Breast conserving surgery–Can we be even more conservative?

Bell, Ashleigh; Townend, Alice

doi:10.1016/j.ejso.2018.02.179

Cited by 1 publication

(8 citation statements)

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“…In total, 1114 citations were identified. Thirty studies were eligible for inclusion in the meta-analysis on changes in reoperation rate, reporting data on 599 016 participants enrolled between January 1, 1998, and December 31, 2018. Studies included a median (range) of 487 (100-521 578) participants (Table 1).…”

Section: Resultsmentioning

confidence: 99%

“…Most studies (n = 20) were undertaken in the US; the remainder were conducted in the UK (n = 6), Canada (n = 3), and Australia (n = 1) . Fifteen studies were full-text publications, and 15 studies were reported as conference abstracts.…”

Section: Resultsmentioning

confidence: 99%

“…Abbreviation: NA, not applicable. a One study did not report sufficient information to derive midpoints of recruitment. b Twelve of 21 studies (57.1%) of actual changes in reoperation did not report the preguideline margin threshold. c Two studies of projected changes included women in the postguideline period. The Society of Surgical Oncology–American Society for Radiation Oncology guideline was not used in this period.…”

Section: Resultsmentioning

confidence: 99%

“… c Two studies of projected changes included women in the postguideline period. The Society of Surgical Oncology–American Society for Radiation Oncology guideline was not used in this period.…”

Section: Resultsmentioning

confidence: 99%

“…An additional 9 studies assessed projected changes in reoperation, in which a margin of no ink on tumor was retrospectively applied to a preguideline cohort and avoidance of reoperation was estimated. All 9 studies were undertaken in institutional settings (hence stratification by study setting was not possible).…”

Section: Resultsmentioning

confidence: 99%

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Changes in Reoperation After Publication of Consensus Guidelines on Margins for Breast-Conserving Surgery

et al. 2020

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The 2014 publication of the Society of Surgical Oncology-American Society for Radiation Oncology (SSO-ASTRO) Consensus Guideline on Margins for Breast-Conserving Surgery recommended a negative margin definition of no ink on tumor. Adoption of this guideline would represent a major change in surgical practice that could lower the rates of reoperation.OBJECTIVE To assess changes in reoperation rates after publication of the SSO-ASTRO guideline.DATA SOURCES A systematic search of Embase, PREMEDLINE, Evidence-Based Medicine Reviews, Scopus, and Web of Science for biomedical literature published from January 2014 to July 2019 was performed. This search was supplemented by web searches and manual searching of conference abstracts.STUDY SELECTION Included studies compared the reoperation rates in preguideline vs postguideline cohorts (actual change), retrospectively applied the SSO-ASTRO guideline to a preguideline cohort (projected change), or described the economic outcomes of the guideline.DATA EXTRACTION AND SYNTHESIS Study characteristics and reoperation rates were extracted independently by 2 reviewers. Odds ratios (ORs) were pooled by random effects meta-analysis. Analyses were stratified by study setting (institutional or population) and preguideline accepted margins. The economic outcomes of the guideline were summarized narratively. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline was followed. MAIN OUTCOMES AND MEASURESOdds ratios for postguideline vs preguideline reoperation rates.RESULTS From 1114 citations, 30 studies (with 599 016 participants) reported changes in reoperation rates. Studies included a median (range) of 487 (100-521 578) participants, and 20 studies were undertaken in the US, 6 in the UK, 3 in Canada, and 1 in Australia. Among 21 studies of actual changes, pooled ORs showed a statistically significant reduction in reoperation, with an OR lower in institution-based studies than in population-based studies (OR, 0.62 [95% CI, 0.52-0.74] vs 0.76 [95% CI, 0.72-0.80]; P = .04 for subgroup differences). Among 9 studies of projected changes, the pooled OR was lower for preguideline margin thresholds of 2 mm or more compared with 1 mm (OR, 0.47 [95% CI, 0.40-0.56] vs 0.85 [95% CI, 0.79-0.91; P < .001 for subgroup differences). Projected changes were likely to overestimate actual changes. Six studies that estimated the postguideline economic outcome found the guideline to be potentially cost saving, with a median (range) saving of US $3540 ($1800-$25 650) per woman avoiding reoperation.CONCLUSIONS AND RELEVANCE This study found a decrease in reoperation rates after the publication of the SSO-ASTRO guideline; this reduction was greater at an institutional level than a population level, the latter reflecting the differences in guideline adoption between centers. These early outcomes may be conservative estimates of longer-term implications.

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Section: Resultsmentioning

confidence: 99%