The current surgical guidelines recommend an optimal margin width of 2 mm for the management of patients diagnosed with ductal carcinoma in situ (DCIS). However, there are still many controversies regarding re-excision when the optimal margin criteria are not met in the first resection. The purpose of this study is to understand the importance of surgical margin width, re-excision, and treatments to avoid additional surgery on locoregional recurrence (LRR). The study is retrospective and analyzed surgical margins, adjuvant treatments, re-excision, and LRR in patients with DCIS who underwent breast-conserving surgery (BCS). A total of 197 patients were enrolled. Re-operation for a close margin rate was 13.5%, and the 3-year recurrence was 7.6%. No difference in the LRR was reported among the patients subjected to BCS regardless of the margin width (p= 0.295). The recurrence rate according to margin status was not significant (p= 0.484). Approximately 36.9% (n: 79) patients had resection margins < 2 mm. A sub-analysis of patients with margins < 2 mm showed no difference in the recurrence between the patients treated with a second surgery and those treated with radiation (p= 0.091). The recurrence rate according to margin status in patients with margins < 2 mm was not significant (p= 0.161). The margin was not a predictive factor of LRRp= 0.999. Surgical re-excision should be avoided in patients with a focally positive margin and no evidence of the disease at post-surgical imaging.
当前外科指南建议，对于诊断为导管原位癌（DCIS）的患者，最佳手术切缘宽度为2毫米。然而，在首次切除未达到最佳切缘标准时，关于再次切除仍存在诸多争议。本研究旨在探讨手术切缘宽度、再次切除以及避免额外手术对局部区域复发（LRR）治疗的重要性。本研究为回顾性分析，针对接受保乳手术（BCS）的DCIS患者，分析了手术切缘、辅助治疗、再次切除及局部区域复发情况。共纳入197例患者。因切缘过近而再次手术的比例为13.5%，3年复发率为7.6%。无论切缘宽度如何，接受保乳手术的患者在局部区域复发方面未见显著差异（p=0.295）。根据切缘状态的复发率差异不显著（p=0.484）。约36.9%（n=79）的患者手术切缘小于2毫米。对切缘小于2毫米的患者进行亚组分析显示，接受二次手术与接受放射治疗的患者在复发率上无显著差异（p=0.091）。在切缘小于2毫米的患者中，根据切缘状态的复发率差异不显著（p=0.161）。切缘并非局部区域复发的预测因素（p=0.999）。对于切缘局部阳性且术后影像学检查无疾病证据的患者，应避免进行手术再次切除。
肿瘤(癌症)患者之家