BACKGROUND: For patients with breast cancer, a negative surgical margin at first breast-conserving surgery (BCS) minimizes the need for reoperation and likely reduces postoperative anxiety. We assessed technical factors, surgeon and hospital case volume and margin status after BCS in early-stage breast cancer. METHODS: We performed a retrospective cohort study using a regional cancer centre database of patients who underwent BCS for breast cancer from 2000 to 2002. We considered the influence of patient, tumour and technical factors (e.g., size of specimen and preoperative diagnosis of cancer available) and surgeon and hospital case volume on margin status at first and final operation. We performed univariate and multivariate regression analyses. RESULTS: We reviewed 489 cases. There were no differences in patient or tumour characteristics among the low-, medium- and high-volume surgeon groups. High-volume surgeons were significantly more likely than other surgeons to operate with a confirmed preoperative diagnosis and to resect a larger volume of tissue. In our univariate analysis and at first operation, the rates of positive margins were 16.4%, 32.9% and 29.1% for high-, medium- and low-volume surgeons, respectively (p = 0.002). In the multivariate analysis, tumour factors (palpability, size, histology), presence of a confirmed preoperative diagnosis and size of resection specimen significantly predicted negative margins. However, when we controlled for these and other factors, high surgeon volume was not a predictor of negative margins at first surgery (odds ratio 1.8, 95% confidence interval 0.9-3.8, p = 0.09). Increased hospital volume was not associated with a lower rate of positive margins at first surgery. CONCLUSION: Various tumour and technical factors were associated with negative margins at first BCS, whereas surgeon and hospital volume status were not. Technical steps that are under the control of the operating surgeon are likely effective targets for quality initiatives in breast cancer surgery.
BACKGROUND: For patients with breast cancer, a negative surgical margin at first breast-conserving surgery (BCS) minimizes the need for reoperation and likely reduces postoperative anxiety. We assessed technical factors, surgeon and hospital case volume and margin status after BCS in early-stage breast cancer. METHODS: We performed a retrospective cohort study using a regional cancer centre database of patients who underwent BCS for breast cancer from 2000 to 2002. We considered the influence of patient, tumour and technical factors (e.g., size of specimen and preoperative diagnosis of cancer available) and surgeon and hospital case volume on margin status at first and final operation. We performed univariate and multivariate regression analyses. RESULTS: We reviewed 489 cases. There were no differences in patient or tumour characteristics among the low-, medium- and high-volume surgeon groups. High-volume surgeons were significantly more likely than other surgeons to operate with a confirmed preoperative diagnosis and to resect a larger volume of tissue. In our univariate analysis and at first operation, the rates of positive margins were 16.4%, 32.9% and 29.1% for high-, medium- and low-volume surgeons, respectively (p = 0.002). In the multivariate analysis, tumour factors (palpability, size, histology), presence of a confirmed preoperative diagnosis and size of resection specimen significantly predicted negative margins. However, when we controlled for these and other factors, high surgeon volume was not a predictor of negative margins at first surgery (odds ratio 1.8, 95% confidence interval 0.9-3.8, p = 0.09). Increased hospital volume was not associated with a lower rate of positive margins at first surgery. CONCLUSION: Various tumour and technical factors were associated with negative margins at first BCS, whereas surgeon and hospital volume status were not. Technical steps that are under the control of the operating surgeon are likely effective targets for quality initiatives in breast cancer surgery.
Authors: John D Birkmeyer; Andrea E Siewers; Emily V A Finlayson; Therese A Stukel; F Lee Lucas; Ida Batista; H Gilbert Welch; David E Wennberg Journal: N Engl J Med Date: 2002-04-11 Impact factor: 91.245
Authors: Nadeem Q Mirza; Georges Vlastos; Funda Meric; Thomas A Buchholz; Nestor Esnaola; S Eva Singletary; Henry M Kuerer; Lisa A Newman; Frederick C Ames; Merrick I Ross; Barry W Feig; Raphael E Pollock; Marsha McNeese; Eric Strom; Kelly K Hunt Journal: Ann Surg Oncol Date: 2002-04 Impact factor: 5.344
Authors: J M Escribà; L Esteban; J Gálvez; M J Pla; A Melià; M Gil-Gil; R Clèries; L Pareja; X Sanz; M Bustins; J M Borrás; J Ribes Journal: Clin Transl Oncol Date: 2016-09-13 Impact factor: 3.405
Authors: Benjamin W Maloney; David M McClatchy; Brian W Pogue; Keith D Paulsen; Wendy A Wells; Richard J Barth Journal: J Biomed Opt Date: 2018-10 Impact factor: 3.170
Authors: Woohyun Jung; Eunyoung Kang; Sun Mi Kim; Dongwon Kim; Yoonsun Hwang; Young Sun; Cha Kyong Yom; Sung-Won Kim Journal: J Breast Cancer Date: 2012-12-31 Impact factor: 3.588
Authors: Samuel S Streeter; Benjamin W Maloney; Rebecca A Zuurbier; Wendy A Wells; Richard J Barth; Keith D Paulsen; Brian W Pogue Journal: Phys Med Biol Date: 2021-06-01 Impact factor: 4.174