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Unpublished data were sought from study authors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Eligibility criteria<\/jats:title>\n                    <jats:p>Eligible studies reported on patients undergoing breast conserving surgery (for stages I-III breast cancer), allowed an estimation of outcomes in relation to margin status, and followed up patients for a minimum of 60 months. Patients with ductal carcinoma in situ only or treated with neoadjuvant chemotherapy or by mastectomy were excluded. Where applicable, margins were categorised as tumour on ink (involved), close margins (no tumour on ink but &lt;2 mm), and negative margins (\u22652 mm).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>68 studies from 1 January 1980 to 31 December 2021, comprising 112\u2009140 patients with breast cancer, were included. Across all studies, 9.4% (95% confidence interval 6.8% to 12.8%) of patients had involved (tumour on ink) margins and 17.8% (13.0% to 23.9%) had tumour on ink or a close margin. The rate of distant recurrence was 25.4% (14.5% to 40.6%) in patients with tumour on ink, 8.4% (4.4% to 15.5%) in patients with tumour on ink or close, and 7.4% (3.9% to 13.6%) in patients with negative margins. Compared with negative margins, tumour on ink margins were associated with increased distant recurrence (hazard ratio 2.10, 95% confidence interval 1.65 to 2.69, P&lt;0.001) and local recurrence (1.98, 1.66 to 2.36, P&lt;0.001). Close margins were associated with increased distant recurrence (1.38, 1.13 to 1.69, P&lt;0.001) and local recurrence (2.09, 1.39 to 3.13, P&lt;0.001) compared with negative margins, after adjusting for receipt of adjuvant chemotherapy and radiotherapy. In five studies published since 2010, tumour on ink margins were associated with increased distant recurrence (2.41, 1.81 to 3.21, P&lt;0.001) as were tumour on ink and close margins (1.44, 1.22 to 1.71, P&lt;0.001) compared with negative margins.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Involved or close pathological margins after breast conserving surgery for early stage, invasive breast cancer are associated with increased distant recurrence and local recurrence. Surgeons should aim to achieve a minimum clear margin of at least 1 mm. On the basis of current evidence, international guidelines should be revised.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Systematic review registration<\/jats:title>\n                    <jats:p>CRD42021232115.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmj-2022-070346","type":"journal-article","created":{"date-parts":[[2022,9,21]],"date-time":"2022-09-21T20:05:24Z","timestamp":1663790724000},"page":"e070346","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":124,"title":["Margin status and survival outcomes after breast cancer conservation surgery: prospectively registered systematic review and meta-analysis"],"prefix":"10.1136","volume":"378","author":[{"given":"James R","family":"Bundred","sequence":"first","affiliation":[{"name":"Leeds Institute of Molecular Medicine, University of Leeds, Leeds, UK"},{"name":"Leeds Institute of Emergency Surgery, St James University Hospital, Leeds, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Michael","sequence":"additional","affiliation":[{"name":"Manchester University NHS Foundation Trust, Wythenshawe, Manchester, UK"},{"name":"Division of Cancer sciences, University of Manchester, Manchester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beth","family":"Stuart","sequence":"additional","affiliation":[{"name":"Cancer Sciences, University of Southampton, Southampton, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ramsey I","family":"Cutress","sequence":"additional","affiliation":[{"name":"Cancer Sciences, University of Southampton, Southampton, UK"},{"name":"University Hospital Southampton, Southampton, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kerri","family":"Beckmann","sequence":"additional","affiliation":[{"name":"Cancer Epidemiology and Population Health Research Group, University of South Australia, Adelaide, SA, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernd","family":"Holleczek","sequence":"additional","affiliation":[{"name":"Division of Clinical Epidemiology Aging Research, German Cancer Research Centre (DKFZ), Heidelberg, Germany"},{"name":"Saarland Cancer Registry, Saarbr\u00fccken, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jane E","family":"Dahlstrom","sequence":"additional","affiliation":[{"name":"ACT Pathology, Canberra Health Services and Australian National University Medical School, ACT, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacqui","family":"Gath","sequence":"additional","affiliation":[{"name":"Independent Cancer Patients' Voice, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Dodwell","sequence":"additional","affiliation":[{"name":"Nuffield Department of Population Health, University of Oxford, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6007-056X","authenticated-orcid":false,"given":"Nigel J","family":"Bundred","sequence":"additional","affiliation":[{"name":"Manchester University NHS Foundation Trust, Wythenshawe, Manchester, UK"},{"name":"Division of Cancer sciences, University of Manchester, Manchester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2022,9,21]]},"reference":[{"key":"2025110101560144000_378.sep21_8.e070346.1","doi-asserted-by":"publisher","DOI":"10.1245\/s10434-014-3480-5"},{"key":"2025110101560144000_378.sep21_8.e070346.2","unstructured":"Kennedy I. 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