Is the reexcision rate higher if breast conservation surgery is performed by surgical trainees?

Moorthy, Krishna; Asopa, Vipin; Wiggins, Elizabeth B.; Callam, M J

doi:10.1016/j.amjsurg.2003.11.041

Cited by 23 publications

(17 citation statements)

References 18 publications

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“…The rates of 13% for incomplete excisions for palpable tumors and 22% for nonpalpable tumors are comparable with rates found in literature. Moorthy et al [ 13 ] reported a re-excision rate of 21% for palpable tumors and 32% for nonpalpable tumors. Regarding re-excisions, Dixon et al [ 11 ] reported on patients with nonpalpable tumors who were operated on by unsupervised residents resulting in a higher rate of re-excisions (57% vs. 4%).…”

Section: Discussionmentioning

confidence: 99%

“…However, no distinction was made in level of experience of the resident. Recently, Moorthy et al [ 13 ] showed no difference in re-excision rates between attending surgeons and residents who were in their final years of training (AS 27.8% and SRs 25.7%). Furthermore, Landheer et al [ 12 ] reported no difference in margin-free resection between surgeons and residents, but made no distinction between palpable and nonpalpable tumors or level of experience of the residents.…”

Section: Discussionmentioning

confidence: 99%

“…These data raise the question of whether surgical residents can safely perform BCT without limiting patient outcome. Limited data are available on the effects of surgical experience on completeness of tumor excision [ 11 – 13 ].…”

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confidence: 99%

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

et al. 2007

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

et al. 2007

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“…Friedman and Pace [12] in their study found no significant difference between residents who were trained on animal models and those who were trained first as the camera operator and progressing to first assistant, without any training on a simulator. [12][13][14][15][16][17] On the other hand, several authors have complained that the laparoscopic generation of surgeons starts their training in biliary surgery without any experience with the open technique; however, less experience in open biliary surgery, apparently, does not influence the safety of LC. [13] As a matter of fact, surgeons who started LC after their residency had a higher rate of biliary complications than did colleagues who learned LC during their residency.…”

Section: Discussionmentioning

confidence: 99%

Role of Ultrasonography in Prediction of Technical Difficulties in Laparosopic Cholecystectomy - Clinical Research

Husain¹,

Firdaus²,

Pathak³

2016

Int. Jour. of Dent. and Med. Spec.

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Background: Laparoscopic surgery widely, known as single incision laparoscopic cholecystectomy (LC), has been proved as the gold standard surgical technique and is now considered the treatment of choice as well as preferred surgical technique in cholecystectomy. The use of laparoscopic technique in cholecystectomy is widely used for cholelithiasis patients. An abdominal ultrasonography (USG) often precedes this surgery and can verify the diagnosis, as well as help in showing possible complications during the perioperative period. Aim: A prospective study was conducted to evaluate the pre-operative with and without (based on clinical fi ndings) USG fi ndings and predictive diffi culties in cholelithiasis patients comparing with surgical fi ndings in LC. The post-operative evaluating criteria were as follows: (1) Duration of surgery, (2) Bleeding, (3) Dissection of Calot's triangle, (4) Dissection of gallbladder wall, (5) Spillage of bile and stone, (6) Diffi culty of gall bladder stone. Methods: We studied and evaluated surgical diffi culties in 150 patients of cholelithiasis who underwent abdominal USG test for surgical LC. Variables such as identifi cation and amount of gallstones involved were evaluated, both in preoperative USG and during surgery to evaluate sensitivity, specifi city, concordance and positive and negative predictive values. All patients had routine blood tests (including liver function tests), electrocardiography, chest X-ray, and abdominal ultrasound scan performed preoperatively. All patients received general anesthesia, and the standard Reddick and Olsen technique was performed. The harmonic scalpel was used in all cases. Results: On evaluation of surgical diffi culties in cholelithiasis patients, we found 135 females and 15 males for surgical LC. Out of which 36 (24.0%) cases to be predicted as diffi cult, 26 (17.33%) were laparoscopic converted for open surgery, 36 (24.0%) were technically diffi cult. 54 (36.0%) cases were predicted easy to perform on USG. On evaluation, our fi ndings were found to be signifi cant, and hence, we concluded that pre-operative ultrasound examination if of importance for predicting diffi culties in LC, but still required further studies.

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“…The common conception is the more junior is the operating surgeon, the wider is the surgical margin or higher chance of surgical margin to be involved. Few studies have indicated that an experienced surgeon plays major role in the outcome of BCS with lower local recurrence and better long-term survival (4,5,6). Thus…”

Section: Introductionmentioning

confidence: 99%

Surgeons’ Experience In Breast Conserving Surgery: Does It Influence Surgical Margin?

Suhaimi¹

2016

JSA

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A surgeon's experience plays an important role in breast conserving surgery (BCS). The common conception is that, the more junior is the operating surgeon, the surgical margin will be wider or closer to the tumour edge. Thus the aim of this study is to look into the adequacy of surgical margin performed by different level of surgeons' experience in patients whom underwent wide local excision (WLE) and hook-wire localization (HWL) in our surgical unit. The surgical experience of the operating surgeon and their surgical margins will be analyzed. This is a retrospective study from January 2000 to December 2012. Eighty-eight patients with early breast cancer underwent WLE and HWL by 3 different groups of surgeons (breast surgeons, junior surgeons and surgical registrars) were included. The surgical margins were analyzed for involved-margin, closed-margin or excessed-margin.The incidence of involved-margin, closed-margin and excessed-margin is the lowest among breast surgeons compared to other groups. However, the results were not statistically significant. The incidence of involved surgical margin is significantly higher within junior surgeons for HWL compared to the breast surgeons. The incidence of involved, closed or excessed surgical margin were lowest when performed by breast surgeon but not significantly different between the three groups. However, for HWL the breast surgeons significantly better compared to the other groups.

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Is the reexcision rate higher if breast conservation surgery is performed by surgical trainees?

Cited by 23 publications

References 18 publications

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

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

Role of Ultrasonography in Prediction of Technical Difficulties in Laparosopic Cholecystectomy - Clinical Research

Surgeons’ Experience In Breast Conserving Surgery: Does It Influence Surgical Margin?

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