title: The consequence of multiple re-excisions to obtain clear lumpectomy margins in breast cancer patients.
abstract: BACKGROUND
  Microscopically clear lumpectomy margins are critical for optimizing local control with breast conservation for cancer. Re-excisions are often necessary to achieve clear surgical margins. Factors that contribute to nonnegative margins and necessitate re-excision may increase the risk of local recurrence.
  
  
  METHODS
  Patients who were treated with breast conservation for breast cancers were identified from a prospective database maintained by one of the authors. Factors associated with local recurrence were evaluated in 459 consecutive patients with attention to the number of re-excisions required to obtain clear margins.
  
  
  RESULTS
  Twenty-eight patients (5%) developed local recurrences at a mean follow-up of 78 months. In multivariate analysis, local recurrence was most significantly associated with the omission of radiotherapy (19% vs. 5%; relative risk [RR], 3.64; 95% confidence interval, 1.6-8.2), followed by young age (52 vs. 58; 95% confidence interval, -.83 to -10.6 years) and the number of re-excisions required to obtain clear margins (none, 4%; one, 7% [RR, 2.05; 95% confidence interval, .86-4.89]; two or more, 17% [RR, 5.20; 95% confidence interval, 1.44-18.8]). Tumor size, the number of involved nodes, pathology, and adjuvant chemotherapy were not significantly related to local recurrence.
  
  
  CONCLUSIONS
  The risk of local recurrence after breast conservation for breast cancer increases progressively with the number of re-excisions needed to achieve clear margins. Patients in whom the cancer is fully excised with clear margins in the first excision will have less of a chance of local recurrence compared with patients who need further re-excision to achieve clear margins.
authors.affiliation: The Comprehensive Breast Center, 425 West 59th Street, Suite 7A, New York 10019, USA.
authors.forename: Tehillah S
authors.initials: TS
authors.lastname: Menes
authors.forename: Paul Ian
authors.initials: PI
authors.lastname: Tartter
authors.forename: Ira
authors.initials: I
authors.lastname: Bleiweiss
authors.forename: James H
authors.initials: JH
authors.lastname: Godbold
authors.forename: Alison
authors.initials: A
authors.lastname: Estabrook
authors.forename: Sharon Rosenbaum
authors.initials: SR
authors.lastname: Smith
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000532:radiotherapy* / Q000601:surgery*; D005260:Female; D006801:Humans; D015412:Mastectomy, Segmental; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000601:surgery; D011446:Prospective Studies; D018714:Radiotherapy, Adjuvant; D012307:Risk Factors