PERCENTAGE OF PATIENTS REQUIRED RE-EXCISSION OR MASTECTOMY FOLLOWING POST-BREAST CONSERVING SURGERY

Abstract

Objective:

 To evaluate the frequency, predictors, and outcomes of re-excision or mastectomy following BCS in patients with operable breast carcinoma.

Study design: Prospective observational study

Place and duration of study:

Department of general surgery, Surgical Unit 1, Ward 3, Jinnah post graduate medical Centre Karachi from August 2023 to August 2024.

Methods:

A total of 50 patients with operable breast carcinoma were enrolled who were on BCS. Both clinical and radiological parameters, intraoperative findings, and histopathological parameters were recorded prospectively. Intraoperative frozen-sectional evaluation of margins was performed in all patients and immediate re-excision/shaving of the cavity was performed if margins were involved.

Results:

 A negative margin was obtained in 76% of patients, while 24% needed additional surgery. A total of 16% underwent re-excision lumpectomy and 8% completed mastectomy. Two patients by none other than their choice went for mastectomy when they were able to be offered more breast conservation techniques. Factors that were significantly associated with margin positivity were larger tumor size (>3cm, p = 0.02) and lobular histology (p = 0.04). Selected cases had a high risk for recurrent intervention due to previous close margins, poor radiotherapy compliance, and irregular follow up. During a mean follow-up of 12 months, no local recurrence was seen.

Conclusion:

Larger tumor size and lobular histology were associated with margin positivity. Careful surgical planning, intraoperative margin assessment, multidisciplinary care, and adherence to adjuvant therapy may help reduce re-excision rates and improve outcomes following breast-conserving surgery