Primary surgery: margins

The first topic of the consensus panel was the estimated clinical benefit of tumour-free margins after excision of the primary invasive tumour. At the St. Gallen Conference 2017, the panel suggested that “no ink on tumour” (meaning the tumour does not extend to the edge of excised tissue) provides adequate local control, i.e. an optimal local recurrence rate and/or lower rate of secondary surgery, in patients to receive standard radiotherapy [1]. This year, the panel zoomed in further on this topic. The majority of the panellists (86%) agreed that “no ink on tumour” also provides clinical benefit in patients with multifocal residual disease after neoadjuvant systemic therapy. In case of lobular cancer (no neoadjuvant systemic therapy!), 73% of the panellists accepted “no ink on tumour” to provide clinical benefit, and in case of the presence of extensive intraductal component, 63% of the panellists agreed “no ink on tumour” to provide clinical benefit. In addition, almost half of the panellists (46%) took the view that even 1 mm “ink on tumour” should require re-excision. In contrast, 38% of the panellists regarded 4 mm “ink on tumour” acceptable to forgo re-excision.

1. Curiglioane G, et al. Ann Oncol 2017; 28: 1700–1712.

Posted on 21 May 201915 March 2021