Senologie - Zeitschrift für Mammadiagnostik und -therapie 2020; 17(02): e34-e35
DOI: 10.1055/s-0040-1710665
Abstracts
Senologie

Occurrence of residual cancer within re-excisions in surgery of invasive breast cancer and ductal carcinoma in situ

C Pahmeyer
1  Uniklinik Köln, Brustkrebszentrum Köln, Köln, Deutschland
,
A Schablack
1  Uniklinik Köln, Brustkrebszentrum Köln, Köln, Deutschland
,
P Mallmann
2  Uniklinik Köln, Gynäkologie und Geburtshilfe, Köln, Deutschland
,
D Ratiu
2  Uniklinik Köln, Gynäkologie und Geburtshilfe, Köln, Deutschland
,
B Grüttner
2  Uniklinik Köln, Gynäkologie und Geburtshilfe, Köln, Deutschland
,
W Malter
1  Uniklinik Köln, Brustkrebszentrum Köln, Köln, Deutschland
,
C Eichler
1  Uniklinik Köln, Brustkrebszentrum Köln, Köln, Deutschland
› Author Affiliations
 

Introduction Surgical margin status remains the most important determinant for local recurrence within invasive breast cancer and ductal carcinoma in situ. Breast conserving surgery has become a standard procedure besides subcutaneous mastectomy. We compared the number of positive margins in initial histology with rates of residual tumor in re-excision specimen depending on the operative strategy. Furthermore, we analysed cost-effectiveness of re-excisions.

Methods 101 patients with IBC or DCIS treated with secondary surgery due to positive margins were included. Protocols of tumor-conferences were analysed regarding primary surgical strategy and its following R-situation. The first group underwent breast conserving surgery and secondary mastectomy. The second group was primarily treated with subcutaneous mastectomy followed by secondary surgery.

Results Within the first group, 22.7 % did not show residual tumor in re-excision specimen. Of the second group, primarily treated with subcutaneous mastectomy, 54.3 % had no residual tumor after the second surgery. Consequentially 45,7 % still needed a re-excision after subcutaneous mastectomy to achieve a tumor free margin. Cost-effectiveness was determined as secondary endpoint in this study. If a patient needs a secondary mastectomy due to R1 status the hospital gains 602,65€ in comparison to a primary breast conserving operation.

Conclusion Patients showing positive margins after initial surgery should receive a second operation to achieve R0-status and therefore lower the risk of local recurrence of tumor. In every second patient who had first received a subcutaneous mastectomy, no tumor could be detected in the secondary operation despite a previous R1 situation.



Publication History

Publication Date:
24 June 2020 (online)

© Georg Thieme Verlag KG
Stuttgart · New York