title: Association between operative closure type and acute infection, local recurrence, and disease surveillance in patients undergoing breast conserving therapy for early-stage breast cancer.
abstract: BACKGROUND
  This study investigates the effect of full-thickness versus superficial closure of the breast parenchyma on the likelihood of subsequent infection and local recurrence after lumpectomy for early-stage breast cancer. In patients undergoing breast-conserving therapy (BCT), operative closure technique has been largely influenced by expected cosmetic outcome. However, the common practice of promoting postoperative fluid collection raises concerns about potential bacterial colonization, tumor cell migration, and impaired post-BCT surveillance.
  
  
  METHODS
  From 1985 through 2004, operative closure technique was determined in 516 breasts in 580 women with stage T0-2N0-1 breast cancers undergoing BCT. Medical records were reviewed to determine closure technique, incidence of postoperative infection, and local recurrence characteristics.
  
  
  RESULTS
  Median follow-up was 6.4 years from the completion of radiotherapy. The rate of acute infection was higher with the superficial closure technique: 11.7% (27/230) versus 5.2% (15/286) (P = .009). In T1-2 patients, there was no difference in the rate of local recurrence based on closure type: 5.6% (11/195) versus 3.5% (8/231) (P = .348). On multivariate analysis, acute infections and margin status were associated with increased local recurrence. Superficial closure was associated with larger recurrences less likely to be detected on mammogram. In stage T0-T2 patients, 80% of recurrent tumors after superficial closures were greater than 1 cm compared with no recurrent tumors greater than 1 cm after full-thickness closures (P = .005). In patients with superficial closure, 29% of recurrences in the tumor bed were initially detected on mammogram versus 100% in patients with deep closure (P = .003).
  
  
  CONCLUSIONS
  Closure method was not predictive of local recurrence. Our findings regarding infection and post-treatment surveillance suggest, however, that full-thickness closure may be the preferred technique in BCT patients.
authors.affiliation: University of Florida College of Medicine, Department of Radiation Oncology, Gainesville, FL 32610-0385, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Indelicato
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Grobmyer
authors.forename: Heather
authors.initials: H
authors.lastname: Newlin
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Morris
authors.forename: Linda S
authors.initials: LS
authors.lastname: Haigh
authors.forename: Edward M
authors.initials: EM
authors.lastname: Copeland
authors.forename: Nancy Price
authors.initials: NP
authors.lastname: Mendenhall
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000601:surgery*; D005260:Female; D006801:Humans; D015412:Mastectomy, Segmental / Q000009:adverse effects / Q000379:methods*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000209:etiology*; D013530:Surgical Wound Infection / Q000209:etiology*; D013536:Suture Techniques / Q000009:adverse effects*