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The Impact of Neoadjuvant Chemotherapy on Margin Re-excision in Breast-Conserving Surgery

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Abstract

Background

Neoadjuvant chemotherapy (NAC) can improve cosmesis by reducing resection volume. Breast-conserving surgery (BCS) aims to achieve clear excision margins while optimizing cosmesis. However, the influence of NAC on margin re-excision after BCS is unclear. This study examines the rate and determinants of margin re-excision in patients undergoing BCS following NAC in our institution.

Methods

From 2011–2015, all patients treated with NAC prior to BCS were identified from a prospectively maintained database. Mann–Whitney and Fisher’s exact test tests were used to compare variables in patients who did and did not require re-excision. Patients undergoing primary surgical treatment in 2015 comprised an unmatched comparison group.

Results

Of 211 patients treated with NAC, 69 initially underwent BCS. The re-excision rate was 32% (n = 22) compared to 17% in the primary operable group (38 of 221, p = 0.02). Re-excision rates were lowest in triple-negative and HER2+ tumors (0% and 10%, respectively). Lobular carcinoma and ER+ tumors had a significantly higher rate of re-excision (100% and 42%, respectively). Of 22 patients undergoing re-excision, 9 had further BCS and 13 had a mastectomy.

Conclusion

The re-excision rate following NAC is almost twice that of patients who underwent primary operative management. Her2+ and triple-negative tumors have lower re-excision rates and may represent a selected cohort most suitable for BCS. Patients with invasive lobular carcinoma or ER+ disease have significantly higher rates of margin positivity, and these patients should be considered for a cavity shave during primary surgery to reduce the rates of re-excision.

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Authors and Affiliations

  1. Department of Breast Surgery, St. Vincent’s University Hospital, Elm Park, Dublin 4, Ireland

    Liam A Devane, Chwanrow K Baban, Enda W McDermott & Ruth S Prichard

  2. Department of Radiology, St. Vincent’s University Hospital, Elm Park, Dublin 4, Ireland

    A O’Doherty

  3. Department of Pathology, St. Vincent’s University Hospital, Elm Park, Dublin 4, Ireland

    Cecily Quinn

Authors
  1. Liam A Devane
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  2. Chwanrow K Baban
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  3. A O’Doherty
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  4. Cecily Quinn
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  5. Enda W McDermott
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  6. Ruth S Prichard
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Correspondence to Ruth S Prichard.

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Devane, L.A., Baban, C.K., O’Doherty, A. et al. The Impact of Neoadjuvant Chemotherapy on Margin Re-excision in Breast-Conserving Surgery. World J Surg 44, 1547–1551 (2020). https://doi.org/10.1007/s00268-020-05383-8

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  • DOI: https://doi.org/10.1007/s00268-020-05383-8

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