Factors associated with reoperation in breast-conserving surgery for cancer: A prospective study of American Society of Breast Surgeon members Journal Article


Authors: Landercasper, J.; Borgert, A. J.; Fayanju, O. M.; Cody, H. 3rd; Feldman, S.; Greenberg, C.; Linebarger, J.; Pockaj, B.; Wilke, L.
Article Title: Factors associated with reoperation in breast-conserving surgery for cancer: A prospective study of American Society of Breast Surgeon members
Abstract: Background More than 20% of patients undergoing initial breast-conserving surgery (BCS) for cancer require reoperation. To address this concern, the American Society of Breast Surgeons (ASBrS) endorsed 10 processes of care (tools) in 2015 to be considered by surgeons to de-escalate reoperations. In a planned follow-up, we sought to determine which tools were associated with fewer reoperations. Methods A cohort of ASBrS member surgeons prospectively entered data into the ASBrS Mastery (R)' registry on consecutive patients undergoing BCS in 2017. The association between tools and reoperations was estimated via multivariate and hierarchical ranking analyses. Results Seventy-one surgeons reported reoperations in 486 (12.3%) of 3954 cases (mean 12.7% [standard deviation (SD) 7.7%], median 11.5% [range 0-32%]). There was an eightfold difference between surgeons in the 10th and 90th percentile performance groups. Actionable factors associated with fewer reoperations included routine planned cavity side-wall shaves, surgeon use of ultrasound (US), neoadjuvant chemotherapy, intra-operative pathologic margin assessment, and use of a pre-operative diagnostic imaging modality beyond conventional 2D mammography. For patients with invasive cancer, >= 24% of those who underwent reexcision did so for reported margins of < 1 or 2 mm, representing noncompliance with the SSO-ASTRO margin guideline. Conclusions Although ASBrS member surgeons had some of the lowest rates of reoperation reported in any registry, significant intersurgeon variability persisted. Further efforts to lower rates are therefore warranted. Opportunities to do so were identified by adopting those processes of care, including improved compliance with the SSO-ASTRO margin guideline, which were associated with fewer reoperations.
Keywords: irradiation; neoadjuvant chemotherapy; outcomes; lumpectomy; quality indicators; stage-i; conservation surgery; margin assessment; no ink; re-excision rates
Journal Title: Annals of Surgical Oncology
Volume: 26
Issue: 10
ISSN: 1068-9265
Publisher: Springer  
Date Published: 2019-10-01
Start Page: 3321
End Page: 3336
Language: English
ACCESSION: WOS:000484928300040
DOI: 10.1245/s10434-019-07547-w
PROVIDER: wos
PMCID: PMC6733824
PUBMED: 31342360
Notes: Erratum issued, see DOI: 10.1245/s10434-019-07799-6 -- Source: Wos
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MSK Authors
  1. Hiram S Cody III
    216 Cody