Department of Surgery, Virginia Commonwealth University, Richmond, VA, USA.
Ann Surg Oncol. 2013 Jul;20(7):2250-5. doi: 10.1245/s10434-012-2831-3. Epub 2013 May 18.
Breast conservation surgery (BCS) results in survival equal to mastectomy for early-stage breast cancer. Ipsilateral breast tumor recurrence (IBTR) after BCS is thought to be related to margin status. At our institution, reexcision is performed only if tumor is at inked margin or with extensive disease close to multiple margins. The purpose of this study was to determine rates of reexcision and recurrences among BCS patients using this policy.
We performed an institutional review board-approved retrospective analysis of BCS patients who underwent surgery between January 2001 and June 2005. We identified patients who had a second breast excision within 8 weeks of the first, and those patients with an IBTR. Clinical and pathologic features of patients' tumors were reviewed.
We identified 543 patients who underwent BCS, 84 patients (15.5 %) underwent reexcision for margin status. The crude IBTR rate was 3.4 %, and the 5-year local recurrence-free survival of the reexcised group was 90.6 % compared with 97.4 % in the non-reexcised group (p = 0.0097). Of the 64 reexcision patients, 6 (9.4 %) had an IBTR versus 12 (2.6 %) of the 459 non-reexcised patients (p = 0.0151).
Our reexcision rate is low compared with other reports. This results from a policy that defines "no tumor on ink" as an adequate margin for BCS, and the use of selective irradiation boosts based on margins assessed by our pathologists. Our local recurrence rate compares favorably with those seen in other studies while minimizing the need for additional operations. A higher IBTR rate after reexcision likely reflects tumor biology.
保乳手术（BCS）在早期乳腺癌患者的生存率方面与乳房切除术相当。BCS 后同侧乳房肿瘤复发（IBTR）被认为与切缘状态有关。在我们的机构，如果肿瘤位于墨线边缘或有多条边缘且广泛接近多个边缘，则仅进行再次切除。本研究的目的是确定使用该策略的 BCS 患者的再次切除率和复发率。
我们对 2001 年 1 月至 2005 年 6 月间接受手术的 BCS 患者进行了机构审查委员会批准的回顾性分析。我们确定了在第一次手术后 8 周内进行第二次乳房切除术的患者，以及有 IBTR 的患者。回顾了患者肿瘤的临床和病理特征。
我们确定了 543 例接受 BCS 的患者，84 例（15.5%）因切缘状态而行再次切除。总的 IBTR 率为 3.4%，接受再次切除的患者 5 年局部无复发生存率为 90.6%，而非再次切除的患者为 97.4%（p=0.0097）。在 64 例再次切除的患者中，有 6 例（9.4%）发生 IBTR，而在 459 例未再次切除的患者中，有 12 例（2.6%）发生 IBTR（p=0.0151）。
与其他报告相比，我们的再次切除率较低。这是由于我们的政策将“无墨水肿瘤”定义为 BCS 的充分切缘，并且根据我们的病理学家评估的切缘使用选择性放疗增强。我们的局部复发率与其他研究相似，同时最大限度地减少了额外手术的需要。再次切除后的 IBTR 率较高可能反映了肿瘤生物学。
