Background: Breast cancer burden is on the increase in the developing world. Breast-conserving therapy (BCT) is prescribed for early breast cancer. It is the wide local excision of the tumour usually followed by radiation treatment to the breast. It is the mainstay treatment for carefully selected patients with early breast cancer presenting to the Groote Schuur Hospital's Oncology and Endocrine Surgical unit, Cape Town South Africa. There has not been a formal audit to review the outcomes of BCT in the unit. Objectives: The objective of this study is to determine and analyse the excision margins for all the wide local excisions and the re-excision and local recurrence rates during the study period. Methods: This is a histopathological and oncology records review of the patients that have undergone BCT in the unit from the 1st of January 2006 until the 31st of December 2010. The University of Cape Town's Faculty of Health Sciences Human Research Ethics Committee granted approval. Data points accrued included patient age, pathological tumour size and nodal status, histological tumour type, oestrogen receptor status, presence of lymphovascular invasion, volume of specimen excised, margin status, management of involved or close margins, completeness of radiotherapy, ipsilateral breast recurrence rate and total duration of follow up. Results: A total of 192 patients had BCT during the study period. The mean age is 53 years (range 25 to 84 years). A median of 229.5 cm3 volume of specimen was excised (range 4 cm3 to 10530 cm3). Infiltrating ductal carcinoma was the commonest histological type at 79.1%. 42.7% were pT1 tumours, 49.0% pT2 tumours and 2.6 % pT3. The resection margin status are: positive margins rate of 15.1%, 8.3 % close margin (≤ 1 mm), 35.9% 1 – 5 mm, 23.4% 6 – 10 mm and > 10 mm 17.2%. An overall of 26 (13.5%) patients underwent a repeat surgical procedure. 16 (8.3%) had re-excision and 10 (5.2%) had a mastectomy. Residual tumour was present in 50% of the re-excisions and 63.6% of mastectomies. As per category of the resection margins, 68.9% of patients with positive margins had repeat surgery (48.3% re-excision and 20.6% mastectomy). 31.1% of patients with positive margins did not have repeat surgery despite the indication due to advanced age, loss to follow up or residual tumour on the deep chest wall margin. 80.8% patients completed radiotherapy treatment post breast-conserving surgery. At a median follow up of 60 months (range 1 to 108 months), a total of 11 (6.8%) patients had ipsilateral breast local recurrence. Median time to recurrence is 39 months (range 12 to 106 months). Conclusion: Positive and close margin re-excision and local recurrence rates in our unit are acceptable and comparable to other units in South Africa and internationally.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:uct/oai:localhost:11427/24506 |
| Date | January 2017 |
| Creators | Nashidengo, Pueya Mekondjo |
| Contributors | Cairncross, Lydia Leone, Panieri, Eugenio |
| Publisher | University of Cape Town, Faculty of Health Sciences, Department of Surgery |
| Source Sets | South African National ETD Portal |
| Language | English |
| Detected Language | English |
| Type | Master Thesis, Masters, MMed |
| Format | application/pdf |
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