article · BMC Surgery
Surgical completeness is essential for successful breast cancer treatment, yet data on resection margins are seldom reported from sub-Saharan Africa. An analysis of clinical and pathological records examined 1,020 women with stage I to III breast cancer who underwent mastectomies at Muhimbili National Hospital in Tanzania. Margin status was documented in 976 cases, revealing that 17.9 percent had positive or close surgical margins, with clear negative margins achieved in 82.1 percent. Where margins were compromised, most involved only a single margin, predominantly the deep margin followed by the superior margin. Incomplete resection occurred significantly more often in younger women, notably those under 30 years old, and in patients with advanced tumour sizes, particularly stage T4 tumours. Other characteristics such as histological subtype, tumour grade, and neoadjuvant therapy showed no statistically significant link to margin involvement.
Achieving clear surgical margins during cancer removal is vital to prevent disease recurrence and improve survival. By documenting margin outcomes in Tanzania, this work highlights how late-stage presentation and young patient age compromise surgical success. Understanding these risks supports targeted efforts to detect breast tumours earlier and tailor surgical planning in low-resource healthcare environments.
The abstract does not indicate an application pathway for commercialisation, as it presents observational epidemiological and surgical audit data without evaluating a specific technology, product, or marketable service.
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BACKGROUND: The quality and completeness of surgery remains critical for optimal oncological outcomes in breast cancer. A key indicator of surgical completeness is the resection margin status, which should ideally be negative, indicated by no ink on invasive tumor. However, such data is rarely reported from sub-Saharan Africa. This study aims to describe the clinical characteristics of women with non-metastatic breast cancer who underwent a mastectomy, and identify the factors influencing the resection margin status at a cancer hospital in Tanzania. METHODOLOGY: This was a retrospective cohort study analyzing clinical and pathological data of female patients, with a histologically confirmed breast cancer at stage I-III, who underwent a mastectomy at Muhimbili National Hospital in Tanzania. Data were extracted from histopathology reports and clinical records, focusing on margin status and associated variables including age, tumor size (T-status), nodal involvement (N-status), histological subtype, grade, luminal subtype, laterality, and receipt of neo-adjuvant therapy. The primary outcome was margin status post mastectomy. Descriptive statistics were used to summarize patient characteristics, and chi-square tests were applied to assess associations between variables and margin status. Statistical significance was set at p < 0.05. RESULTS: Out of the 1,020 patients analyzed, margin status was documented for 976 cases. Among these, 801 patients (82.1%) had negative margins, while 175 (17.9%) had positive or close margins; of the latter, 88.6% were positive and 11.4% close. Most patients with margin involvement (88%) had only a single margin affected. The deep margin was most frequently involved in 87% of patients with involved margins, followed by the superior margin in 57%. Margin involvement was significantly higher among younger patients, particularly those under 30 years of age (p < 0.001), and was also strongly associated with advanced T-status (p < 0.001), especially T4 tumors, where 31.7% had involved margins. No significant associations were found with histological subtype, luminal classification, laterality, receipt of neoadjuvant therapy. CONCLUSION: This study revealed a high rate of margin positivity following mastectomy, largely driven by advanced tumor stage and young age at presentation. To improve surgical outcomes in low-resource settings, we recommend interventions to improve earlier diagnosis and expanded use of neoadjuvant therapy for patients with locally advanced disease.
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DOI: 10.1186/s12893-025-03118-x
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