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2023, Number 12

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Ginecol Obstet Mex 2023; 91 (12)

Surgical margins in shaved cavity in quadrantectomy for breast cancer in Medellín, Colombia

Bonilla SÓA
Full text How to cite this article

Language: Spanish
References: 19
Page: 869-877
PDF size: 204.72 Kb.


Key words:

Breast neoplasms, Reoperation, Breast carcinoma in situ, Surgeons, Colombia, Female.

ABSTRACT

Objectives: To determine the usefulness of quadrantectomy cavity shaving for breast cancer in reducing reoperation and to explore its associated factors and describe sociodemographic and clinical data of the patients.
Materials and Methods: A retrospective, descriptive, retrospective cohort study conducted between January 1, 2017 and December 31, 2018 in patients older than 18 years with histologic diagnosis of invasive and in situ breast cancer who underwent quadrantectomy with shaving of all cavity margins. This is the registry of patients of a surgeon in Medellin, Colombia. Demographic, clinical, and paraclinical data were collected and analyzed using descriptive statistics.
Results: 194 patients with a mean age of 61.6 years were included. The margins were negative in 85.6% (n = 161) and positive in 14.4% (n = 28). The shaved cavity was involved in 16% (n = 31), no reintervention was required in 95.9% (n = 186), and 4.1% (n = 8) underwent reintervention. The reduction in reoperation was 10.3% (n=20). Factors associated with positive margins were: harpoon marking (OR = 1.19; 95%CI: 1.07-1.32; p = 0.04), multifocal tumor (OR = 3.95; 95%CI: 2.29-6.81; p = 0.00), affected shave (OR = 3.26; 95%CI: 1.75-6.04). No increased risk of local recurrence was found between groups (OR = 0.85; 95%CI: 0.80-0.90; p = 0.35).
Conclusions: Shaving all margins of the quadrantectomy cavity was associated with a lower rate of involved margins and fewer reinterventions. Factors associated with positive margins were: harpoon marking, multifocal tumor, and shave damage; there was no increased risk of recurrence.


REFERENCES

  1. Global Cancer Statistics 2020: GLOBOCAN Estimatesof Incidence and Mortality Worldwide for 36 Cancersin 185 Countries. https://gco.iarc.fr/today/onlineanalysis-multi-bars?v=2020&mode=cancer&mode_population=countries&population=900&populations=900&key=total&sex=2&cancer=39&type=0&statistic=5&prevalence=0&population_group=0&ages_group%5B%5D=0&ages_group%5B%5D=14&nb_items=10&group_cancer=1&include_nmsc=0&include_nmsc_other=1&type_multiple=%257B%2522inc%2522% 253Atrue%252C%2522mort%2522%253Atrue%252C%2522prev%2522%253Afalse%257D&orientation=horizontal&type_sort=0&type_nb_items=%257B%2522top%2522%253Atrue%252C%2522bottom%2522%253Afalse%257D

  2. Sung H, Ferlay J, Siegel RL, Laversanne M, SoerjomataramI, Jemal A, et al. Global Cancer Statistics 2020: GLOBOCANEstimates of Incidence and Mortality Worldwide for 36Cancers in 185 Countries. CA Cancer J Clin 2021; 71 (3):209-49. doi:10.3322/caac.21660

  3. Veronesi U, Cascinelli N, Mariani L, Greco M, Saccozzi R,Luini A, et al. Twenty-year follow-up of a randomized studycomparing breast-conserving surgery with radical mastectomyfor early breast cancer. N Engl J Med 2002; 347 (16):1227-32. doi:10.1056/NEJMoa020989

  4. Fisher B, Anderson S, Bryant J, Margolese RG, Deutsch M,Fisher ER, et al. Twenty-year follow-up of a randomized trialcomparing total mastectomy, lumpectomy, and lumpectomyplus irradiation for the treatment of invasive breastcancer. N Engl J Med 2002; 347 (16): 1233-41. doi:10.1056/NEJMoa022152.

