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. 2019 Oct;26(10):3321-3336.
doi: 10.1245/s10434-019-07547-w. Epub 2019 Jul 24.

Factors Associated with Reoperation in Breast-Conserving Surgery for Cancer: A Prospective Study of American Society of Breast Surgeon Members

Jeffrey Landercasper  1   2 , Andrew J Borgert  3 , Oluwadamilola M Fayanju  4 , Hiram Cody 3rd  5 , Sheldon Feldman  6 , Caprice Greenberg  7 , Jared Linebarger  8   9 , Barbara Pockaj  10 , Lee Wilke  7
Affiliations

Factors Associated with Reoperation in Breast-Conserving Surgery for Cancer: A Prospective Study of American Society of Breast Surgeon Members

Jeffrey Landercasper et al. Ann Surg Oncol. 2019 Oct.

Erratum in

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® 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.

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Figures

Fig. 1
Fig. 1
Patients and surgeons
Fig. 2
Fig. 2
Intersurgeon variability of reoperation rates after initial breast conserving surgery for breast cancer
Fig. 3
Fig. 3
Overall reoperation rates after initial breast conserving surgery for cancer performed by American Society of Breast Surgeon (ASBrS) members entering cases into the ASBrS Mastery® Patient Registry (2013-2017)
See this image and copyright information in PMC

References

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