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首页> 外文期刊>Oncology >What are safe margins of resection for invasive and in situ breast cancer?
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What are safe margins of resection for invasive and in situ breast cancer?

机译：浸润性和原位乳腺癌的安全切除范围是多少？

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Adequate surgical margins in breast-conserving surgery are an important predictor of local recurrence (LR) rates. The definition of tumor-free margins in National Surgical Adjuvant Breast and Bowel Project (NSABP) trials requires that tumor cells do not touch ink, but subsequent retrospective single-institution studies have suggested that wider margins confer greater protection against LR. Particularly wide margins have been proposed for ductal carcinoma in situ. However, wider margin requirements lead to higher re-excision rates, with attendant economic, psychological, and cosmetic costs, and perhaps increased mastectomy rates. Juxtaposed against these concerns about optimal margin width, a meta-analysis of clinical trials has demonstrated the survival value of minimizing LR. We are therefore at a juncture where a reduction of LR may be achieved by tumor resection with wide margins, but data regarding optimal margin width are conflicting and the risk/benefit balance of tumorectomy with wide margins has not been demonstrated. A randomized trial of reexcision for close margins inserted into trials of systemic therapy could be considered but seems unlikely. Alternatively, detailed longitudinal data need to balance the value and the cost of wide margins. Until better data are available, the desirable margin width will vary depending on individual circumstances, including age, histology, and patient preference.
机译：保乳手术中足够的手术余量是局部复发率的重要预测指标。国家外科手术辅助乳房和肠项目（NSABP）试验中无肿瘤切缘的定义要求肿瘤细胞不接触墨水，但是随后的回顾性单机构研究表明，更宽的切缘赋予了对LR的更大保护。对于原位导管癌已经提出了特别宽的边缘。然而，更宽的保证金要求导致更高的再切除率，伴随着经济，心理和美容成本，并且可能增加了乳房切除术的率。与对最佳边距宽度的这些关注并列的是，对临床试验的荟萃分析显示出最小化LR的生存价值。因此，我们处于一个关口，可以通过切缘较宽的肿瘤切除术来降低LR，但有关最佳切缘宽度的数据存在矛盾，并且尚未证明切缘较宽的肿瘤切除术的风险/获益平衡。可以考虑在系统治疗试验中插入近端切除术的随机试验，但似乎不太可能。另外，详细的纵向数据需要平衡宽边距的价值和成本。在可获得更好的数据之前，所需的页边距宽度将根据个人情况（包括年龄，组织学和患者喜好）而变化。

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