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Surgeon Variability and Factors Predicting for Reoperation Following Breast-Conserving Surgery

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Reoperation after breast-conserving surgery (BCS) is common and has been partially associated with the lack of consensus on margin definition. We sought to investigate factors associated with reoperations and variation in reoperation rates across breast surgeons at our cancer center.

Methods

Retrospective analyses of patients with clinical stage I–II breast cancer who underwent BCS between January and December 2014 were conducted prior to the recommendation of ‘no ink on tumor’ margin. Patient demographics and tumor and surgical data were extracted from medical records. A multivariate regression model was used to identify factors associated with reoperation.

Results

Overall, 490 patients with stage I (n  = 408) and stage II (n  = 89) breast cancer underwent BCS; seven patients had bilateral breast cancer and underwent bilateral BCS procedures. Median invasive tumor size was 1.1 cm, reoperation rate was 22.9% (n  = 114) and varied among surgeons (range 15–40%), and, in 100 (88%) patients, the second procedure was re-excision, followed by unilateral mastectomy (n  = 7, 6%) and bilateral mastectomy (n  = 7, 6%). Intraoperative margin techniques (global cavity or targeted shaves) were utilized in 50.1% of cases, while no specific margin technique was utilized in 49.9% of cases. Median total specimen size was 65.8 cm3 (range 24.5–156.0). In the adjusted model, patients with multifocal disease were more likely to undergo reoperation [odds ratio (OR) 5.78, 95% confidence interval (CI) 2.17–15.42]. In addition, two surgeons were found to have significantly higher reoperation rates (OR 6.41, 95% CI 1.94–21.22; OR 3.41, 95% CI 1.07–10.85).

Conclusions

Examination of BCS demonstrated variability in reoperation rates and margin practices among our breast surgeons. Future trials should look at surgeon-specific factors that may predict for reoperations.

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Funding

This study was funded in part by National Institutes of Health (NIH) Grant R25CA089017 and the Breast Cancer Research Foundation.

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Authors and Affiliations

  1. Department of Surgery, Brigham and Women’s Hospital and Dana Farber Cancer Institute, Boston, MA, USA

    Monica G. Valero MD, Melissa Anne Mallory MD, Mustafa Tukenmez MD, Tari King MD & Mehra Golshan MD, FACS

  2. Harvard Medical School, Boston, MA, USA

    Monica G. Valero MD, Melissa Anne Mallory MD, Jaeho Hwang BA, Craig Bunnell MD, MPH, MBA, Tari King MD & Mehra Golshan MD, FACS

  3. Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA, USA

    Katya Losk MPH, Kristen Camuso MPH & Craig Bunnell MD, MPH, MBA

Authors
  1. Monica G. Valero MD
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  2. Melissa Anne Mallory MD
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  3. Katya Losk MPH
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  4. Mustafa Tukenmez MD
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  5. Jaeho Hwang BA
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  6. Kristen Camuso MPH
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  7. Craig Bunnell MD, MPH, MBA
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  8. Tari King MD
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  9. Mehra Golshan MD, FACS
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Corresponding author

Correspondence to Mehra Golshan MD, FACS.

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Disclosure

Monica G. Valero, Melissa Anne Mallory, Katya Losk, Mustafa Tukenmez, Jaeho Hwang, Kristen Camuso, Craig Bunnell, Tari King, and Mehra Golshan have no conflict of interests to declare.

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Valero, M.G., Mallory, M.A., Losk, K. et al. Surgeon Variability and Factors Predicting for Reoperation Following Breast-Conserving Surgery. Ann Surg Oncol 25, 2573–2578 (2018). https://doi.org/10.1245/s10434-018-6526-2

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  • DOI: https://doi.org/10.1245/s10434-018-6526-2

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