Breast‐conserving Therapy for Palpable and Nonpalpable Breast Cancer: Can Surgical Residents Do the Job Irrespective of Experience?

Abstract

Background The aim of this study was to evaluate the influence of operative experience in obtaining tumor-free margins in breast-conserving therapy. In the case of palpable breast cancers, lumpectomies can safely be performed by any surgical resident. For nonpalpable breast cancers, lumpectomies should be treated only by senior residents or attending surgeons, even if supervision during the operation is given by an attending surgeon for junior residents. Radicality of breast carcinoma excision, defined by the tumor-free margin of the removed specimen has been determined to be the major prognostic factor for local recurrence. The aim of this study was to evaluate the influence of operative experience in obtaining tumor-free margins in breast-conserving therapy (BCT). Can lumpectomy for breast carcinoma be performed by surgical residents safely? Methods All lumpectomies for breast carcinoma between 1999 and 2003 were included out of a prospective database of a single institution. Radicality of resection and patient and histopathologic tumor characteristics were analyzed for 660 lumpectomies. Operative experience of the surgeon performing the lumpectomy was staged as junior residents (JR, years 1-3 in residency), senior residents (SR; years 4-6 in residency), and attending surgeon (AS). Results A significant difference in obtaining tumor-free margins for palpable tumors was found between ASs (81%) vs. SRs assisted by another resident (92%). For nonpalpable tumors, a significant difference was found in two groups: (1) SRs assisted by another surgical resident (86%) vs. JRs assisted by another surgical resident (61%) and (2) ASs (83%) vs. JRs assisted by another resident (61%) or assisted by an AS (73%). Conclusion Surgical residents can safely perform BCT in patients with palpable breast cancer. The level of experience has no statistical significance for palpable tumors in a high-volume center. Nonpalpable lesions should be treated only by SRs or ASs.In the past decades screening mammography has become widely used so, consequently, tumors are being detected at earlier stages. Earlier detection of malignant breast tumors results in an increase in the incidence of small tumors. Breast-conserving therapy (BCT) has become a possible treatment option for most breast tumors. Large prospective randomized trials demonstrate a similar survival rate for breast cancer patients treated with BCT or radical mastectomy, making BCT the treatment standard [1,2].Patients treated with BCT carry the lifelong risk of local recurrence, which occurs at or near the surgical site Berry Cleffken and Job Postelmans have contributed equally to this work.

Surgical Outcome of Patients with Core-Biopsy-Proven Nonpalpable Breast Carcinoma: A Large Cohort Follow-Up Study

“…Dedicated breast surgeons obtain more tumor-free margins and perform less initial mastectomies than surgical residents or general surgeons. 27 , 28 As in this study both general and dedicated breast surgeons performed the BCS and mastectomies, possibly the number of tumor-free margins was lower and the number of initial mastectomies was higher than when only dedicated breast surgeons participated. 28 The overall number of days until all tumorous tissue was removed was 28 and differed significantly between in situ carcinomas and invasive carcinomas: 25 versus 38 days ( p = 0.0001).…”

Ultrasound-guided wire localization of lesions detected on screening mammography in Osogbo, Nigeria and its impact on breast conservative surgery

“…This is in contrast to 25 excisions suggested by another study. [19] The complication rate in this study is rather high but this could be due to the learning curve. Cosmesis particularly BD or flattening was noticed to be a problem particularly when the surgery involves the central area of the breast.…”

Breast Education in General Surgery Residency

“…It has been shown in one study that patients with palpable tumors are less likely to have a positive margin if an attending or senior resident (who should have a larger case number) performs their breast conserving surgery as opposed to a junior resident. 4 Further diminishing the quality of breast training is that most breast surgery is performed in the junior years of residency, with residents performing little breast surgery during their senior years of residency. 5 This study reports a survey of a convenience sample of general surgery trainees applying to one fellowship program in surgical oncology.…”