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Do Patients After Reexcision Due to Involved or Close Margins Have the Same Risk of Local Recurrence as Those After One-Step Breast-Conserving Surgery?

  • Gynecologic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Purpose

To explore whether patients after a reexcision due to involved or close margins have the same risk of local recurrence (LR) than those after a one-step breast-conserving surgery (BCS); to learn whether the presence of residual cancer in the reexcision specimen influences the probability of LR.

Methods

We reviewed demographic, clinical, radiologic, and pathologic records of a cohort of women diagnosed with invasive cancer or carcinoma-in situ who underwent BCS surgery as final surgical treatment between January 1, 2003, and December 31, 2011. Univariable and multivariable Cox regression analyses were used to evaluate influencing factors of LR.

Results

A total of 2657 patients were eligible for inclusion onto this study. LR was observed in 67 patients (2.5 %) after a median follow-up of 52 months. Reexcision surgery was performed in 486 patients (18.3 %). The 5-year LR-free survival rate was 94.5 % in the reexcision group and 98.0 % in the group with one-step BCS surgery (p < 0.001). In multivariable Cox regression analyses including different covariates patients with a reexcision had a two to eightfold higher risk of LR. Residual cancer in the reexcision specimen did not influence the LR rate (hazard ratio 1.1, p = 0.779).

Conclusions

This study suggests the importance of a complete tumor resection ideally within one surgical procedure. Therefore, rigorous preoperative planning, multidisciplinary decision making, and additional intraoperative techniques (e.g., ultrasound, specimen radiography, and/or cavity shaved margin) should be used to avoid the need for reexcision.

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Disclosure

The authors declare no conflict of interest.

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Authors and Affiliations

  1. Breast Unit, Heidelberg University, Heidelberg, Germany

    André Hennigs MD, Valerie Fuchs, Fabian Riedel MD, Michael Golatta MD, Christoph Domschke MD, Florian Schuetz MD, Christof Sohn MD & Joerg Heil MD

  2. Department of Pathology, Heidelberg University, Heidelberg, Germany

    Hans-Peter Sinn MD

  3. Institute of Medical Biometry and Informatics, Heidelberg University, Heidelberg, Germany

    Geraldine Rauch PhD

  4. National Center for Tumor Diseases, Heidelberg University, Heidelberg, Germany

    Katharina Smetanay MD & Andreas Schneeweiss MD

Authors
  1. André Hennigs MD
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  2. Valerie Fuchs
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  3. Hans-Peter Sinn MD
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  4. Fabian Riedel MD
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  6. Katharina Smetanay MD
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  7. Michael Golatta MD
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  12. Joerg Heil MD
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Correspondence to Joerg Heil MD.

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Hennigs, A., Fuchs, V., Sinn, HP. et al. Do Patients After Reexcision Due to Involved or Close Margins Have the Same Risk of Local Recurrence as Those After One-Step Breast-Conserving Surgery?. Ann Surg Oncol 23, 1831–1837 (2016). https://doi.org/10.1245/s10434-015-5067-1

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  • DOI: https://doi.org/10.1245/s10434-015-5067-1

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