Re-Operation and Mastectomy Rates after Breast Conservative Surgery for Positive or Close Margins: A Review

Gilles Houvenaeghel, Eric Lambaudie, Marie Bannier, Sandrine Rua Ribeiro, Julien Barrou, Mellie Heinemann, Max Buttarelli and Monique Cohen

Department of Surgical Oncology, Paoli Calmettes Institute and CRCM, CNRS, INSERM, Aix Marseille University,France
Department of Surgical Oncology, Paoli Calmettes Institute, France

^*Correspondance to: Gilles Houvenaeghel 

 PDF  Full Text DOI: 10.25107/2474-1647.2149

Abstract

Introduction: For positive or close margins after initial Breast Conservative Surgery (BCS) for Breast Cancer (BC), it is usually proposed re-operation with a second conservative surgery or mastectomy. We analyzed literature studies to determined re-operation rate and type of re-operation, differences according to treatment periods, histologic tumor type and results after initial BCS with oncoplasty.Methods: We included 15 studies with highest numbers of patients treated from 2002 to 2016 and our institutional data from our institutional data base including patients treated from year 1995 to 2016. Re-operation rates and type of re-operation were determined for all studies, then according to successive treatment periods and different histologic tumor types. We specifically analyzed positive margins rates and positive or close margins rates for BCS with oncoplasty.Results: Re-operation rate was 27.49% (CI 95% 27.4 to 27.6, range: 10.2% to 34%) among 402357 patients with BCS for DCIS or invasive BC with a decreased of re-operation rates among successive periods from 28.96% to 30.66% and 21.34%. Re-operation rates were higher for DCIS (33.1%) and lobular BC (40.6%). Mastectomy rate among patients with re-operation was 40.77% (CI 40.5 to 41.1, range: 10.7 to 62.1) and a third intervention for mastectomy was required for 13.5% of patients. We observed a decreased of mastectomy rates among successive periods from 59.62% to 48.8% and 36.81% with higher rate for lobular BC (70.5%). Positive margins rate after BCS with oncoplasty was 2.04% and close or positive margins were reported in 11.8%. Mastectomy rates for re-operation after BCS with oncoplasty were high (more than 60%).Conclusion: Re-operation rate decrease progressively across successive and mastectomy rate also decrease progressively. Mastectomy rate is high for lobular invasive carcinoma and after initial resection with oncoplasty and patient’s information for a risk of a third operation with mastectomy should be done in case of re-operation.

Keywords

Mastectomy; Re-operation; Breast cancer; Margins

Cite the article

Houvenaeghel G, Lambaudie E, Bannier M, Ribeiro SR, Barrou J, Heinemann M, et al. Re-Operation and Mastectomy Rates after Breast Conservative Surgery for Positive or Close Margins: A Review. Clin Surg. 2018; 3: 2149.