Prediction of Margin Involvement and Local Recurrence After Skin-Sparing and Simple Mastectomy

• Published in: European journal of surgical oncology Vol. 42; no. 7; pp. 935 - 941
• Main Authors: Al-Himdani, S, Timbrell, S, Tan, K.T, Morris, J, Bundred, N.J
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.07.2016
• Subjects: Adult; Aged; Aged, 80 and over; Breast cancer; Breast Neoplasms - mortality; Breast Neoplasms - pathology; Breast Neoplasms - surgery; Breast Neoplasms - therapy; Breast reconstruction; Chemotherapy, Adjuvant; DCIS; Female; Follow-Up Studies; Hematology, Oncology and Palliative Medicine; Humans; Kaplan-Meier Estimate; Local recurrence; Margins of Excision; Mastectomy; Mastectomy, Simple - adverse effects; Middle Aged; Neoadjuvant Therapy - methods; Neoplasm Recurrence, Local - diagnosis; Neoplasm Recurrence, Local - prevention & control; Neoplasm Staging; Organ Sparing Treatments; Predictive Value of Tests; Radiotherapy, Adjuvant; Retrospective Studies; Risk Factors; Skin; Surgery; Surgical margins; Mastectomy; Surgical margins; Breast cancer; Local recurrence; Breast reconstruction; DCIS
• ISSN: 0748-7983; 1532-2157
• DOI: 10.1016/j.ejso.2016.04.055

Abstract Skin-sparing mastectomy (SSM) facilitates immediate breast reconstruction. We investigated locoregional recurrence rates after SSM compared with simple mastectomy and the factors predicting oncological failure. Methods Patients with early breast cancer that underwent mastectomy between 2000-2005 at a single institution were studied to ascertain local and systemic recurrence rates between groups. Kaplan-Meier curves and log-rank test were used to evaluate disease-free survival. Results Patients (n=577) underwent simple mastectomy (80%) or SSM (20%). Median follow up was 80 months. Patients undergoing SSM were of younger average age, less often had involved lymph nodes (22% vs 44%, p<0.001), more often had DCIS present (79% vs 53%, p<0.001) and involved margins (29% vs 15%, p=0.001). Involved surgical margins were associated with large size (p=0.001). The 8-year local recurrence (LR) rates were 7.9% for SSM and 5% for simple mastectomy respectively (p=0.35). Predictors of locoregional recurrence were lymph node involvement (HR 8.0, for >4 nodes, p<0.001) and involved surgical margins (HR 3.3, p=0.002). In node negative patients, SSM was a predictor of locoregional recurrence (HR 4.8 [1.1, 19.9], p=0.033). Conclusion (s) : Delayed reconstruction is more appropriate for node positive early breast cancer after post-mastectomy radiotherapy. Re-excision of involved margins is essential to prevent local recurrence after mastectomy.