220P - Safe resection margins in breast-conserving surgery

Date 11 September 2017
Event ESMO 2017 Congress
Session Poster display session
Topics Breast Cancer, Locally Advanced
Breast Cancer
Surgery and/or Radiotherapy of Cancer
Presenter Yevhenii Kostiuchenko
Citation Annals of Oncology (2017) 28 (suppl_5): v68-v73. 10.1093/annonc/mdx364
Authors Y. Kostiuchenko1, I. Motuzyuk1, O. Sydorchuk1, N. Kovtun2, M. Krotevich3
  • 1Oncology Department, Bogomolets National Medical University, 01601 - Kyiv/UA
  • 2Department Of Statistics And Demography, Taras Shevchenko National Univeristy of Kyiv, 01033 - Kyiv/UA
  • 3Pathology, National Cancer Institute, 03022 - Kyiv/UA

Abstract

Background

Our first research concerning resection margins in breast-conserving surgery (BCS) for breast cancer patients (BCP) was performed in 2003-2006. In the group of BCP where after positive margins we performed mastectomy (0%) and in the group where the negative margins were achieved immediately (1.27%) the incidence of local recurrences was lower comparing to the group that had re-resections (4.76%) or the group without microscopic control of margins (8.16%). We tried to understand the causes of local recurrences after BCS, and develop recommendations on achieving safe resection margins.

Methods

To clarify the possibility of cancer spreading to the side of regional lymph nodes we were injecting a solution of aqueous methylene in four points around a tumor in 30 minutes before surgery and subsequently we were studying cuts made at the distance up to 5 cm from the tumor margin. In 12% of cases we identified tumor elements in cuts located at a distance of more than 3 cm. In this study we included 996 BCP of I-III stages who had BCS at the National Cancer Institute in 2008-2015. The main group consisted of 379 BCP who had an additional removal of tissues towards the axillary area as a monoblock during the BCS (with additional histological control as mentioned above). 617 BCP in the control group had standard BCS. The average age of BCP was 50.6±1,1 in the main group, and 49,8±0,9 in the control group (p > 0.05). Median follow-up was 142 weeks.

Results

Achieving negative margins at the area of possible metastasis significantly reduces local recurrence rates, especially in a stage II (5.34%) and III (3.35%) BCP. The incidence of distant metastases (diagnosed in 93 (9.34%) cases) was significantly lower in the main group – 21 (5.54%) comparing to the control group – 72 (11.67%), both in general and in each stage (p  0.05).

Conclusions

BCS with the additional removal of tissues towards the axillary area and lymph nodes dissection as a monoblock is reasonable and significantly reduces local and distant metastases rates. However, more long-term research in this area is urgently needed, especially in terms of benefit in survival.

Clinical trial identification

The study is approved by the Commission on issues of ethics of the National Cancer Institute (Protocol No. 7 of 08.04.2010) and the Commission on issues of ethics of the Bogomolets National Medical University (Protocol No. 71 of 10.04.2013).

Legal entity responsible for the study

Bogomolets National Medical University, National Cancer Institute

Funding

None

Disclosure

All authors have declared no conflicts of interest.