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Surgical Technique and Time to Adjuvant Chemotherapy in Breast Cancer Patients
Anees Chagpar1, Donald Lannin1, *Fangyong Li1, *Nina Horowitz1, *Brigid Killelea1, *Theodore Tsangaris2, *Tara Sanft1, *Malini Harigopal1, *Xiaopan Yao1, *Maysa Abu-Khalaf1, *Erin Hofstatter1, *Veerle Bossuyt1, *Lajos Pusztai1
1Yale University, New Haven, CT;2Thomas Jefferson University, Philadephia, PA

Objective: Time to adjuvant chemotherapy (aCTx) affects survival in women with breast cancer and is an accepted quality metric. We sought to determine whether surgical techniques which reduce re-excision rate improve time to aCTx.
Design: Randomized controlled trial
Setting: Academic medical center
Patients: 235 patients with stage 0-3 breast cancer undergoing standard partial mastectomy (SPM) participated in this trial. 62 (26.3%) received aCTx, 4 had neoadjuvant therapy. The remaining 58 patients formed the cohort of interest.
Interventions: Patients were randomized to undergo routine cavity shave margins (CSM) vs. SPM
Main outcome measures: Time to aCTx
Results: Median time to aCTx was 42.5 days (range; 20 - 97). Patients requiring re-excision had a significantly longer time to aCTx (median 40 vs. 50 days, p=0.025). While resection of CSM was associated with a reduced re-excision rate (10.9% vs. 27.6%, p=0.001), this did not translate into a shorter time to aCTx (median 47.5 vs. 41.0 days, p=0.474). 12 (20.7%) patients received aCTx within 30 days; only 1 patient (1.6%) had aCTx > 90 days from surgery. Factors significantly associated with time to aCTx ≥ 30 days included ER+ status (85.7% vs. 57.1%, p=0.05), ductal histology (p=0.03) and need for re-excision (100% vs. 73.3%, p=0.05). Resection of CSM resulted in ~5% more patients receiving aCTx within 30 days of surgery, but this did not reach statistical significance (23.3% vs. 17.9%, p=0.749). Size and grade of invasive cancer, lymph node status, patient age, race, ethnicity, BMI, and insurance status were not associated with time to aCTx.
Conclusion: Re-excisions delay aCTx, but techniques such as excision of CSM may not reduce the re-excision rate significantly enough to impact time to aCTx.


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