Surgical De-Escalation for Re-Excision in Patients with a Margin Less Than 2 mm and a Diagnosis of DCIS
The current surgical guidelines recommend an optimal margin width of 2 mm for the management of patients diagnosed with ductal carcinoma in situ (DCIS). However, there are still many controversies regarding re-excision when the optimal margin criteria are not met in the first resection. The purpose...
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| Format: | Article |
| Language: | English |
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MDPI AG
2024-02-01
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| Series: | Cancers |
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| Online Access: | https://www.mdpi.com/2072-6694/16/4/743 |
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| author | Gianluca Vanni Marco Pellicciaro Nicola Di Lorenzo Rosaria Barbarino Marco Materazzo Federico Tacconi Andrea Squeri Rolando Maria D’Angelillo Massimiliano Berretta Oreste Claudio Buonomo |
| author_facet | Gianluca Vanni Marco Pellicciaro Nicola Di Lorenzo Rosaria Barbarino Marco Materazzo Federico Tacconi Andrea Squeri Rolando Maria D’Angelillo Massimiliano Berretta Oreste Claudio Buonomo |
| author_sort | Gianluca Vanni |
| collection | DOAJ |
| description | The current surgical guidelines recommend an optimal margin width of 2 mm for the management of patients diagnosed with ductal carcinoma in situ (DCIS). However, there are still many controversies regarding re-excision when the optimal margin criteria are not met in the first resection. The purpose of this study is to understand the importance of surgical margin width, re-excision, and treatments to avoid additional surgery on locoregional recurrence (LRR). The study is retrospective and analyzed surgical margins, adjuvant treatments, re-excision, and LRR in patients with DCIS who underwent breast-conserving surgery (BCS). A total of 197 patients were enrolled. Re-operation for a close margin rate was 13.5%, and the 3-year recurrence was 7.6%. No difference in the LRR was reported among the patients subjected to BCS regardless of the margin width (<i>p</i> = 0.295). The recurrence rate according to margin status was not significant (<i>p</i> = 0.484). Approximately 36.9% (n: 79) patients had resection margins < 2 mm. A sub-analysis of patients with margins < 2 mm showed no difference in the recurrence between the patients treated with a second surgery and those treated with radiation (<i>p</i> = 0.091). The recurrence rate according to margin status in patients with margins < 2 mm was not significant (<i>p</i> = 0.161). The margin was not a predictive factor of LRR <i>p</i> = 0.999. Surgical re-excision should be avoided in patients with a focally positive margin and no evidence of the disease at post-surgical imaging. |
| first_indexed | 2024-03-07T22:38:23Z |
| format | Article |
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| institution | Directory Open Access Journal |
| issn | 2072-6694 |
| language | English |
| last_indexed | 2024-03-07T22:38:23Z |
| publishDate | 2024-02-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Cancers |
| spelling | doaj.art-192873c84dfe41828eb69d416a54592c2024-02-23T15:10:45ZengMDPI AGCancers2072-66942024-02-0116474310.3390/cancers16040743Surgical De-Escalation for Re-Excision in Patients with a Margin Less Than 2 mm and a Diagnosis of DCISGianluca Vanni0Marco Pellicciaro1Nicola Di Lorenzo2Rosaria Barbarino3Marco Materazzo4Federico Tacconi5Andrea Squeri6Rolando Maria D’Angelillo7Massimiliano Berretta8Oreste Claudio Buonomo9Breast Unit Policlinico Tor Vergata, Department of Surgical Science, Tor Vergata University, Viale Oxford 81, 00133 Rome, ItalyBreast Unit Policlinico Tor Vergata, Department of Surgical Science, Tor Vergata University, Viale Oxford 81, 00133 Rome, ItalyDepartment of Surgical Sciences, Tor Vergata University, 00133 Rome, ItalyRadiotherapy, Department of Oncoematology, Policlinico Tor Vergata, 00133 Rome, ItalyBreast Unit Policlinico Tor Vergata, Department of Surgical Science, Tor Vergata University, Viale Oxford 81, 00133 Rome, ItalyDepartment of Surgical Sciences, Unit of Thoracic Surgery, Tor Vergata University, 00133 Rome, ItalySchool of Specialization in Medical Oncology Unit, Department of Human Pathology “G. Barresi”, University of Messina, 98100 Messina, ItalyRadiotherapy, Department of Oncoematology, Policlinico Tor Vergata, 00133 Rome, ItalyDepartment of Clinical and Experimental Medicine, University of Messina, 98100 Messina, ItalyBreast Unit Policlinico Tor Vergata, Department of Surgical Science, Tor Vergata University, Viale Oxford 81, 00133 Rome, ItalyThe current surgical guidelines recommend an optimal margin width of 2 mm for the management of patients diagnosed with ductal carcinoma in situ (DCIS). However, there are still many controversies regarding re-excision when the optimal margin criteria are not met in the first resection. The purpose of this study is to understand the importance of surgical margin width, re-excision, and treatments to avoid additional surgery on locoregional recurrence (LRR). The study is retrospective and analyzed surgical margins, adjuvant treatments, re-excision, and LRR in patients with DCIS who underwent breast-conserving surgery (BCS). A total of 197 patients were enrolled. Re-operation for a close margin rate was 13.5%, and the 3-year recurrence was 7.6%. No difference in the LRR was reported among the patients subjected to BCS regardless of the margin width (<i>p</i> = 0.295). The recurrence rate according to margin status was not significant (<i>p</i> = 0.484). Approximately 36.9% (n: 79) patients had resection margins < 2 mm. A sub-analysis of patients with margins < 2 mm showed no difference in the recurrence between the patients treated with a second surgery and those treated with radiation (<i>p</i> = 0.091). The recurrence rate according to margin status in patients with margins < 2 mm was not significant (<i>p</i> = 0.161). The margin was not a predictive factor of LRR <i>p</i> = 0.999. Surgical re-excision should be avoided in patients with a focally positive margin and no evidence of the disease at post-surgical imaging.https://www.mdpi.com/2072-6694/16/4/743DCISductal carcinoma in situomitting margin re-excisionsurgical de-escalationlocoregional recurrence |
| spellingShingle | Gianluca Vanni Marco Pellicciaro Nicola Di Lorenzo Rosaria Barbarino Marco Materazzo Federico Tacconi Andrea Squeri Rolando Maria D’Angelillo Massimiliano Berretta Oreste Claudio Buonomo Surgical De-Escalation for Re-Excision in Patients with a Margin Less Than 2 mm and a Diagnosis of DCIS Cancers DCIS ductal carcinoma in situ omitting margin re-excision surgical de-escalation locoregional recurrence |
| title | Surgical De-Escalation for Re-Excision in Patients with a Margin Less Than 2 mm and a Diagnosis of DCIS |
| title_full | Surgical De-Escalation for Re-Excision in Patients with a Margin Less Than 2 mm and a Diagnosis of DCIS |
| title_fullStr | Surgical De-Escalation for Re-Excision in Patients with a Margin Less Than 2 mm and a Diagnosis of DCIS |
| title_full_unstemmed | Surgical De-Escalation for Re-Excision in Patients with a Margin Less Than 2 mm and a Diagnosis of DCIS |
| title_short | Surgical De-Escalation for Re-Excision in Patients with a Margin Less Than 2 mm and a Diagnosis of DCIS |
| title_sort | surgical de escalation for re excision in patients with a margin less than 2 mm and a diagnosis of dcis |
| topic | DCIS ductal carcinoma in situ omitting margin re-excision surgical de-escalation locoregional recurrence |
| url | https://www.mdpi.com/2072-6694/16/4/743 |
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