As breast conserving therapy has become the standard of care for patients with early stage breast cancer an area of debate within the surgical literature has been the rate of positive surgical margins requiring re-excision. Nationally re-excision rates are highly variable and have been reported as high as 40%. Any cancer diagnosis and treatment is stressful for patients and having to return to the operating room for a second surgery can greatly affect both patient satisfaction and cosmetic outcomes. Within our institution we wanted to examined our population over ten years undergoing breast conserving therapy to determine our re-excision rates as compared to nationally reported rates. We also wanted to address if following the January of 2013 position statement from the American Society of Breast Surgeons that proposed a treatment algorithm for determining the need for re-excision of surgical margins. We found that our overall re-excision rates were 16%, compared to the national reported rates of 20-40%. Within our patient population we also found that our re-excision rate decreased after January 2013 from 20% to eight percent.
Conflict(s) of Interest
References with DOI
1. Wilke LG, Czechura T, Wang C, et al. Repeat surgery after breast conservation for the treatment of stage 0 to II breast carcinoma: a report from the National Cancer Date Base, 2004-2010. JAMA Surg 2014; 149: 1296-305. https://doi.org/10.1001/jamasurg.2014.926
2. McCahill LE, Single RM, Aiello Bowles EJ, et al. Variability in reexcision following breast conservation surgery. JAMA 2012; 307: 467-75. https://doi.org/10.1001/jama.2012.43
3. Fisher B, Anderson S, Bryant J, et al. Twenty year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med. 2002; 347: 1233-1241. https://doi.org/10.1056/nejmoa022152
4. Houssami N, Macaskill P, Marinovich ML, et al. Meta-analysis of the impact of surgical margins on local recurrence in women with early-stage invasive breast cancer treated with breast conserving surgery. Eur J Cancer. 2010; 46: 3219-3232. https://doi.org/10.1016/j.ejca.2010.07.043
5. Azu M, Abrahamse P, Katz SJ, Jagsi R, Morrow M. What is an adequate margin for breast-conserving surgery? Surgeon Attitudes and Correlates. Am Surg Oncol. 2010; 17: 558-63. https://doi.org/10.1245/s10434-009-0765-1
6. Blair SL, Thompson K, Rococco J, Malcarne V, Beitsch PD, Ollila DW. Attaining negative margins in breast conservation operations: Is there a consensus among breast surgeons? J Am Coll Surg. 2009; 209: 608-613. https://doi.org/10.1016/s1043-321x(10)79584-9
Blair, Kathryne J. and Legenza, Mary
"Re-Excision Rates Following Breast Conserving Therapy: A Single Institutions Experience Over Ten Years,"
Marshall Journal of Medicine:
3, Article 11.
Available at: http://mds.marshall.edu/mjm/vol3/iss3/11