Surgeon Volume, Patient Age, and Tumor-Related Factors Influence the Need for Re-Excision After Breast-Conserving Surgery

Hughes, Lauren; Hamm, Jeremy; McGahan, Colleen; Baliski, Christopher

doi:10.1245/s10434-016-5602-8

Cited by 30 publications

(13 citation statements)

References 35 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“… 10 17 25 27 32 33 Specialist breast cancer surgeons may be more proficient at obtaining negative margins, and less likely to re-excise close margins. 16 Patient selection and appropriateness of BCS as the initial treatment choice is also a factor. Anecdotal evidence suggests that treatment decisions made in high-volume hospitals are often made by multidisciplinary teams (MDTs) and differ from those made by clinicians working in isolation.…”

Section: Discussionmentioning

confidence: 99%

“…Factors associated with reoperation can be broadly divided into patient-level sociodemographic and clinical factors, together with health system-level factors. 16 Comprehensive investigation into health system factors, which are potentially modifiable, is lacking, with few large population-based studies conducted, 8 10 11 17 only one of which 10 used best-practice multilevel modelling techniques to capture health system-level variation. If confirmed, variation in reoperation rates related to health system, rather than patient-level factors, has important policy and practice implications.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Reoperation after breast-conserving surgery for cancer in Australia: statewide cohort study of linked hospital data

et al. 2018

View full text Add to dashboard Cite

ObjectivesTo investigate between-hospital variation in the probability of reoperation within 90 days of initial breast-conserving surgery (BCS), and the contribution of health system-level and other factors.DesignPopulation-based, retrospective cohort study.SettingNew South Wales (NSW), Australia.ParticipantsLinked administrative hospitalisation data were used to define a cohort of adult women undergoing initial BCS for breast cancer in NSW between 1 July 2002 and 31 December 2013.Primary outcome measuresMultilevel, cross-classified models with patients clustered within hospitals and residential areas were used to examine factors associated with any reoperation, and either re-excision or mastectomy, within 90 days.ResultsOf 34 458 women undergoing BCS, 29.1% underwent reoperation within 90 days, half of which were mastectomies. Overall, the probability of reoperation decreased slightly over time. However, there were divergent patterns by reoperation type; the probability of re-excision increased alongside a concomitant decrease in the probability of mastectomy. Significant between-hospital variation was observed. Non-metropolitan location and surgery at low-volume hospitals were associated with a higher overall probability of reoperation, and of mastectomy specifically, after accounting for patient-level factors, calendar year and area-level socioeconomic status. The magnitude of association with geographical location and surgical volume decreased over time.ConclusionsReoperation rates within 90 days of BCS varied significantly between hospitals. For women undergoing mastectomy after BCS, this represents a dramatic change in clinical course. Multilevel modelling suggests unwarranted clinical variation may be an issue, likely due to disparities in access to multidisciplinary breast cancer care and preoperative diagnostic procedures. However, the observed reduction in disparities over time is encouraging and indicates that guidelines and policy initiatives have the potential to improve regional breast cancer care.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Reoperation after breast-conserving surgery for cancer in Australia: statewide cohort study of linked hospital data

et al. 2018

View full text Add to dashboard Cite

show abstract

“…Several studies have reported reoperation rate and type of reoperation after BCS,1–15 but only a few focused on predictive factors determining reoperation type 11,13,16. We have analyzed institutional BC database in order to determine rates and associated factors for reoperation, mastectomy, and third reoperation.…”

Section: Introductionmentioning

confidence: 99%

<p>Positive or close margins: reoperation rate and second conservative resection or total mastectomy?</p>

