PPubMed22 Aug 2022Cited 10×

Assessment of Surgeon Factors Associated With Margin Re-excision After Breast-Conserving Surgery Assessment of Factors Associated With Margin Re-excision After Breast-Conserving Surgery Assessment of Factors Associated With Margin Re-excision After Breast-Conserving Surgery

Jeffery M. Chakedis, Sharon B. Chang, Annie Tang, Gillian E. Kuehner, Alison C. Savitz, Brooke Vuong, Maihgan A. Kavanagh

Abstract

'Alison C. Savitz' 'Brooke Vuong' 'Maihgan A. Kavanagh'] This cross-sectional study examines 5-year re-excision rates and use of recommended techniques among breast surgeons in a single health system.

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Routine use of cavity shave margins and other surgeon practices significantly lower re‑excision rates after breast‑conserving surgery.

What’s new

i.Identified wide variability in 5‑year re‑excision rates among 55 breast surgeons
ii.Linked specific surgeon practices—cavity shave margins, oncoplastic techniques, higher operative volume—to lower re‑excision rates
iii.Provided quantitative evidence that routine cavity shave margins reduce mean re‑excision from 21.7% to 14.1%
iv.Surveyed surgeon demographics and technique utilization to correlate with outcomes

How they did it

The authors performed a cross‑sectional study of patients undergoing breast‑conserving surgery from 1 Jan 2016 to 31 Dec 2020 identified via a prospectively collected registry. They surveyed breast surgeons about demographics and technique use, then applied univariable and multivariable linear regression to assess factors associated with re‑excision rates.

What they found

Overall re‑excision rate was 18.8% across 9,054 BCS cases
Individual surgeon 5‑year re‑excision rates ranged from 7.8% to 36.8% (3.3‑fold difference)
Surgeons always using cavity shave margins had lower mean re‑excision (14.1% vs 21.7%; P=.004)
Since 2018, cavity shave margins were used in 18% of patients and yielded a re‑excision rate of 13.9% versus 19.4% without shave margins (P<.001)
Multivariable model: always using cavity shave margins associated with β = ‑6.11 (95% CI ‑11.0 to ‑1.64; P=.02)

Caveats

✕Re‑excision was used as a surrogate for involved pathologic margins, which may not capture all margin issues

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Assessment of Surgeon Factors Associated With Margin Re-excision After Breast-Conserving Surgery Assessment of Factors Associated With Margin Re-excision After Breast-Conserving Surgery Assessment of Factors Associated With Margin Re-excision After Breast-Conserving Surgery

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