Reoperation rate after breast conserving surgery as quality indicator in breast cancer treatment: A reappraisal.
Breast
/ surgery
Breast Neoplasms
/ surgery
Cross-Sectional Studies
Female
Humans
Margins of Excision
Mastectomy, Segmental
/ standards
Middle Aged
Multivariate Analysis
Odds Ratio
Prospective Studies
Quality Assurance, Health Care
/ methods
Quality Indicators, Health Care
/ statistics & numerical data
Reoperation
/ standards
Risk Factors
Surgeons
/ statistics & numerical data
Workload
/ statistics & numerical data
Breast neoplasms
Mastectomy
Operative
Recurrence
Segmental margins of excision
Surgical procedures
Journal
Breast (Edinburgh, Scotland)
ISSN: 1532-3080
Titre abrégé: Breast
Pays: Netherlands
ID NLM: 9213011
Informations de publication
Date de publication:
Oct 2020
Oct 2020
Historique:
received:
06
02
2020
revised:
04
07
2020
accepted:
28
07
2020
pubmed:
26
8
2020
medline:
30
6
2021
entrez:
26
8
2020
Statut:
ppublish
Résumé
To analyse the role of repeated breast surgery (RBS) after breast conserving surgery (BCS) as a quality indicator in a consecutive series of breast cancer patients. Data from 1233 breast cancer patients submitted to BCS from 2015 to 2019 were reviewed. The influence of several variables on RBS rate (182/1232; 14.8%) was examined. Univariate and multivariate analyses were conducted to look for significant associations with the risk of RBS. Surgical workload, BCS rate and clinicopathological variables were consistent over the study period, while RBS rate decreased after the introduction of shaving of cavity margins (from 17.9% to 9.5%). Tumor persistence at RBS was higher for mastectomy vs. re-excision (87.3% vs. 37.8%; p = 0.05), inconclusive vs. positive diagnostic biopsy (48.2% vs. 69.4%; p = 0.003), ductal carcinoma in situ vs. invasive carcinoma (69.0% vs. 51.3%; p = 0.046) and lower after neoadjuvant therapy (14.3% vs. 57.8%; p = 0.044). Several clinicopathological variables were associated with the risk of RBS, but only multifocality [Odds Ratio (OR): 1.8; p = 0.009], microcalcifications (OR: 2.0, p = 0.000), neoadjuvant therapy (OR: 0.4; p = 0.014), pathological intraoperative assessment (OR: 0.6; p = 0.010) and shaving of cavity margins (OR: 0.3; p = 0.000) retained independent value at multivariate analysis. RBS rate can be reduced by shaving of cavity margins. Current standards for RBS should not be made more stringent due to the existence of non-actionable risk factors. The value of RBS as a quality indicator should be scrutinzed.
Identifiants
pubmed: 32841804
pii: S0960-9776(20)30150-8
doi: 10.1016/j.breast.2020.07.008
pmc: PMC7451417
pii:
doi:
Types de publication
Evaluation Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
181-188Informations de copyright
Copyright © 2020 The Author(s). Published by Elsevier Ltd.. All rights reserved.
Déclaration de conflit d'intérêts
Declaration of competing interest None declared.
Références
Ann Surg Oncol. 2016 Oct;23(10):3239-46
pubmed: 27411549
Ann Surg Oncol. 2016 Oct;23(10):3232-8
pubmed: 27338744
JAMA. 2011 Feb 9;305(6):569-75
pubmed: 21304082
PLoS One. 2017 Jan 3;12(1):e0168705
pubmed: 28046058
BMJ. 2012 Jul 12;345:e4505
pubmed: 22791786
N Engl J Med. 2015 Aug 6;373(6):503-10
pubmed: 26028131
N Engl J Med. 2002 Oct 17;347(16):1233-41
pubmed: 12393820
Breast. 2014 Dec;23(6):870-5
pubmed: 25305040
Ann Surg Oncol. 2014 Mar;21(3):704-16
pubmed: 24515565
J Surg Oncol. 2017 Dec;116(8):1040-1045
pubmed: 28750136
Ann Surg. 2013 Feb;257(2):249-55
pubmed: 23187751
JAMA. 2012 Feb 1;307(5):467-75
pubmed: 22298678
Ann Surg Oncol. 2013 Apr;20(4):1287-94
pubmed: 23135311
Ann Surg Oncol. 2015 Dec;22 Suppl 3:S422-7
pubmed: 26310280
Ann Surg. 2019 Jul 8;:
pubmed: 31290763
Ann Surg Oncol. 2013 May;20(5):1436-43
pubmed: 23135312
Ann Surg Oncol. 2019 Nov;26(12):3856-3862
pubmed: 31456094
Ann Surg Oncol. 2015 Oct;22(10):3174-83
pubmed: 26215198
Gland Surg. 2018 Dec;7(6):536-553
pubmed: 30687627
Ann Surg Oncol. 2014 Mar;21(3):717-30
pubmed: 24473640
Ann Surg Oncol. 2017 Jun;24(6):1516-1524
pubmed: 28116620
Ann Surg Oncol. 2014 Oct;21(10):3185-91
pubmed: 25047472
J Breast Cancer. 2018 Sep;21(3):321-329
pubmed: 30275861
JAMA Oncol. 2017 Oct 1;3(10):1352-1357
pubmed: 28586788
J Am Coll Surg. 2018 Jul;227(1):6-11
pubmed: 29428232
Arch Surg. 2009 May;144(5):455-62; discussion 462-3
pubmed: 19451489
Ann Surg Oncol. 2016 Sep;23(9):2802-8
pubmed: 27034079
Ann Surg Oncol. 2016 Mar;23(3):729-34
pubmed: 26467458
Ann Surg Oncol. 2016 Nov;23(12):3801-3810
pubmed: 27527714
Eur J Cancer. 2017 Nov;86:59-81
pubmed: 28963914
Lancet. 2005 Dec 17;366(9503):2087-106
pubmed: 16360786
Am J Surg. 2017 Dec;214(6):1104-1109
pubmed: 28974314
Ann Surg Oncol. 2017 Oct;24(10):3093-3106
pubmed: 28766206
JAMA. 2012 Feb 1;307(5):509-10
pubmed: 22298680
Ann Surg Oncol. 2019 Oct;26(10):3321-3336
pubmed: 31342360
J Clin Oncol. 2014 May 10;32(14):1502-6
pubmed: 24711553
Am J Surg. 2019 May;217(5):862-867
pubmed: 30739736
Ann Surg Oncol. 2019 Oct;26(10):3063-3070
pubmed: 31342388
Ann Surg Oncol. 2017 Jan;24(1):52-58
pubmed: 27581607
JAMA Surg. 2014 Dec;149(12):1296-305
pubmed: 25390819
N Engl J Med. 2002 Oct 17;347(16):1227-32
pubmed: 12393819
Ann Surg Oncol. 2019 May;26(5):1238-1244
pubmed: 30790112