Reexcisions in Breast-Conserving Surgery for Breast Cancer:Can They Be Avoided?

摘要

In a recent issue of the Journal, O'Sullivan and colleagues report on their efforts for microscopic disease-free margins even when multiple reexcisions in breast conservation therapy for early-stage breast cancer are required. On one hand, positive or close margins after breast-conserving surgery (BCS) have been recognized as an important risk factor of local recurrence and reduced overall survival.On the other hand, improved adjuvant radiotherapy including boost and systemic adjuvant chemotherapy, endocrine therapy for estrogen receptor-positive tumors, and probably targeted therapy for HER2-po-sitive breast cancer reduces distant recurrence risk and may also decrease the rate of local recurrence after BCS. Reexcisions may result in poor cosmetic results and poor psychosocial status of the patients. Thus, two crucial questions with major clinical con-sequences arise: given the efficacy of modern adjuvant treatment, could we avoid reexcisions And if not, should we consider total mastectomy with new plastic reconstruction techniques that offer good cosmetic results with acceptable morbidity