Intraoperative margin assessment in breast-conserving surgery. Preliminary analysis of cost-effectiveness and organisational benefits

Introduction
Breast-conserving surgery (BCS) is the standard treatment for early breast cancer, offering comparable oncological effectiveness to mastectomy with better aesthetic outcomes. Achieving negative surgical margins is essential, as positive margins increase the risk of recurrence and reoperation, which place a burden on both patients and the healthcare system. This retrospective study evaluated the effectiveness of intraoperative margin assessment in BCS, focusing on its impact on reducing reoperation rates and analysing financial and organisational benefits.

Material and methods
Between 2016 and 2023, 549 patients underwent BCS with intraoperative margin assessment using frozen section analysis. Positive surgical margins were identified in 70 patients (12.8%). Through intraoperative re-excisions, negative margins were ultimately achieved in 55 cases, avoiding mastectomy or later reoperation. Only four patients (0.7%) required reoperation after the initial procedure.

Results
Avoiding reoperation generated significant cost savings. The average cost of one reoperation was estimated at PLN 12,829 (approximately EUR 3,013) in centres without comprehensive oncological care and PLN 17,855 (approximately EUR 4,194) in centres with comprehensive oncological care. The total savings for avoided procedures amounted to PLN 898,045 (about EUR 210,918) and PLN 1,249,857 (about EUR 293,545), respectively.

Conclusions
Intraoperative margin assessment during BCS is an effective strategy that minimises the need for repeated procedures, improves patient outcomes, and provides measurable economic benefits at the healthcare system level. Wider implementation of this method may help optimise surgical resources while enhancing the quality of care.