Should Re-excision Lumpectomy Rates Be a Quality Measure in Breast-Conserving Surgery?

Schwartz, Theresa; Degnim, Amy C.; Landercasper, Jeffrey

doi:10.1245/s10434-013-3206-0

Cited by 19 publications

(12 citation statements)

References 19 publications

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“…The concept of discussing chemotherapy sequencing during shared decision making with the patient as a method to lower reoperations should not contribute to the unintended consequences that have been attributed to other initiatives aimed at lowering ROR, such as larger lumpectomies, worse cosmetic outcomes, and increased mastectomy rates from surgeon risk aversion, a fear of being penalized for a reoperation if the surgeon is participating in a quality improvement program 25. It could even be postulated that better cosmetic outcomes might result from smaller lumpectomies for patients demonstrating a good clinical response to NAC.…”

Section: Discussionmentioning

confidence: 99%

Fewer Reoperations After Lumpectomy for Breast Cancer with Neoadjuvant Rather than Adjuvant Chemotherapy: A Report from the National Cancer Database

et al. 2017

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BackgroundReoperations occur frequently after initial lumpectomy for breast cancer. The authors hypothesized that the receipt of neoadjuvant chemotherapy (NAC) is associated with fewer reoperations.MethodsThe association between timing of chemotherapy and reoperation rates (ROR) after lumpectomy was investigated for patients with stages 1–3 breast cancer in the National Cancer Database (NCDB) from 2010 to 2013 by multivariable logistic regression modeling. Then propensity score-matching was performed.ResultsThe unadjusted ROR for 71,627 stages 1–3 patients was 11.4% for those who had NAC compared with 20.3% for those who had postoperative chemotherapy (p < 0.001) (odds ratio [OR] 0.53; 95% confidence interval [CI] 0.49–0.57; p < 0.001). The ORs for the reoperations performed for patients with stages 1, 2, and 3 cancers who received NAC were respectively 0.65 (95% CI 0.56–0.75), 0.50 (95% CI 0.45–0.56), and 0.27 (95% CI 0.19–0.38) The p values for all were lower than 0.001.ConclusionFor a population of patients receiving chemotherapy, the receipt of chemotherapy before instead of after surgery was associated with fewer reoperations after initial lumpectomy for breast cancer.

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Section: Discussionmentioning

confidence: 99%

Fewer Reoperations After Lumpectomy for Breast Cancer with Neoadjuvant Rather than Adjuvant Chemotherapy: A Report from the National Cancer Database

et al. 2017

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“…Increased mastectomy rates and poor cosmetic outcomes are potential unintended adverse outcomes of efforts to lower reoperation rates and therefore should be monitored. 40 – 42 These risks were recognized but were felt to be balanced by the potential to improve overall patient care by following conference recommendations. There is evidence that both reoperation rate and cosmetic outcome can improve by adoption of oncoplastic techniques.…”

Section: Discussionmentioning

confidence: 99%

Toolbox to Reduce Lumpectomy Reoperations and Improve Cosmetic Outcome in Breast Cancer Patients: The American Society of Breast Surgeons Consensus Conference

et al. 2015

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BackgroundMultiple recent reports have documented significant variability of reoperation rates after initial lumpectomy for breast cancer. To address this issue, a multidisciplinary consensus conference was convened during the American Society of Breast Surgeons 2015 annual meeting.MethodsThe conference mission statement was to “reduce the national reoperation rate in patients undergoing breast conserving surgery for cancer, without increasing mastectomy rates or adversely affecting cosmetic outcome, thereby improving value of care.” The goal was to develop a toolbox of recommendations to reduce the variability of reoperation rates and improve cosmetic outcomes. Conference participants included providers from multiple disciplines involved with breast cancer care, as well as a patient representative. Updated systematic reviews of the literature and invited presentations were sent to participants in advance. After topic presentations, voting occurred for choice of tools, level of evidence, and strength of recommendation.ResultsThe following tools were recommended with varied levels of evidence and strength of recommendation: compliance with the SSO-ASTRO Margin Guideline; needle biopsy for diagnosis before surgical excision of breast cancer; full-field digital diagnostic mammography with ultrasound as needed; use of oncoplastic techniques; image-guided lesion localization; specimen imaging for nonpalpable cancers; use of specialized techniques for intraoperative management, including excisional cavity shave biopsies and intraoperative pathology assessment; formal pre- and postoperative planning strategies; and patient-reported outcome measurement.ConclusionsA practical approach to performance improvement was used by the American Society of Breast Surgeons to create a toolbox of options to reduce lumpectomy reoperations and improve cosmetic outcomes.

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“…Recent efforts to standardize the approach to addressing pathologic margin status also have the potential to effect reoperation rates 45 . Although no clear single solution has emerged, high variability suggests this intervention could be a useful quality measure 7,11,12 , or at least a factor that affects patient satisfaction and cost 46,47 .…”

Section: Discussionmentioning

confidence: 99%

Reoperation Costs in Attempted Breast-Conserving Surgery: A Decision Analysis

Pataky

Baliski

2016

Current Oncology

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Should Re-excision Lumpectomy Rates Be a Quality Measure in Breast-Conserving Surgery?

Cited by 19 publications

References 19 publications

Fewer Reoperations After Lumpectomy for Breast Cancer with Neoadjuvant Rather than Adjuvant Chemotherapy: A Report from the National Cancer Database

Fewer Reoperations After Lumpectomy for Breast Cancer with Neoadjuvant Rather than Adjuvant Chemotherapy: A Report from the National Cancer Database

Toolbox to Reduce Lumpectomy Reoperations and Improve Cosmetic Outcome in Breast Cancer Patients: The American Society of Breast Surgeons Consensus Conference

Reoperation Costs in Attempted Breast-Conserving Surgery: A Decision Analysis

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