Awareness of residents’ technical ability can affect margin status in breast conserving operations
- 6 Downloads
The current study was performed to determine if awareness of the potential affect of residents could affect margin status.
Retrospective review of all patients who underwent lumpectomy from July 2006 to May 2017 was evaluated. The effect of surgical residents’ participation and their technical ability was evaluated to determine the effect on margin status. Logistic regression analysis was performed to determined factors which affect margin status.
Of 444 patients, 14% of patients had positive margins. The positive margin rate was lower during the second time period after the effect of technical ability of the residents was known 12% versus 19% (p = 0.10). Greater participation by the attending surgeon (32% vs. 21%) occurred in the second time period. In multivariate logistic regression analysis, operations done by residents with satisfactory technical skills or attending surgeon were less likely to have positive margins than those done by residents with unsatisfactory technical skills (OR 0.19, 95% CI 0.10–0.38; p = 0.0001). With mean follow-up of 48 months, 1.4% had local recurrences as a first event.
Technically ability of residents appears to affect margin status after lumpectomy. Increased intervention by the attending surgeon can improve this outcome.
KeywordsLumpectomy Breast conservation Margin Teaching Technical ability
Compliance with ethical standards
Conflict of interest
All authors declare that they have no conflict of interest.
This retrospective study was approved by the Institutional Review Board.
Research involving human and animal participants
This article does not contain any studies with human participants or animals performed by any of the authors.
Not applicable as this was a retrospective study.
- 1.http://www.nccn.org/professionals/. Accessed 31 Dec 2018
- 2.Moran MS, Schnitt SJ, Giuliano AE, Harris JR, Khan SA, Horton J, Klimberg S, Chavez-MacGregor M, Freedman G, Houssami N, Johnson PL, Morrow M, Society of Surgical Oncology, American Society for Radiation Oncology (2014) Society of surgical oncology-American society for radiation oncology consensus guideline on margins for breast-conserving surgery with whole-breast irradiation in stages I and II invasive breast cancer. J Clin Oncol 32(14):1507–1515. https://doi.org/10.1200/jco.2013.53.3935 CrossRefPubMedGoogle Scholar
- 5.Parvez E, Hodgson N, Cornacchi SD, Ramsaroop A, Gordon M, Farrokhyar F et al (2014) Survey of American and Canadian general surgeons’ perceptions of margin status and practice patterns for breast conserving surgery. Breast J 20(5):481–488. https://doi.org/10.1111/tbj.12299 CrossRefPubMedGoogle Scholar
- 14.Boughey JC, Hieken TJ, Jakub JW, Degnim AC, Grant CS, Farley DR et al (2014) Impact of analysis of frozen-section margin on reoperation rates in women undergoing lumpectomy for breast cancer: evaluation of the National Surgical Quality Improvement Program data. Surgery 156(1):190–197. https://doi.org/10.1016/j.surg.2014.03.025 CrossRefPubMedGoogle Scholar
- 15.Corsi F, Sorrentino L, Bonzini M, Bossi D, Truffi M, Amadori R et al (2017) Cavity shaving reduces involved margins and reinterventions without increasing costs in breast-conserving surgery: a propensity score-matched study. Ann Surg Oncol 24(6):1516–1524. https://doi.org/10.1245/s10434-017-5774-x CrossRefPubMedGoogle Scholar
- 16.Schnabel F, Boolbol SK, Gittleman M, Karni T, Tafra L, Feldman S et al (2014) A randomized prospective study of lumpectomy margin assessment with use of MarginProbe in patients with nonpalpable breast malignancies. Ann Surg Oncol 21(5):1589–1595. https://doi.org/10.1245/s10434-014-3602-0 CrossRefPubMedGoogle Scholar