  5. Houssami N, Macaskill P, Luke Marinovich M, Morrow M.The association of surgical margins and local recurrence inwomen with early-stage invasive breast cancer treated withbreast-conserving therapy: a meta-analysis. Ann Surg Oncol2014; 21 (3): 717-30. doi:10.1245/s10434-014-3480-5

  6. Buchholz TA, Somerfield MR, Griggs JJ, El-Eid S, HammondMEH, Lyman GH, et al. Margins for breast-conservingsurgery with whole-breast irradiation in stage I and IIinvasive breast cancer: American Society of Clinical OncologyEndorsement of the Society of Surgical Oncology/American Society for Radiation Oncology Consensus Guideline.J Clin Oncol 2014; 32 (14): 1502-6. doi:10.1200/JCO.2014.55.1572

  7. Havel L, Naik H, Ramirez L, Morrow M, LandercasperJ. Impact of the SSO-ASTRO margin guideline on ratesof re-excision after lumpectomy for breast cancer: ameta-analysis. Ann Surg Oncol 2019; 26 (5): 1238-44.doi:10.1245/s10434-019-07247-5

  8. Park CC, Mitsumori M, Nixon A, Recht A, Connolly J, GelmanR, et al. Outcome at 8 years after breast-conservingsurgery and radiation therapy for invasive breast cancer:influence of margin status and systemic therapy on localrecurrence. J Clin Oncol 2000; 18 (8): 1668-75. doi:10.1200/JCO.2000.18.8.1668

  9. Moran MS, Schnitt SJ, Giuliano AE, Harris JR, Khan SA, HortonJ, et al. Society of Surgical Oncology -American Societyfor Radiation Oncology Consensus Guideline on Margins forbreast-conserving surgery with whole-breast irradiation instages I and II invasive breast cancer. Ann Surg Oncol 2014;21 (3): 704-16. doi:10.1245/s10434-014-3481-4

  10. Metcalfe LN, Zysk AM, Yemul KS, Jacobs LK, Oker EE,Underwood HR, et al. Beyond the margins -economiccosts and complications associated with repeated breastconservingsurgeries. JAMA Surg 2017; 152 (11): 1084.doi:10.1001/jamasurg.2017.2661

  11. Rubio IT, Ahmed M, Kovacs T, Marco V. Margins in breastconserving surgery: A practice-changing process. EurJ Surg Oncol EJSO 2016; 42 (5): 631-40. doi:10.1016/j.ejso.2016.01.019

  12. Macmillan RD, Purushotham AD, Mallon E, Love JG, GeorgeWD. Tumour bed positivity predicts outcome after breastconservingsurgery. Br J Surg 1997; 84 (11): 1559-62. PMID:9393279

  13. Macmillan RD, Purushotham AD, Mallon E, Ramsay G,George WD. Breast-conserving surgery and tumour bedpositivity in patients with breast cancer. Br J Surg 2005;81 (1): 56-8. doi:10.1002/bjs.1800810119

  14. Gibson GR, Lesnikoski BA, Yoo J, Mott LA, Cady B, Barth RJ.A Comparison of ink-directed and traditional whole-cavityre-excision for breast lumpectomy specimens with positivemargins. Ann Surg Oncol 2001; 8 (9): 693. doi:10.1007/s10434-001-0693-1

  15. Chen K, Zhu L, Chen L, Li Q, Li S, Qiu N, et al. Circumferentialshaving of the cavity in breast-conserving surgery: arandomized controlled trial. Ann Surg Oncol 2019; 26 (13):4256-63. doi:10.1245/s10434-019-07725-w

  16. Dupont E, Tsangaris T, Garcia-Cantu C, Howard-McNattM, Chiba A, Berger AC, et al. Resection of cavity shavemargins in stage 0-II breast cancer patients undergoingbreast conserving surgery: a prospective multicenter randomizedcontrolled trial. Ann Surg 2021; 273 (5): 876-81.doi:10.1097/SLA.0000000000003449.

  17. Clement Z. Should cavity shave margins be performedas a routine in breast conserving surgery? A review ofrandomized controlled trials. Int J Surg Med 2017; 3 (2): 1.

  18. Wang K, Ren Y, He J. Cavity Shaving plus Lumpectomy versusLumpectomy Alone for Patients with Breast Cancer UndergoingBreast-Conserving Surgery: A Systematic Review andMeta-Analysis. Gupta S, editor. PLOS ONE 2017; 12 (1):e0168705. doi: 10.1371/journal.pone.0168705

  19. Mohamedahmed AYY, Zaman S, Srinivasan A, Peterknecht E,Saeed S Mohammed S, AlBendary M, et al. Do we need toroutinely perform cavity shaving with breast-conserving surgeryfor breast cancer? A systematic review and meta-analysis.Surg Oncol 2021; 36: 7-14. doi:10.1016/j.suronc.2020.11.003




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Ginecol Obstet Mex. 2023;91