TITLE:
Variability in Surgical Quality among Surgeons in Breast Cancer Surgery
AUTHORS:
S. G. D. Gangadaran
KEYWORDS:
Breast Cancer, Surgical Quality, Mastectomy
JOURNAL NAME:
Advances in Breast Cancer Research,
Vol.5 No.4,
August
29,
2016
ABSTRACT: Introduction:
Quality assurance is an essential aspect of cancer care. Assessment of surgical quality in breast cancer is still evolving.
Variability in surgical care among surgeons has been well documented in
literature and we sought to investigate such variation between two groups of
surgeons referring patients to our oncology center. Methods: A prospective
review of patient records of all breast cancer referrals to our department was
made. Two groups were identified and segregated based on the performance of
mastectomy by a general surgeon (GS) or by a surgical oncologist (SO). Patients
treated with modified radical mastectomy for clinical stages 1 - 3 were included
for the study. Patient demographic data and disease related information were
collected in addition to thorough evaluation of the surgical pathology report.
Margin positivity, mean nodal harvest, nodal ratio, inadequate axillary
clearance, revision surgery and the use of radiotherapy for inadequate nodal
dissection were the parameters evaluated in the study. Results: A total of 142
patient records were evaluated 72 designated as group 1 (general surgeons) and 70 as group 2 (surgical oncologist). The median age was 52 years and
both groups were evenly balanced for age, laterality of breast lesion,
histological type and grade. The mean nodal
harvest was 8 vs. 14 nodes, and significant
differences were observed in favor of surgical oncology group in margin
positivity (P = 0.01), inadequate
axillary clearance (P = 0.0001), and requirement of radiotherapy for inadequate
axillary clearance (P = 0.0001) but not for revision surgery (P = 0.134). An
assessment of prognostic factors revealed both groups to be well balanced for
confounding factors. Conclusion: Breast cancer surgical care is amenable to
quality assessment. Variation in oncological clearance exists between surgical
oncologist and non-oncology
trained surgeons involved in mastectomy for breast cancer. An assessment of factors leading to the observed quality
differences may be addressed in future trials to ensure optimal breast cancer
care.