title: Teaching residents may affect the margin status of breast-conserving operations.
abstract: OBJECTIVE
  The current study was performed to evaluate the effects of teaching surgical residents on the margin status after lumpectomy.
  
  
  METHODS
  A retrospective review of all patients from July 2006 to Nov 2009 was performed. The impact of the technical ability of surgical residents to perform lumpectomy was evaluated to determine if there was an effect on the margin status. A logistic regression analysis was performed to adjust for clinical variables known to affect the margin status.
  
  
  RESULTS
  Of 106 patients, 19% had positive margins. Residents with unsatisfactory technical skills had a positive margin rate of 34% compared to 8% for residents with satisfactory skills (p = 0.004). In the multivariate logistic regression analysis, the operating surgeon remained significantly associated with a positive margin status. Operations performed by residents with satisfactory technical skills or by attending surgeons were less likely to have positive margins than those performed by residents with unsatisfactory technical skills (OR 0.26, 95% CI 0.08-0.86; p = 0.03). After a mean follow-up of 60 months, the breast cancer-specific survival rate was 94%, and there were no local recurrences as a first event.
  
  
  CONCLUSIONS
  The technical ability of residents may affect the margin status after lumpectomy. The importance of teaching surgical residents needs to be considered in future quality of care evaluations.
authors.affiliation: Department of Surgery, Maricopa Medical Center, Hogan Building, 2nd Floor, 2601 E Roosevelt Street, Phoenix, AZ, 85008, USA.
authors.forename: Gina R
authors.initials: GR
authors.lastname: Shirah
authors.affiliation: Arizona Cancer Center, University of Arizona, Tucson, AZ, USA.|Mel and Enid Zuckerman Arizona College of Public Health, University of Arizona, Tucson, AZ, USA.
authors.forename: Chiu-Hsieh
authors.initials: CH
authors.lastname: Hsu
authors.affiliation: Department of Surgery, Maricopa Medical Center, Hogan Building, 2nd Floor, 2601 E Roosevelt Street, Phoenix, AZ, 85008, USA.
authors.forename: Meredith A
authors.initials: MA
authors.lastname: Heberer
authors.affiliation: Department of Surgery, Maricopa Medical Center, Hogan Building, 2nd Floor, 2601 E Roosevelt Street, Phoenix, AZ, 85008, USA.
authors.forename: Lauren I
authors.initials: LI
authors.lastname: Wikholm
authors.affiliation: Banner Boswell Memorial Hospital, Sun City, AZ, USA.
authors.forename: Jonathan J
authors.initials: JJ
authors.lastname: Goodman
authors.affiliation: Department of Surgery, Maricopa Medical Center, Hogan Building, 2nd Floor, 2601 E Roosevelt Street, Phoenix, AZ, 85008, USA.
authors.forename: Marcia E
authors.initials: ME
authors.lastname: Bouton
authors.affiliation: Department of Surgery, Maricopa Medical Center, Hogan Building, 2nd Floor, 2601 E Roosevelt Street, Phoenix, AZ, 85008, USA. Komenaka@hotmail.com.|Arizona Cancer Center, University of Arizona, Tucson, AZ, USA. Komenaka@hotmail.com.
authors.forename: Ian K
authors.initials: IK
authors.lastname: Komenaka
mesh_terms: D000328:Adult; D000368:Aged; D001940:Breast / Q000601:surgery*; D001943:Breast Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D002983:Clinical Competence / Q000706:statistics & numerical data*; D004503:Education, Medical, Graduate; D005260:Female; D013502:General Surgery / Q000193:education*; D006801:Humans; D007396:Internship and Residency; D016015:Logistic Models; D015412:Mastectomy, Segmental / Q000193:education*; D008875:Middle Aged; D009367:Neoplasm Staging; D059351:Organ Sparing Treatments / Q000706:statistics & numerical data*; D011787:Quality of Health Care; D012189:Retrospective Studies
keywords: Lumpectomy; Margin; Resident; Teaching; Technical ability