title: The safety of multiple re-excisions after lumpectomy for breast cancer.
abstract: BACKGROUND
  Breast cancer patients may undergo multiple re-excisions after lumpectomy in an attempt to obtain clear margins and avoid mastectomy. We sought to determine the overall local recurrence rate and surgical outcome of patients undergoing two or more re-excisions and to identify predictors of success in attaining clear margins.
  
  
  METHODS
  Retrospective review of breast cancer patients who underwent lumpectomy for invasive cancer or ductal carcinoma in situ (DCIS) from 1997 to 2007. Patients who underwent two or more re-excisions were identified and analyzed.
  
  
  RESULTS
  We identified 3,737 patients who underwent lumpectomy over this 10-year period. 875 (23.4%) had close or positive margins requiring a second procedure; 797 (91.1%) had a re-excision; and 78 (8.9%) went directly to mastectomy. Seventy patients underwent multiple re-excisions; 66 patients had 2 re-excisions, 3 patients had 3 re-excisions, and 1 patient had 4 re-excisions. 70% (49/70) of multiple re-excision patients achieved clear margins (26 DCIS, 35 T1, 8 T2, and 1 T3 tumors). All 49 patients who successfully treated with multiple re-excisions received radiation. At a median follow-up of 64 months, 1 of 49 (2.0%) patients had an in-breast recurrence, and 1 of 49 (2.0%) patients had a distant recurrence. Statistically significant risk factors for persistently involved margins after two re-excisions included multifocality and positive lymph node status.
  
  
  CONCLUSIONS
  Multiple re-excisions to obtain clear margins are a safe alternative to mastectomy for women with invasive cancer or DCIS. There is an acceptably low risk of local and systemic failure when negative margins are ultimately achieved.
authors.affiliation: Department of Surgical Oncology, Massachusetts General Hospital, Boston, MA, USA. scoopey@partners.org
authors.forename: Suzanne
authors.initials: S
authors.lastname: Coopey
authors.forename: Barbara L
authors.initials: BL
authors.lastname: Smith
authors.forename: Stephanie
authors.initials: S
authors.lastname: Hanson
authors.forename: Julliette
authors.initials: J
authors.lastname: Buckley
authors.forename: Kevin S
authors.initials: KS
authors.lastname: Hughes
authors.forename: Michele
authors.initials: M
authors.lastname: Gadd
authors.forename: Michelle C
authors.initials: MC
authors.lastname: Specht
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery*; D018270:Carcinoma, Ductal, Breast / Q000473:pathology / Q000601:surgery*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000473:pathology / Q000601:surgery*; D018275:Carcinoma, Lobular / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015412:Mastectomy, Segmental; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000601:surgery*; D018365:Neoplasm, Residual / Q000473:pathology / Q000601:surgery*; D011379:Prognosis; D012086:Reoperation; D012189:Retrospective Studies; D015996:Survival Rate