Retrospective study of surgical factors’ impact on reoperation in BCS
Research type
Research Study
Full title
A Retrospective cohort study of reoperation after primary breast conserving surgery to analyse the impact of SURGICAL factors on reoperation rate and assess how optimal the total resection volume in these patients
IRAS ID
116785
Contact name
Natarajan Vaithilingam
Contact email
Sponsor organisation
University of East Anglia
Research summary
Breast conserving surgery (BCS) with adjuvant radiotherapy (XRT) is the current best practice in the treatment of early breast cancer. The overall survival is similar in both BCS and mastectomy though there is a little higher risk of cancer coming back at the site of operation with breast conserving therapy (BCT).
Clear microscopic margin after wide local excision (WLE) is mandatory for successful BCT. The general consensus at present is 1mm for invasive cancer and 1-2 mm for DCIS(ductal carcinoma in-situ).
In the ideal world there should be one operation attaining clear microscopic margins with minimal cosmetic defect. There are many challenges to the surgeon in achieving this goal particularly in tumours not felt by hand. They are usually due to many tumour factors like DCIS, MF (multi focal tumour), ILC (invasive lobular cancer) etc and difficulty in identifying and quantifying these on imaging before the operation.
Surgeons plan to take out more tissue around tumour to minimize the impact of these factors on the risk of reoperation.
They aim to achieve a uniform 1 cm macroscopic margin all around the tumour and check the adequacy of this during the operation with one of the many available techniques. Further excision is done in the same operation if there is close macroscopic margin.
In spite of all these at least one in five patients requires further operation to remove more breast tissue.There is also some evidence that the amount of breast tissue removed is about 3 times of the ideal resection volume.
This study aims to look in to these factors further, primarily focusing on whether there is scope for refinement in surgical technique and practice to improve these figures.It is expected that the recommendations following the study would possibly improve the scope of BCS and reduce the need for therapeutic mammaplasty and possibly mastectomy.
REC name
London - Stanmore Research Ethics Committee
REC reference
14/LO/0180
Date of REC Opinion
16 Jan 2014
REC opinion
Favourable Opinion