Annals of Surgical Oncology

, Volume 26, Issue 5, pp 1238–1244 | Cite as

Impact of the SSO-ASTRO Margin Guideline on Rates of Re-excision After Lumpectomy for Breast Cancer: A Meta-analysis

  • Liska Havel
  • Himani Naik
  • Luis Ramirez
  • Monica Morrow
  • Jeffrey LandercasperEmail author
Breast Oncology



One in five patients undergoing initial lumpectomy for invasive breast cancer subsequently undergoes re-excision or mastectomy. A lack of clarity of when to re-excise based on lumpectomy margin width contributes to this high rate of reoperation. We sought to determine the impact of the Society of Surgical Oncology (SSO) and American Society of Radiation Oncologist (ASTRO) margin guideline on reoperation rates after lumpectomy. The guideline recommended omission of routine re-excision in specimens with “no ink on tumor”.


A systematic literature review was performed. For eligible studies, a random-effects model was used for a meta-analysis of lumpectomy re-excision prevalence before and after publication of the SSO-ASTRO margin guideline. Study heterogeneity was measured by the Cochran’s Q test.


Five institutional, one population-based, and one national registry study met inclusion requirements. Sample size per study ranged from 237 to 26,102. There was significant interstudy heterogeneity (Q = 19.779; p = 0.003). Pooled re-excision prevalence was 22% (confidence interval [CI] 20–23) before and 14% (CI 12–15) after guideline publication. With the pre-guideline re-excision prevalence used as the reference value, the associated odds ratio for re-excision after the guideline was 0.65 (CI 0.54–0.78; p < 0.0001).


The findings of a 35% reduction in the odds of re-excision after the guideline publication and a reduction in re-excision prevalence from 22 to 14% supports the notion that the SSO-ASTRO margin guideline was impactful. These findings are congruent with the projected reductions in re-excision at the time of guideline publication.



The authors thank Paul Abrahamse for providing de-identified SEER data.18


All authors received financial support from the Gundersen Medical Foundation and the Gundersen Health System for this research. There was no funding from industry or other entities.

Conflict of interest

The authors declare that they have no conflict of interest.


Monica Morrow-Honoraria from Roche and Genomic Health


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Copyright information

© Society of Surgical Oncology 2019

Authors and Affiliations

  • Liska Havel
    • 1
  • Himani Naik
    • 1
  • Luis Ramirez
    • 1
  • Monica Morrow
    • 2
  • Jeffrey Landercasper
    • 1
    Email author
  1. 1.Gundersen Medical FoundationLa CrosseUSA
  2. 2.Breast Service, Department of SurgeryMemorial Sloan Kettering Cancer CenterNew YorkUSA

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