eBCa: SSO-ASTRO margins guideline cuts BCS reoperation rate

  • Monaghan A & al.
  • Am J Surg
  • 17 Jan 2019

  • curated by Miriam Davis, PhD
  • Univadis Clinical Summaries
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Takeaway

  • Implementation of the 2014 Society of Surgical Oncology and American Society for Radiation Oncology (SSO-ASTRO) guidelines for negative margins was associated with reduction of reoperation rates after breast-conserving surgery (BCS) in patients with early invasive breast cancer (eBCa).
  • The guidelines define negative margins as wider than "no tumor on ink."

Why this matters

  • Before the implementation of this guideline, reoperations ranged from 17% to 35%.
  • Findings show that the guidelines worked as intended for negative margins.
  • Reoperation is associated with poor cosmesis, delayed adjuvant treatment, increased surgical complications, and higher costs.

Study design

  • Retrospective chart review of 1112 women with eBCa undergoing BCS before and after guidelines were introduced (2011-2017).
  • Funding: None disclosed.

Key results

  • Compared with the preguidelines era, the overall reoperation rate postguidelines decreased by an unadjusted 3.89% (going from 22.56% to 18.68%); the adjusted OR decrease was 0.28 (P<.0001>
  • Reoperations on close negative margins (OR, 0.17; P<.0001 and widely negative margins p also decreased compared with the preguidelines era.>
  • Reoperation likelihood did not change across periods in the case of positive margins, another indication that the guidelines worked as intended.

Limitations

  • Higher proportion of patients aged 65-74 years in the postguideline cohort.
  • Reliance on claims data.