L Hughes1,2, J Hamm3, C McGahan3, C Baliski4,5. 1. Department of Surgical Oncology, Sindi Ahluwalia Hawkins Centre for the Southern Interior, BC Cancer Agency, Kelowna, BC, Canada. 2. University of British Columbia Okanagan, Kelowna, BC, Canada. 3. Cancer Surveillance and Outcomes, BC Cancer Agency, Vancouver, BC, Canada. 4. Department of Surgical Oncology, Sindi Ahluwalia Hawkins Centre for the Southern Interior, BC Cancer Agency, Kelowna, BC, Canada. cbaliski@bccancer.bc.ca. 5. Department of Surgery, University of British Columbia, Vancouver, BC, Canada. cbaliski@bccancer.bc.ca.
Abstract
BACKGROUND: Breast-conserving surgery (BCS) is the preferred surgical approach for the majority of patients with early-stage breast cancer. There are frequent issues regarding pathologic margin status, requiring margin re-excision, and, in the literature, there is significant variability in re-excision rates, suggesting this is a potential quality-of-care issue. Understanding the patient-, disease-, and physician-related factors influencing reoperation rates is of importance in an effort to minimize this occurrence. METHODS: A retrospective analysis of all patients referred to our cancer center over a 3-year period (1 January 2011-31 December 2013) was performed. Surgeon volume, and patient- and tumor-related factors were assessed for their impact on re-excision rates. Multivariate logistic regression analysis was performed to identify variables of significance influencing reoperation rates after attempted BCS. RESULTS: Overall, 594 patients underwent initial BCS, with 159 (26.8%) patients requiring at least one re-excision to ensure negative pathologic margins. On multivariate analysis, low surgeon case volume, patient age (under 46 years of age), tumor size (>2 cm), and lobular carcinoma were associated with an increased re-excision rate. CONCLUSION: Re-excisions are frequent after BCS and are influenced by surgeon volume, patient age, and tumor-related factors. These factors should be considered when counseling patients considering BCS, and also for quality assurance.
BACKGROUND: Breast-conserving surgery (BCS) is the preferred surgical approach for the majority of patients with early-stage breast cancer. There are frequent issues regarding pathologic margin status, requiring margin re-excision, and, in the literature, there is significant variability in re-excision rates, suggesting this is a potential quality-of-care issue. Understanding the patient-, disease-, and physician-related factors influencing reoperation rates is of importance in an effort to minimize this occurrence. METHODS: A retrospective analysis of all patients referred to our cancer center over a 3-year period (1 January 2011-31 December 2013) was performed. Surgeon volume, and patient- and tumor-related factors were assessed for their impact on re-excision rates. Multivariate logistic regression analysis was performed to identify variables of significance influencing reoperation rates after attempted BCS. RESULTS: Overall, 594 patients underwent initial BCS, with 159 (26.8%) patients requiring at least one re-excision to ensure negative pathologic margins. On multivariate analysis, low surgeon case volume, patient age (under 46 years of age), tumor size (>2 cm), and lobular carcinoma were associated with an increased re-excision rate. CONCLUSION: Re-excisions are frequent after BCS and are influenced by surgeon volume, patient age, and tumor-related factors. These factors should be considered when counseling patients considering BCS, and also for quality assurance.
Authors: Benjamin D Smith; Xiudong Lei; Kevin Diao; Ying Xu; Yu Shen; Grace L Smith; Sharon H Giordano; Sarah M DeSnyder; Kelly K Hunt; Mediget Teshome; Reshma Jagsi; Simona F Shaitelman; Susan K Peterson; Cameron W Swanick Journal: Ann Surg Oncol Date: 2020-01-08 Impact factor: 5.344
Authors: Jeffery M Chakedis; Annie Tang; Alison Savitz; Liisa L Lyon; Patricia E Palacios; Brooke Vuong; Maihgan A Kavanagh; Gillian E Kuehner; Sharon B Chang Journal: Ann Surg Oncol Date: 2022-07-29 Impact factor: 4.339
Authors: Winona L Richey; Jon S Heiselman; Ma Luo; Ingrid M Meszoely; Michael I Miga Journal: Int J Comput Assist Radiol Surg Date: 2021-08-12 Impact factor: 3.421
Authors: Michael A Pinkert; Lonie R Salkowski; Patricia J Keely; Timothy J Hall; Walter F Block; Kevin W Eliceiri Journal: J Med Imaging (Bellingham) Date: 2018-01-22
Authors: Kathryn Ottolino-Perry; Anam Shahid; Stephanie DeLuca; Viktor Son; Mayleen Sukhram; Fannong Meng; Zhihui Amy Liu; Sara Rapic; Nayana Thalanki Anantha; Shirley C Wang; Emilie Chamma; Christopher Gibson; Philip J Medeiros; Safa Majeed; Ashley Chu; Olivia Wignall; Alessandra Pizzolato; Cheryl F Rosen; Liis Lindvere Teene; Danielle Starr-Dunham; Iris Kulbatski; Tony Panzarella; Susan J Done; Alexandra M Easson; Wey L Leong; Ralph S DaCosta Journal: Breast Cancer Res Date: 2021-07-12 Impact factor: 6.466
Authors: Marina T van Leeuwen; Michael O Falster; Claire M Vajdic; Philip J Crowe; Sanja Lujic; Elizabeth Klaes; Louisa Jorm; Art Sedrakyan Journal: BMJ Open Date: 2018-04-10 Impact factor: 2.692