在乳房肿瘤切除术时增加切除边缘是否可以避免再次切除的需要？
Do additional shaved margins at the time of lumpectomy eliminate the need for re-excision?
作者信息
Jacobson Allyson F, Asad Juhi, Boolbol Susan K, Osborne Michael P, Boachie-Adjei Kwadwo, Feldman Sheldon M
机构信息
Department of General Surgery, Division of Breast Surgery, Beth Israel Medical Center, 10 Union Square East, Ste 4E, New York, NY 10003, USA.
出版信息
Am J Surg. 2008 Oct;196(4):556-8. doi: 10.1016/j.amjsurg.2008.06.007.
BACKGROUND
Most women diagnosed with breast cancer undergo breast-conservation surgery. Re-excision rates for positive margins have been reported to be greater than 50%. The purpose of our study was to determine if removing additional shaved margins from the lumpectomy cavity at the time of lumpectomy reduces re-excisions.
METHODS
A retrospective study was performed on 125 women who had undergone lumpectomy with additional shaved margins taken from the lumpectomy cavity. Pathology reports were reviewed for tumor size and histology, lumpectomy and additional margin status, and specimen and margin volume.
RESULTS
If additional margins were not taken, 66% would have required re-excision. Because of taking additional shaved margins, re-excision was eliminated in 48%.
CONCLUSION
Excising additional shaved margins at the original surgery reduced reoperations by 48%. There is a balance between removing additional margins and desirable cosmesis after breast-conservation surgery. The decision to take extra margins should be based on the surgeon's judgment.
背景
大多数被诊断为乳腺癌的女性会接受保乳手术。据报道，切缘阳性的再次切除率超过50%。我们研究的目的是确定在乳房肿瘤切除术时从肿瘤切除腔去除额外的剃除边缘是否能减少再次切除。
方法
对125例行乳房肿瘤切除术并从肿瘤切除腔获取额外剃除边缘的女性进行回顾性研究。对病理报告进行审查，以了解肿瘤大小和组织学、肿瘤切除术及额外边缘状态以及标本和边缘体积。
结果
如果未获取额外边缘，66%的患者将需要再次切除。由于获取了额外的剃除边缘，48%的患者无需再次切除。
结论
在初次手术时切除额外的剃除边缘可使再次手术减少48%。在保乳手术后，去除额外边缘与理想的美容效果之间存在平衡。是否采取额外边缘的决定应基于外科医生的判断。
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