Houvenaeghel¹,

Lambaudie²,

Bannier³

et al. 2019

CMAR

View full text Add to dashboard Cite

Introduction Reoperation after breast-conserving surgery (BCS) could be proposed for positive or close margins. Reoperation type, re-excision or mastectomy, depends on several factors in relation to patient’s and tumor’s characteristics. We have analyzed our breast cancer (BC) database in order to determine second and third attempts for BCS and mastectomy rates, as well as associated factors for type of surgery. Methods All patients with BCS between 1995 and 2017 were included. Patient’s characteristics, pathologic results, and treatments were analyzed. Reoperation rate, type of reoperation, second reoperation, and associated factors of reoperation, mastectomy, and third intervention were determined. Three periods were determined: P1–P3. Results We analyzed 10,761 patients: 1,161 with ductal carcinoma in situ (DCIS) and 9,600 with invasive BC. The reoperation rate was 41.4% for DCIS and 28.0% for invasive BC. Using multivariate analysis, we identified tumor size >20 mm as being a risk factor for reoperation, whereas age >50 years, P2–3, and some localization decreased reoperation rates. For invasive BC, age >40 years, triple-negative tumors, neoadjuvant chemotherapy, and noncentral tumors decreased reoperation rates and lobular tumor, multifocal tumors, lymphovascular invasion, DCIS component, and Her2-positive tumors increased reoperation rates. For patients requiring reoperation, re-excision was performed in 48.1% (1,523/3,168) and mastectomy was required after first re-excision in 13.46% (205/1,523). For DCIS, mastectomy rates were higher for grade 2 and tumor ≥20 mm. For invasive BC, mastectomy rates were higher for lobular, multifocal, ≥20 mm, Her2-positive tumors and diffuse positive margins and lower for age >50 years and during the last period. Even if interval time between surgery and adjuvant treatments was higher for patients with reoperation, survival rates were not different between patients with and without reoperation. Conclusion A decrease in reoperation and mastectomy rates had been reported with several associated factors. A third intervention with mastectomy was required in 13.5% of patients. This information should be done in case of reoperation.

show abstract

“…Experience leads to compliance with recommendations on margins despite the surgical type of reconstruction and the location. This trend of better outcomes is noticeable for many surgeons in different types of surgery [ 25 , 26 ].…”

Section: Discussionmentioning

confidence: 98%

Identifying the factors that influence surgeon's compliance with excisional margins of non-melanoma skin cancer

Cautela

Mannocci²,

Reggiani

et al. 2018

PLoS ONE

View full text Add to dashboard Cite

The rising incidence of Non Melanoma Skin Cancers (NMSC) leads to a high number of surgical procedures worldwide. The strict compliance with international guidelines with regard to excisional margins may help decrease the number of re-excision procedures and reduce the risk of NMSC recurrence. The aim of this study was to investigate the prevalence of excisional margins as recommended by the European Academy of Dermatology and Venereology (EADV) and the European Dermatology Forum (EDF) guidelines, and the factors (demographic or clinical) that influence surgeons’ compliance with these guidelines.This was a prevalence study looking at surgical excisions of NMSCs performed over a period of 2 years (2011–2012). A sample size of 1669 patients was considered. Definition of excisional margins recommended by the international guidelines (EADV and EDF) were used as point of reference for the analysis. Tumor and histologic specimen size were calculated ex vivo by 5 different pathologists. The size of skin specimens was measured with a major axis and a minor axis. The same was done for the tumor present on the skin specimens. The differences between the major and minor axes of surgical specimen and tumor were calculated. These differences were subsequently divided by two, hypothesizing that the lesion had the same distance from the margins of the surgical specimen.The differences obtained were named “Delta”, the formulas applied being the following:Delta major = (major axis specimen—major axis tumor)/2; Delta minor = (minor axis specimen—minor axis tumor)/2.Results show a significant statistical difference, associated with factors such as: age of the patient, anatomical localization of the tumor, histological diagnosis, and surgeons’ experience.The identification of these factors sheds light on clinicians’ practice and decision-making regarding excisional margins. Hopefully a higher level of adherence to the guidelines can be achieved in the future.

show abstract

Surgeon Volume, Patient Age, and Tumor-Related Factors Influence the Need for Re-Excision After Breast-Conserving Surgery

Abstract: 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.

Cited by 30 publications

References 35 publications

Reoperation after breast-conserving surgery for cancer in Australia: statewide cohort study of linked hospital data

Reoperation after breast-conserving surgery for cancer in Australia: statewide cohort study of linked hospital data

<p>Positive or close margins: reoperation rate and second conservative resection or total mastectomy?</p>

Identifying the factors that influence surgeon's compliance with excisional margins of non-melanoma skin cancer

Contact Info

Product

Resources

About