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Do surgical margins matter after mastectomy?: A systematic review

Do surgical margins matter after mastectomy?: A systematic review
Do surgical margins matter after mastectomy?: A systematic review

BACKGROUND: No consensus exists regarding adequacy of margins after mastectomy. To determine if pathological margin proximity is associated with local (LR) or distant recurrence after mastectomy for early invasive breast cancer or ductal carcinoma in situ.

METHODS: A systematic review of literature published from 1980 to 2019 and meta-analysis was conducted. Unpublished data were sought from authors (PROSPERO (CRD42019127541)). Thirty-four studies comprising 34,833 breast cancer patients were included in the quantitative synthesis. Eligible studies reported on patients undergoing curative mastectomy for cancer allowing estimation of outcomes in relation to margin status/width. The association between pathological margin status and local (LR) and distant recurrence was considered using random effects modelling. PRISMA guidelines were followed.

RESULTS: Positive margins were associated with increased LR on multivariable analyses (HR, 2·64, (95%CI 2·01-3·46)) and LR was higher regardless of the distance of tumour from the margin defined as positive. After skin-sparing mastectomy, positive margins were associated with increased LR (HR 3·40, (95%CI 1·9-6·2)). In the 4 studies reporting distant recurrence, patients with involved margins had a higher risk (HR 1·53, (95%CI 1·03-2·25)).

CONCLUSIONS: Failure to achieve clear margins after mastectomy may increase the risks of local and distant recurrence. Adequate margin clearance should be recommended to minimize recurrence after mastectomy in National and International Guidelines.

Breast cancer, MastectomyWord count: 2736, Resection margin
0748-7983
2185-2194
Bundred, James
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Michael, Sarah
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Bowers, Sarah
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Barnes, Nicola
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Jauhari, Yasmin
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Plant, Dafydd
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Maishman, Thomas
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Cutress, Ramsey
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Holleczek, Bernd
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Dodwell, David
a554c94f-ac82-4394-b826-b17c96e809d3
Bundred, Nigel
81763280-2028-45e7-82ac-d04f3c04c5dc
Bundred, James
01e37faa-50c0-4b97-a07a-46d88bced254
Michael, Sarah
8899c89a-30bf-4164-821c-519ff7c41cd8
Bowers, Sarah
63534ccb-e089-4023-9472-6ba26d656c07
Barnes, Nicola
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Jauhari, Yasmin
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Plant, Dafydd
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Maishman, Thomas
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Cutress, Ramsey
68ae4f86-e8cf-411f-a335-cdba51797406
Holleczek, Bernd
f98e319e-3ac9-415e-b208-1b8ddc41fa08
Dodwell, David
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Bundred, Nigel
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Bundred, James, Michael, Sarah, Bowers, Sarah, Barnes, Nicola, Jauhari, Yasmin, Plant, Dafydd, Maishman, Thomas, Cutress, Ramsey, Holleczek, Bernd, Dodwell, David and Bundred, Nigel (2020) Do surgical margins matter after mastectomy?: A systematic review. European Journal of Surgical Oncology, 46 (12), 2185-2194. (doi:10.1016/j.ejso.2020.08.015).

Record type: Review

Abstract

BACKGROUND: No consensus exists regarding adequacy of margins after mastectomy. To determine if pathological margin proximity is associated with local (LR) or distant recurrence after mastectomy for early invasive breast cancer or ductal carcinoma in situ.

METHODS: A systematic review of literature published from 1980 to 2019 and meta-analysis was conducted. Unpublished data were sought from authors (PROSPERO (CRD42019127541)). Thirty-four studies comprising 34,833 breast cancer patients were included in the quantitative synthesis. Eligible studies reported on patients undergoing curative mastectomy for cancer allowing estimation of outcomes in relation to margin status/width. The association between pathological margin status and local (LR) and distant recurrence was considered using random effects modelling. PRISMA guidelines were followed.

RESULTS: Positive margins were associated with increased LR on multivariable analyses (HR, 2·64, (95%CI 2·01-3·46)) and LR was higher regardless of the distance of tumour from the margin defined as positive. After skin-sparing mastectomy, positive margins were associated with increased LR (HR 3·40, (95%CI 1·9-6·2)). In the 4 studies reporting distant recurrence, patients with involved margins had a higher risk (HR 1·53, (95%CI 1·03-2·25)).

CONCLUSIONS: Failure to achieve clear margins after mastectomy may increase the risks of local and distant recurrence. Adequate margin clearance should be recommended to minimize recurrence after mastectomy in National and International Guidelines.

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Accepted/In Press date: 18 August 2020
e-pub ahead of print date: 28 August 2020
Keywords: Breast cancer, MastectomyWord count: 2736, Resection margin

Identifiers

Local EPrints ID: 444557
URI: http://eprints.soton.ac.uk/id/eprint/444557
ISSN: 0748-7983
PURE UUID: d46c4f3c-f962-4c28-9ac7-15b7e57fbf3c

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Date deposited: 23 Oct 2020 16:33
Last modified: 26 Nov 2021 05:57

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Contributors

Author: James Bundred
Author: Sarah Michael
Author: Sarah Bowers
Author: Nicola Barnes
Author: Yasmin Jauhari
Author: Dafydd Plant
Author: Thomas Maishman
Author: Ramsey Cutress
Author: Bernd Holleczek
Author: David Dodwell
Author: Nigel Bundred

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