Volume of Excision and Cosmesis with Routine Cavity Shave Margins Technique

Mook, Julie A.; Klein, Rebecca L.; Kobbermann, Anne; Unzeitig, Alison; Euhus, David M.; Peng, Yan; Sarode, Venetia; Moldrem, Amy; Leitch, A. Marilyn; Andrews, Valerie; Teotia, Sumeet; Rao, Roshni

doi:10.1245/s10434-011-1982-y

Cited by 43 publications

(29 citation statements)

References 18 publications

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“…15 However, Mook et al, in a retrospective study, found that cavity shaving was associated with a smaller volume of excised tissue than was standard partial mastectomy (80.7 cm3 versus 165.1 cm3), which raises the possibility that surgeons who perform cavity shaving routinely excise less tissue initially and excise excess tissue during shaving. 13 Positive margin in our study before shave was in 40% but after shaving it was in only 10% of shave group, however in non-shave group it was in 35% of patients. Several retrospective studies have shown similar findings.…”

Section: Demographic and Clinical Patients' Data (Table)contrasting

confidence: 48%

“…However, others claimed that it is sufficient to excise selective margins where the tumor appears to be close to the edge of the specimen on the basis of intraoperative imaging and gross assessment. [7][8][9][10] The tumor edges differ from patient to patients and can be summarized in the following types: [11][12][13] • Positive edges: tumor cells are present at the edge In all studies, the highest local reoccurrence rate corresponds to "more than focally positive margins" and lowest local recurrences rate to "negative margin tumors".…”

Section: Introductionmentioning

confidence: 99%

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Cavity shave margins for breast conservative surgery

2017

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Background: 20-40% of patients have positive margins after partial mastectomy. Taking additional tissue circumferentially around the cavity left by partial mastectomy "cavity shave margins" may reduce the rate of positive margins. This review aims to evaluate the effect of routine excision of circumferential cavity shave margins after breast-conserving surgery.Methods: This randomized controlled trial had been conducted in General Surgery Department, Sohag Faculty of Medicine from January 2015 to April 2017. 40 patients with early breast cancer were candidates for partial mastectomy and randomly assigned in a 1:1 ratio to have either additional circumferential cavity shave margins or not.Results: The mean age of both groups were around 39 years (range 30-50 years). More than half of the cases fell in stage I, with a little more than 20% of them were in stage 0 and the rest in stage II at time of operation. Although cavity shave group had longer operative time, longer hospital stay, and higher amount of blood loss; all these showed non-significant difference between the two groups. The mean amount of resected volume was significantly higher among cavity shave group compared to non-cavity shave group. The percentage of positive margin reduced from 40% before shave to only 10% after shave margin.Conclusions: Cavity shaving resulted in significant reduction of the rates of positive margins and re-operation among patients undergoing breast-conserving surgery.

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Section: Demographic and Clinical Patients' Data (Table)contrasting

confidence: 48%

Section: Introductionmentioning

confidence: 99%

Cavity shave margins for breast conservative surgery

2017

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“…Systematic cavity shaving has been shown to be a feasible and low morbidity procedure 17 . Mook et al demonstrated, in a retrospective study, that serial enlargement of the margins allows the surgeon to remove a smaller amount of breast tissue, preventing oncological damages and gaining considerable cosmetic benefits 18 . In the present study, the benefit of the described technique was noteworthy, and reoperation was avoided in 18 patients from the total number of operated cases.…”

Section: Discussionmentioning

confidence: 99%

Systematic cavity shaving in oncoplastic breast surgery

Pires¹,

Manente²,

Valadares³

et al. 2017

Rev. Bras. Mastol. (Impr.)

