Margins in breast conserving surgery: A practice-changing process

Area of Science:

• Oncology
• Surgical Oncology
• Breast Cancer Research

Background:

• Defining adequate margins in breast conserving surgery (BCS) is a persistent challenge.
• Inconsistent margin definitions lead to high re-excision rates (25-40%), affecting cosmesis, cost, and patient satisfaction.
• Local recurrence (LR) risk is influenced by margin status, impacting patient survival.

Purpose of the Study:

• To review the evolving landscape of margin assessment in BCS.
• To highlight the impact of changing attitudes towards re-excision in breast cancer management.
• To emphasize the integration of patient and treatment factors in margin evaluation.

Main Methods:

• Review of current literature and consensus guidelines on surgical margins in BCS.
• Analysis of trends in re-excision rates and their contributing factors.
• Discussion of advancements in surgical techniques and adjuvant therapies impacting margin assessment.

Main Results:

• Significant variability exists in defining adequate margins, contributing to high re-excision rates.
• Improvements in surgical techniques and multimodal treatments have reduced local recurrence rates in BCS.
• There is a discernible shift towards a more holistic approach in evaluating margins, considering patient and tumor characteristics alongside systemic treatments.

Conclusions:

• The definition of adequate margins in BCS requires further consensus to optimize patient care.
• Multimodal treatment strategies and improved surgical assessment are crucial in minimizing local recurrences.
• Surgeons are increasingly adopting a personalized approach to margin management in breast cancer surgery.