title: Secondary operations are frequently required to complete the surgical phase of therapy in the era of breast conservation and sentinel lymph node biopsy.
abstract: BACKGROUND
  Breast conservation therapy (BCT) is an oncologically equivalent and cosmetically preferable alternative to mastectomy for most early-stage breast cancers. The number of operations required to complete the surgical phase of therapy with BCT has not been widely reported.
  
  
  METHODS
  From our institutional tumor registry, we reviewed the records of all patients receiving primary surgical therapy for breast cancer from January 1, 1998, to June 30, 2002. There were 204 patients with 210 breast cancers in the cohort. These cancers were initially managed with either BCT (n = 150) or mastectomy (modified radical mastectomy or total mastectomy with sentinel lymph node biopsy) (n = 60). We compared the percentages of patients in each group who required additional surgeries to obtain clear margins, manage axillary disease, or otherwise complete the surgical phase of therapy. Patients with secondary surgery related to long-term local recurrence were excluded.
  
  
  RESULTS
  Fifty-one percent of patients initially managed with BCT required additional surgery compared with 12% in the mastectomy group (P <0.05). Factors independently associated with multiple surgeries among all patients included management with BCT (odds ratio [OR] 5.4, P = 0.01) and positive margins at initial excision (OR 4.7, P <0.01). Significant independent predictors of positive margins included BCT (OR 11.9, P <0.01); disease stage (OR 6.7, P <0.01); submission of supplemental margins in addition to the main specimen (OR 2.8, P = 0.03); and positive nodes (OR 1.1, P = 0.04). Breast conservation was ultimately successful in 95% of patients who underwent BCT.
  
  
  CONCLUSIONS
  Patients undergoing BCT may require multiple surgeries to reconcile successful breast conservation with sound oncologic resection.
authors.affiliation: Department of General Surgery, Madigan Army Medical Center, 9040A Reid St., Tacoma, WA 98431-1100, USA.
authors.forename: Philip S
authors.initials: PS
authors.lastname: Mullenix
authors.forename: Daniel G
authors.initials: DG
authors.lastname: Cuadrado
authors.forename: Scott R
authors.initials: SR
authors.lastname: Steele
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Martin
authors.forename: Craig S
authors.initials: CS
authors.lastname: See
authors.forename: Alan L
authors.initials: AL
authors.lastname: Beitler
authors.forename: Preston L
authors.initials: PL
authors.lastname: Carter
mesh_terms: D000368:Aged; D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery; D044584:Carcinoma, Ductal / Q000473:pathology / Q000601:surgery; D018275:Carcinoma, Lobular / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D016015:Logistic Models; D008297:Male; D015411:Mastectomy, Modified Radical / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D015412:Mastectomy, Segmental / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D015413:Mastectomy, Simple / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D008875:Middle Aged; D009367:Neoplasm Staging; D018579:Patient Selection; D011237:Predictive Value of Tests; D012042:Registries; D012086:Reoperation / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D012189:Retrospective Studies; D021701:Sentinel Lymph Node Biopsy / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D016896:Treatment Outcome