Awareness of residents’ technical ability can affect margin status in breast conserving operations

• Published in: Breast cancer research and treatment 2019-10, Vol.177 (3), p.561-568
• Main Authors: VanderVelde, Joel, Walters, Jarvis W., Hsu, Chiu-Hsieh, Ferguson, Elizabeth M. N., Lee, Jennifer, Caruso, Daniel M., Komenaka, Ian K.
• Format: Article
• Language: English
• Subjects: Adult; Breast; Breast cancer; Breast Neoplasms - epidemiology; Breast Neoplasms - pathology; Breast Neoplasms - surgery; Cancer research; Clinical Competence; Female; Humans; Lumpectomy; Margins of Excision; Mastectomy, Segmental - methods; Mastectomy, Segmental - standards; Medicine; Medicine & Public Health; Middle Aged; Neoplasm Grading; Neoplasm Metastasis; Neoplasm Staging; Oncology; Prognosis; Regression analysis; Review; Surgeons; Treatment Outcome
• ISSN: 0167-6806; 1573-7217
• DOI: 10.1007/s10549-019-05344-3

Purpose The current study was performed to determine if awareness of the potential affect of residents could affect margin status. Methods Retrospective review of all patients who underwent lumpectomy from July 2006 to May 2017 was evaluated. The effect of surgical residents’ participation and their technical ability was evaluated to determine the effect on margin status. Logistic regression analysis was performed to determined factors which affect margin status. Results Of 444 patients, 14% of patients had positive margins. The positive margin rate was lower during the second time period after the effect of technical ability of the residents was known 12% versus 19% ( p  = 0.10). Greater participation by the attending surgeon (32% vs. 21%) occurred in the second time period. In multivariate logistic regression analysis, operations done by residents with satisfactory technical skills or attending surgeon were less likely to have positive margins than those done by residents with unsatisfactory technical skills (OR 0.19, 95% CI 0.10–0.38; p  = 0.0001). With mean follow-up of 48 months, 1.4% had local recurrences as a first event. Conclusions Technically ability of residents appears to affect margin status after lumpectomy. Increased intervention by the attending surgeon can improve this outcome.