Annals of Surgical Oncology

, Volume 12, Issue 11, pp 881–885

The Consequence of Multiple Re-Excisions to Obtain Clear Lumpectomy Margins in Breast Cancer Patients

  • Tehillah S. Menes
  • Paul Ian Tartter
  • Ira Bleiweiss
  • James H. Godbold
  • Alison Estabrook
  • Sharon Rosenbaum Smith
Original Articles

DOI: 10.1245/ASO.2005.03.021

Cite this article as:
Menes, T.S., Tartter, P.I., Bleiweiss, I. et al. Ann Surg Oncol (2005) 12: 881. doi:10.1245/ASO.2005.03.021

Abstract

Background

Microscopically clear lumpectomy margins are critical for optimizing local control with breast conservation for cancer. Re-excisions are often necessary to achieve clear surgical margins. Factors that contribute to nonnegative margins and necessitate re-excision may increase the risk of local recurrence.

Methods

Patients who were treated with breast conservation for breast cancers were identified from a prospective database maintained by one of the authors. Factors associated with local recurrence were evaluated in 459 consecutive patients with attention to the number of re-excisions required to obtain clear margins.

Results

Twenty-eight patients (5%) developed local recurrences at a mean follow-up of 78 months. In multivariate analysis, local recurrence was most significantly associated with the omission of radiotherapy (19% vs. 5%; relative risk [RR], 3.64; 95% confidence interval, 1.6–8.2), followed by young age (52 vs. 58; 95% confidence interval, −.83 to −10.6 years) and the number of re-excisions required to obtain clear margins (none, 4%; one, 7% [RR, 2.05; 95% confidence interval, .86–4.89]; two or more, 17% [RR, 5.20; 95% confidence interval, 1.44–18.8]). Tumor size, the number of involved nodes, pathology, and adjuvant chemotherapy were not significantly related to local recurrence.

Conclusions

The risk of local recurrence after breast conservation for breast cancer increases progressively with the number of re-excisions needed to achieve clear margins. Patients in whom the cancer is fully excised with clear margins in the first excision will have less of a chance of local recurrence compared with patients who need further re-excision to achieve clear margins.

Keywords

Breast cancer Lumpectomy Margins Local recurrence 

Copyright information

© The Society of Surgical Oncology, Inc. 2005

Authors and Affiliations

  • Tehillah S. Menes
    • 1
  • Paul Ian Tartter
    • 1
  • Ira Bleiweiss
    • 2
  • James H. Godbold
    • 3
  • Alison Estabrook
    • 1
  • Sharon Rosenbaum Smith
    • 1
  1. 1.The Comprehensive Breast CenterNew York
  2. 2.Department of PathologyMount Sinai Medical Center New York
  3. 3.Department of Community and Preventive MedicineMount Sinai Medical CenterNew York

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