Lumpectomy

[Guest guest]

The Consequence of Multiple Re-Excisions to Obtain Clear Lumpectomy Margins

in Breast Cancer Patients

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ls of Surgical Oncology -Publisher: Springer New York

Issue: Volume 12, Number 11

Original Articles

Tehillah S. Menes1, Ian Tartter1 , Ira Bleiweiss2, H. Godbold3,

Alison Estabrook1 and Sharon Rosenbaum 1

(1) The Comprehensive Breast Center, 425 West 59th Street, Suite 7A, New

York, 10019

(2) Department of Pathology, Mount Sinai Medical Center , Gustave L. Levy

Place, New York, 10029

(3) Department of Community and Preventive Medicine, Mount Sinai Medical

Center, Gustave L. Levy Place, New York, 10029

Abstract

Background Microscopically clear lumpectomy margins are critical for

optimizing local control with breast conservation for cancer. Re-excisions are

often

necessary to achieve clear surgical margins. Factors that contribute to

nonnegative margins and necessitate re-excision may increase the risk of local

recurrence.

Methods: Patients who were treated with breast conservation for breast

cancers were identified from a prospective database maintained by one of the

authors. Factors associated with local recurrence were evaluated in 459

consecutive

patients with attention to the number of re-excisions required to obtain clear

margins.

Results: Twenty-eight patients (5%) developed local recurrences at a mean

follow-up of 78 months. In multivariate analysis, local recurrence was most

significantly associated with the omission of radiotherapy (19% vs. 5%; relative

risk [RR], 3.64; 95% confidence interval, 1.6–8.2), followed by young age (52

vs. 58; 95% confidence interval, .83 to 10.6 years) and the number of

re-excisions required to obtain clear margins (none, 4%; one, 7% [RR, 2.05; 95%

confidence interval, .86–4.89]; two or more, 17% [RR, 5.20; 95% confidence

interval,

1.44–18.8]). Tumor size, the number of involved nodes, pathology, and adjuvant

chemotherapy were not significantly related to local recurrence.

Conclusions: The risk of local recurrence after breast conservation for

breast cancer increases progressively with the number of re-excisions needed to

achieve clear margins. Patients in whom the cancer is fully excised with clear

margins in the first excision will have less of a chance of local recurrence

compared with patients who need further re-excision to achieve clear margins.

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BREAST CANCER OPTIONS 5th Annual Complementary Medicine Conference

PLEASE NOTE NEW DATE

Sunday, April 30, 2006 & shy;8am to 5pm at Bard College, Olin Center.

Keynote speaker, Schachter, MD: “What You Can Do to Prevent Breast

Cancer or Improve the results if You Have Itâ€

Dr. Schachter is well known expert in the field of Complementary Medicine and

was a major contributor to Alternative Medicine's Definitive Guide to Cancer,

and is involved with several complementary medicine organizations. A frequent

lecturer to both professionals and the public, Dr. Schachter also is often a

guest on radio and television, speaking about health and related topics.

The keynote address will be followed by a series of workshops:

Complementary, Alternative and Integrative Approaches to Managing Breast

Cancer, Schachter, MD, Detoxification & amp; Health: Tools to Lower

Environmental Toxins; Horowitz, MD,Transforming Cancer Treatment with

Imagery;Carol Robin, DC,CCN, Balancing & amp; Enhancing the Immune System/

Naturopathic Medicines; Dr. Belanger, ND, MT, Understanding the Role of

Hormones

and the Endocrine System in Breast Cancer, Tom Francescott, ND, Diet & Syndrome

X: A Common Disease Risk Factor; Roufia Payman, DT,CDN, Nutrition & amp;

Cancer, Roufia Payman, DT,CDN, Meditation & the Immune System, Carol Robin, DC,

CCN

Environmental Risks; Breast Cancer, Janet Gray, PhD

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