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Margin Proximity Correlates with Local Recurrence After Mastectomy for Patients Not Receiving Adjuvant Radiotherapy

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

Abstract

Background

Although considerable evidence exists regarding margin status and reexcision for patients undergoing breast conservation therapy, few data address the impact of a close margin for patients undergoing mastectomy without postmastectomy radiotherapy.

Methods

This retrospective review identified 1147 patients who underwent 1206 mastectomies with negative final margins for breast cancer from 2006 to 2010. Margin distance was analyzed as a continuous variable and dichotomized variable ((≤2 vs >2 mm). Patients undergoing adjuvant radiation therapy were excluded from the study. Uni- and multivariable analyses were used to assess the association of reexcision, proximity of the final margin, adjuvant therapy, and other clinical and pathologic factors with local recurrence (LR).

Results

In 158 mastectomies (13.1%), a reexcision was performed for a close (n = 90) or positive (n = 68) margin. All but one were identified intraoperatively using frozen section analysis. The reexcision rates for skin- and nipple-sparing mastectomy (SSM/NSM) were higher than for simple mastectomy (SM) (19.8 vs 9.3%; p < 0.001). The overall 5-year risk for an LR was 3.8%. The risk was 3.1% for a margin greater than 2 mm and 11.2% for a margin of 2 mm or smaller. In the multivariable model, proximity of the final margin measured as a continuous variable was found to be a significant risk factor for LR (p = 0.009), whereas adjuvant endocrine therapy was found to be protective (p = 0.03). Intraoperative reexcision was not significant in the multivariable model (p = 0.23).

Conclusions

For patients undergoing mastectomy for breast cancer, a wider final margin correlated with a reduced risk for LR. The rates for LR were similar between SSM/NSM and SM despite higher rates of intraoperative reexcision for SSM/NSM.

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Disclosure

The authors have no disclosures related to this study.

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Authors and Affiliations

  1. Department of Surgery, Mayo Clinic, Rochester, MN, USA

    Jaime M. Glorioso MD, Alexandra B. Gonzalez Juarrero MD, Amy C. Degnim MD & James W. Jakub MD

  2. Mayo Medical School, Mayo Clinic, Rochester, MN, USA

    Brian R. Rodysill BS

  3. Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA

    William S. Harmsen MS

  4. Division of Health Care Policy and Research and the Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA

    Elizabeth B. Habermann PhD

  5. Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA

    Jodi M. Carter MD, PhD

  6. Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA

    Robert W. Mutter MD

Authors
  1. Jaime M. Glorioso MD
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  2. Alexandra B. Gonzalez Juarrero MD
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  3. Brian R. Rodysill BS
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  4. William S. Harmsen MS
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  5. Elizabeth B. Habermann PhD
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  6. Jodi M. Carter MD, PhD
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  7. Robert W. Mutter MD
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  8. Amy C. Degnim MD
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  9. James W. Jakub MD
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Corresponding author

Correspondence to James W. Jakub MD.

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Glorioso, J.M., Gonzalez Juarrero, A.B., Rodysill, B.R. et al. Margin Proximity Correlates with Local Recurrence After Mastectomy for Patients Not Receiving Adjuvant Radiotherapy. Ann Surg Oncol 24, 3148–3156 (2017). https://doi.org/10.1245/s10434-017-5968-2

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  • DOI: https://doi.org/10.1245/s10434-017-5968-2

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