Width of excision margins after breast conserving surgery for invasive breast cancer and distant recurrence and survival
A partir d'une revue systématique de la littérature publiée entre 1980 et 2021 (68 études ; durée de suivi : au moins 60 mois), cette méta-analyse évalue l'association entre les marges d'exérèse lors d'une chirurgie conservatrice et le taux de récidive (locale et à distance) ou la survie chez les patientes atteintes d'un cancer du sein (112 140 cas)
One premise of cancer treatment is that if a tumour is cut out but tumour cells remain present or close to the edges (of the cut), the risk of cancer returning at the same site is increased. Increased surgical focus on adequacy of margin excision would improve breast cancer survival worldwide.
Importance of tumour removal : In many cancers, such as colorectal cancer, attention to ensuring meticulous removal of the cancer with an encompassing cuff of normal tissue (ie, no tumour at the pathological margin) results in improved outcomes. The association between margin involvement and poorer recurrence and survival outcomes12 led to studies that showed a strong association between the width of tumour from the margin in colorectal cancer and subsequent outcomes. Most patients with early breast cancer are treated with breast conserving surgery. Removing cancers without leaving malignant cells at a surgical margin reduces local recurrence34567 but the effects of margin involvement on distant recurrence and mortality are unclear. How far the tumour should be from the specimen margin to ensure optimum oncological outcomes is contentious.
BMJ , commentaire en libre accès, 2021