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Introdução: A cirurgia conservadora da mama tem se modificado consideravelmente nas últimas décadas. O remodelamento mamário pós-cirurgia conservadora apresenta-se como uma forma de abordagem cirúrgica com bons resultados oncológicos e cosméticos. A margem cirúrgica das cirurgias oncológicas da mama tem se mostrado um fator limitante, pois um percentual considerável das pacientes é submetido a novos procedimentos, aumentando os custos e a morbidade. Objetivo: Descrever a experiência da instituição de ampliação sistemática das margens cirúrgicas na cirurgia conservadora de mama e os benefícios dessa técnica. Métodos: Estudo retrospectivo, que avaliou informações contidas em prontuário de pacientes do Instituto de Mama de Campinas, entre os anos de 2009 e 2015. A ampliação sistemática das margens consiste na retirada de tecido em torno do tumor, com espessura de 1 cm e dimensões de 2 cm nos demais eixos. São avaliadas margens medial, lateral, cranial, inferior, profunda e superficial. Resultados: Em um total de 94 casos com realização de ampliação sistemática das margens cirúrgicas, foram evitadas 18 (20%) reoperações. Apenas duas pacientes necessitaram de nova cirurgia. Conclusão: Trata-se de um procedimento simples e reprodutível, que não prejudica o resultado estético final, e que visa oferecer margens cirúrgicas livres de doença, evitando a reoperação e o atraso do tratamento adjuvante. PALAVRAS-CHAVE:Neoplasia da mama; margens de excisão; mamoplastia. RESUMO ABSTRACTIntroduction: Conservative breast surgery has changed considerably in recent decades. Breast remodeling after conservative surgery is a surgical approach that has good oncological and cosmetic results. The surgical margin of oncological breast surgery has been shown to be a limiting factor, because a considerable percentage of patients undergo additional procedures, which increases costs and morbidity. Objective: To describe the experience of the establishment of systematic cavity shaving in conservative breast surgery and the benefits of this technique. Methods: This is a retrospective study, which evaluated information contained in patient records at the Campinas Breast Institute between 2009 and 2015. Systematic cavity shaving consists of the removal of tissue around the tumor in a thickness of 1 cm, and 2 cm in the other axes. Medial, lateral, cranial, inferior, deep and superficial margins are evaluated. Results: In a total of 94 cases with systematic cavity shaving, 18 (20%) reoperations were avoided. Only two patients required further surgery. Conclusion: It is a simple and reproducible procedure, which does not affect the final aesthetic result, and aims to provide disease-free surgical margins, avoiding reoperation and delayed adjuvant treatment.

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“…However, some authors have suggested that CSM not only halves the rate of re-excision but also improves cosmetic results [4,14]. Chapgar et al (2015) found that the volume of tissue excised in the CSM group was directly proportional to the volume of tissue [3].…”

Section: Discussionmentioning

confidence: 99%

Should cavity shave margins be performed as a routine in breast conserving surgery? A review of randomised controlled trials

Clement¹

2017

Int J Surg Med

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Background:Breast-conserving surgery (BCS) is the standard of care for women with early breast cancer. The margin status is crucial in breast-conserving surgery and is an important determinant for local recurrence. Local recurrence is associated with decreased overall and disease-free survival. Several studies have shown that cavity shave margin reduces the rate of positive margins and local recurrence. This review analyses the randomised controlled trials to compare the role of cavity shave margin in breast conserving surgery and its effect on positive margins and re-excision rates. Methods: A systematic search of literature published before December 2016 for randomised controlled trials in MEDLINE, Pubmed, EMBASE, Proquest, Cochrane central register of controlled trials and Google Scholar was performed. Out of 12 articles, two randomised controlled trials were eligible. Positive margins and re-excision rates were analysed using odds ratio and risk difference. Results: Out of 12 studies, 2 were suitable for review. Overall positive margins were 18.3% and 36% in the CSM and No-CSM groups respectively, with an odds ratio of 0.373 (95% CI, 0.189 to 0.739, P = 0.232) and risk difference of -0.194 (95% CI, -0.336 to -0.053, P= 0.198). The re-excision rates were lower in the CSM group when compared to the No-CSM group (12.2% vs 31.3%) with an odds ratio of 0.28 (95% CI, 0.160 to 0.520, P=0.578) and risk difference was -0.199 (95% CI, -0.309 to -0.089, P=0.264). Conclusion: Analysis of the randomised controlled trials showed that cavity shave margins significantly reduced the risk of positive margins and the need for re-excision. It is a beneficial technique in women undergoing lumpectomy and breast conserving surgery.

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Volume of Excision and Cosmesis with Routine Cavity Shave Margins Technique

Abstract: CSM decreases the need for re-excision. Total tissue volume excised is lower in patients who undergo CSM, and cosmetic results appear to be improved. This approach should be considered for all patients undergoing PM.

Cited by 43 publications

References 18 publications

Cavity shave margins for breast conservative surgery

Cavity shave margins for breast conservative surgery

Systematic cavity shaving in oncoplastic breast surgery

Should cavity shave margins be performed as a routine in breast conserving surgery? A review of randomised controlled trials

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