Demet SARIDEMiR ÜNAL, Mustafa SARAÇOĞLU, Volkan DOĞRU, Veli VURAL, Muhittin YAPRAK, Ayhan MESCİ, Cumhur ARICI, Ahmet Nezihi OYGÜR

Meme Kanseri Nedeni ile Meme Koruyucu Cerrahi Uygulanan Hastalarda Re-eksizyon Uygulanmasını Etkileyen Faktörler

Amaç: Meme koruyucu cerrahi geçiren hastaların önemli bir bölümünde rezidü kanser için re-eksizyon gereksinimi ortaya çıkmaktadır. Bu çalışmanın amacı, Meme koruyucu cerrahi uygulanan hastalarda rezidü tümör ile ilişkili faktörlerin belirlenmesi ve hastaların takipsonuçlarını değerlendirmektir. Gereç ve Yöntemler: Altı yıllık sürede, meme koruyucu cerrahi uygulanan hastalar çalışmaya alındı. Hastalar iki gruba ayrılarak incelendi: Re-eksizyon yapılmayanlar (Grup A), re-eksizyon yapılanlar (Grup B). Takiplerinde mastektomi yapılan hastalar çalışmadan çıkarıldı. Bulgular: Çalışmaya, 153’ü Grup A ve 37’si Grup B’de toplam 190 hasta dahil edildi. Toplamda 192 tümör saptandı; 154’ü Grup A, 38’i Grup B’de. Medyan takip süresi 9,2 yıl (Çeyrekler arası aralık [ÇAA]=5,9-11,1), medyan hastalıksız sağ kalım süresi 8,8 yıldı (ÇAA=5,0-11,0). Takiplerinde iki grup arasında hastalıksız sağ kalım ve lokal nüks açısından anlamlı fark olmadığı görüldü (sırasıyla; p=0.246, p=0.601). Genç hasta, büyük tümör çapı, lenfovasküler invazyon, aksiller lenf nodu tutulumu, yaygın intraduktal kompanent varlığı ve multifokalite, re-eksizyon grubunda fazlaydı. Çoklu değişken analiz, yaş >50 (Odds ratio [OR] 0,17 ve %95Cl 0,04-0,73) ve lenfovasküler invazyon yokluğunun (OR 0,05 ve %95Cl 0,01-0,44); re-eksizyon riskini azalttığını, tümör çapının 2 cm’den büyük olmasının (OR 4,52 ve %95Cl 1,28-15,98); re-eksizyon riskini arttırdığını gösterdi. Sonuç: Re-eksizyon yapılan ve yapılmayan hastalar arasında hastalıksız sağ kalım ve lokal nüks açısından fark yoktur. Riskli hastalar, tanı aşamasında re-eksizyon ihtimali konusunda bilgilendirilmeli, bu hastalarda daha geniş cerrahi eksizyon veya onkoplastik yöntemler tercih edilmelidir.

Factors Influencing The Practice of Re-excision in Patiens Who Underwent Breast Conserving Surgery for Breast Cancer

Objective: A significant proportion of patients undergoing breast con- serving surgery require re-excision for residual cancer. This study aims to determine the factors associated with residual tumor in patients undergoing breast conserving surgery, and to evaluate the follow-up results of the patients. Material and Methods: Patients underwent breast-conserving surgery in a 6-year period were included in this study. Patients were divided in 2 groups; no re-excision (Group A), and required re-excision (Group B). Patients who underwent mastectomy in the follow-up were excluded. Results: In this study, 190 patients were assessed; those 153 in Group A, and 37 in Group B. A total 192 masses were found; 154 in Group A, and 38 in Group B. The median follow-up time, and disease free survival were 9.2 (Inter Quantile Range [IQR]=5.9-11.1) years, and 8.8 (IQR=5.0-11.0) years respec- tively. There was no difference in disease free survival, and local recurrence between groups (p=0.246, and p=0.601; respectively). Axillary lymph node involvement, lymphovas- cular invasion, extensive intraductal component, multifoca- lity, large tumor diameter and younger age patients were higher in re-excision group. Multivariate analysis identified, absence of lymphovascular invasion (Odds Ratio [OR]=0.05; %95Cl 0.01-0,44), and age >50 years (OR=0.17; %95Cl 0.04-0.73) were associated with lower re-excision require- ment; however, tumor diameter >2 cm (OR=4.52;%95Cl 1.28-15.98) was associated with re-excision. Conclusion: There was no difference in disease free survival, and local recurrence between 2 groups. Patients should be informed for the risk of re-excision after initial breast conserving surgery and wider surgical excision or oncoplastic surgery should be performed in risky patients.

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