New England Surgical Society

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Re-excision rates after breast conserving therapy: quality metric or cost?
*David J Linshaw
Dartmouth Hitchcock, Hanover, NH

Objective: Re-excision rate after breast conserving therapy (BCT) has been proposed as a quality metric for breast surgery. Due to lack of precise localization at the time of re-excision, we hypothesize that local regional recurrence in this population may be higher than in patients who do not require re-excision. We aim to determine if re-excision for positive or close margins compromises true oncologic quality, as measured by local regional recurrence. Design: Single institution, retrospective cohort. Setting: Tertiary academic medical center. Patients: Patients treated between 2000 and 2012 with partial mastectomy and radiation for either DCIS or IDC. Interventions: Re-excision. Main Outcome Measures: Local recurrence. Results: We reviewed a total of 1439 patients who underwent partial mastectomy with radiation in the study period: 1118 patients with invasive cancer and 321 with DCIS. Overall re-excision rate was 37.7%. The local regional recurrence rate was significantly higher for patients undergoing re-excision compared to those who did not require re-excision (6.1% vs 3.2%; p=0.01). Subgroup analysis reinforced that re-excision for positive margin was associated with higher recurrence rates for patients with invasive breast cancer (5.6% vs 3.1% p =.04) and with DCIS (7.5% vs 3.2% p =.07). Conclusions: In this single institution study, re-excision was associated with increased local regional recurrence in women who undergo BCT. Further investigation into risk factors for re-excision, multivariate analysis to help control for bias, and larger studies assessing the oncologic and cosmetic impact of re-excision are warranted in order to confirm whether re-excision is a valid quality metric in breast cancer surgery.


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