Resection of Cavity Shave Margins in Stage 0-III Breast Cancer Patients Undergoing Breast Conserving Surgery: A Prospective Multicenter Randomized Controlled Trial
| Autor: | Elisabeth Dupont, David W. Ollila, Mary Murray, Melissa Lazar, Theodore N. Tsangaris, Noreen E. McGowan, Tara McPartland, Marissa Howard-McNatt, Naveenraj L. Solomon, Maria E. Herrera, Maheswari Senthil, Yoana P. Avitan, Andrew Fenton, David Edmonson, Fangyong Li, Eric Brown, Kristalyn K. Gallagher, Amanda Mendiola, Meghan Butler, Adam C. Berger, Jukes P. Namm, Carlos Garcia-Cantu, Ricardo D. Martinez, Edward A. Levine, Brian Yoder, Alliric I. Willis, Anees B. Chagpar, Sharon S. Lum, Akiko Chiba, Jennifer Gass, Laura Walters, Sonali V Pandya |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
Adult
medicine.medical_specialty Randomization medicine.medical_treatment Breast Neoplasms Mastectomy Segmental law.invention Resection 03 medical and health sciences 0302 clinical medicine Breast cancer Randomized controlled trial law medicine Breast-conserving surgery Humans Prospective Studies Stage (cooking) Prospective cohort study Aged Neoplasm Staging Aged 80 and over integumentary system business.industry Margins of Excision Middle Aged medicine.disease Surgery Treatment Outcome 030220 oncology & carcinogenesis 030211 gastroenterology & hepatology Female business Mastectomy Follow-Up Studies |
| Zdroj: | Annals of surgery. 273(5) |
| ISSN: | 1528-1140 |
| Popis: | OBJECTIVE Single-center studies have demonstrated that resection of cavity shave margins (CSM) halves the rate of positive margins and re-excision in breast cancer patients undergoing partial mastectomy (PM). We sought to determine if these findings were externally generalizable across practice settings. METHODS In this multicenter randomized controlled trial occurring in 9 centers across the United States, stage 0-III breast cancer patients undergoing PM were randomly assigned to either have resection of CSM ("shave" group) or not ("no shave" group). Randomization occurred intraoperatively, after the surgeon had completed their standard PM. Primary outcome measures were positive margin and re-excision rates. RESULTS Between July 28, 2016 and April 13, 2018, 400 patients were enrolled in this trial. Four patients (2 in each arm) did not meet inclusion criteria after randomization, leaving 396 patients for analysis: 196 in the "shave" group and 200 to the "no shave" group. Median patient age was 65 years (range; 29-94). Groups were well matched at baseline for demographic and clinicopathologic factors. Prior to randomization, positive margin rates were similar in the "shave" and "no shave" groups (76/196 (38.8%) vs. 72/200 (36.0%), respectively, P = 0.604). After randomization, those in the "shave" group were significantly less likely than those in the "no shave" group to have positive margins (19/196 (9.7%) vs. 72/200 (36.0%), P < 0.001), and to require re-excision or mastectomy for margin clearance (17/196 (8.7%) vs. 47/200 (23.5%), P < 0.001). CONCLUSION Resection of CSM significantly reduces positive margin and re-excision rates in patients undergoing PM. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|