c Department of Surgery, University Hospital Basel and University of Basel, Basel, Switzerland 
d Department of Gynecology and Obstetrics, University Hospital Basel and University of Basel, Basel, Switzerland 
e Patient Advocacy Group, Oncoplastic Breast Consortium, Basel, Switzerland 
f Breast Surgery Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA 
g Department of Surgery, Capio Saint Göran’s Hospital, Stockholm, Sweden 
h Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden 
i Division of Plastic and Reconstructive Surgery, Department of Surgery, Brigham and Women’s Hospital, Boston, MA, USA 
j Cambridge Breast Unit, Addenbrooke’s Hospital Cambridge, Cambridge, UK 
k School of Medicine, Anglia Ruskin University, Cambridge, UK 
l Department of Surgery and Breast Health Center, Comprehensive Cancer Center, Medical University Vienna, Vienna, Austria 
m Department of Breast and Sarcoma Surgery, National Institute of Oncology, Budapest, Hungary 
n Department of Surgery, Netherlands Cancer Institute, Amsterdam, Netherlands 
o Centre for Surgical Research, Bristol Medical School, Bristol, UK 
p Bristol Breast Care Centre, North Bristol National Health Service Trust, Bristol, UK 
q Department of Obstetrics and Gynecology, University Breast Unit, University Women’s Hospital Heidelberg, Heidelberg, Germany 

* Correspondence to: Dr Walter P Weber, Breast Center, University Hospital Basel, Basel 4031, Switzerland Breast Center University Hospital Basel Basel 4031 Switzerland

Abstract

The aims of the Oncoplastic Breast Consortium initiative were to identify important knowledge gaps in the field of oncoplastic breast-conserving surgery and nipple-sparing or skin-sparing mastectomy with immediate breast reconstruction, and to recommend appropriate research strategies to address these gaps. A total of 212 surgeons and 26 patient advocates from 55 countries prioritised the 15 most important knowledge gaps from a list of 38 in two electronic Delphi rounds. An interdisciplinary panel of the Oncoplastic Breast Consortium consisting of 63 stakeholders from 20 countries obtained consensus during an in-person meeting to select seven of these 15 knowledge gaps as research priorities. Three key recommendations emerged from the meeting. First, the effect of oncoplastic breast-conserving surgery on quality of life and the optimal type and timing of reconstruction after nipple-sparing or skin-sparing mastectomy with planned radiotherapy should be addressed by prospective cohort studies at an international level. Second, the role of adjunctive mesh and the positioning of implants during implant-based breast reconstruction should ideally be investigated by randomised controlled trials of pragmatic design. Finally, the BREAST-Q questionnaire is a suitable tool to assess primary outcomes in these studies, but other metrics to measure patient-reported outcomes should be systematically evaluated and quality indicators of surgical morbidity should be further assessed.

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Vol 21 - N° 8

P. e375-e385 - août 2020 Retour au numéro
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