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@ARTICLE{Bundred:163052,
      author       = {J. Bundred and S. Michael and S. Bowers and N. Barnes and
                      Y. Jauhari and D. Plant and T. Maishman and R. Cutress and
                      B. Holleczek$^*$ and D. Dodwell and N. Bundred},
      title        = {{D}o surgical margins matter after mastectomy? {A}
                      systematic review.},
      journal      = {European journal of surgical oncology},
      volume       = {46},
      number       = {12},
      issn         = {0748-7983},
      address      = {Burlington, Mass.},
      publisher    = {Harcourt},
      reportid     = {DKFZ-2020-01838},
      pages        = {2185-2194},
      year         = {2020},
      note         = {2020 Dec;46(12):2185-2194},
      abstract     = {No consensus exists regarding adequacy of margins after
                      mastectomy. To determine if pathological margin proximity is
                      associated with local (LR) or distant recurrence after
                      mastectomy for early invasive breast cancer or ductal
                      carcinoma in situ.A systematic review of literature
                      published from 1980 to 2019 and meta-analysis was conducted.
                      Unpublished data were sought from authors (PROSPERO
                      (CRD42019127541)). Thirty-four studies comprising 34,833
                      breast cancer patients were included in the quantitative
                      synthesis. Eligible studies reported on patients undergoing
                      curative mastectomy for cancer allowing estimation of
                      outcomes in relation to margin status/width. The association
                      between pathological margin status and local (LR) and
                      distant recurrence was considered using random effects
                      modelling. PRISMA guidelines were followed.Positive margins
                      were associated with increased LR on multivariable analyses
                      (HR, 2·64, $(95\%CI$ 2·01-3·46)) and LR was higher
                      regardless of the distance of tumour from the margin defined
                      as positive. After skin-sparing mastectomy, positive margins
                      were associated with increased LR (HR 3·40, $(95\%CI$
                      1·9-6·2)). In the 4 studies reporting distant recurrence,
                      patients with involved margins had a higher risk (HR 1·53,
                      $(95\%CI$ 1·03-2·25)).Failure to achieve clear margins
                      after mastectomy may increase the risks of local and distant
                      recurrence. Adequate margin clearance should be recommended
                      to minimize recurrence after mastectomy in National and
                      International Guidelines.},
      subtyp        = {Review Article},
      cin          = {C070},
      ddc          = {610},
      cid          = {I:(DE-He78)C070-20160331},
      pnm          = {313 - Cancer risk factors and prevention (POF3-313)},
      pid          = {G:(DE-HGF)POF3-313},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:32907774},
      doi          = {10.1016/j.ejso.2020.08.015},
      url          = {https://inrepo02.dkfz.de/record/163052},
}