title: Surgeon Volume, Patient Age, and Tumor-Related Factors Influence the Need for Re-Excision After Breast-Conserving Surgery.
abstract: Breast-conserving surgery (BCS) is the preferred surgical approach for the majority of patients with early-stage breast cancer. There are frequent issues regarding pathologic margin status, requiring margin re-excision, and, in the literature, there is significant variability in re-excision rates, suggesting this is a potential quality-of-care issue. Understanding the patient-, disease-, and physician-related factors influencing reoperation rates is of importance in an effort to minimize this occurrence.
  
  
  
  A retrospective analysis of all patients referred to our cancer center over a 3-year period (1 January 2011-31 December 2013) was performed. Surgeon volume, and patient- and tumor-related factors were assessed for their impact on re-excision rates. Multivariate logistic regression analysis was performed to identify variables of significance influencing reoperation rates after attempted BCS.
  
  
  
  Overall, 594 patients underwent initial BCS, with 159 (26.8%) patients requiring at least one re-excision to ensure negative pathologic margins. On multivariate analysis, low surgeon case volume, patient age (under 46 years of age), tumor size (>2 cm), and lobular carcinoma were associated with an increased re-excision rate.
  
  
  
  Re-excisions are frequent after BCS and are influenced by surgeon volume, patient age, and tumor-related factors. These factors should be considered when counseling patients considering BCS, and also for quality assurance.
authors.affiliation: Department of Surgical Oncology, Sindi Ahluwalia Hawkins Centre for the Southern Interior, BC Cancer Agency, Kelowna, BC, Canada.|University of British Columbia Okanagan, Kelowna, BC, Canada.
authors.forename: L
authors.initials: L
authors.lastname: Hughes
authors.affiliation: Cancer Surveillance and Outcomes, BC Cancer Agency, Vancouver, BC, Canada.
authors.forename: J
authors.initials: J
authors.lastname: Hamm
authors.affiliation: Cancer Surveillance and Outcomes, BC Cancer Agency, Vancouver, BC, Canada.
authors.forename: C
authors.initials: C
authors.lastname: McGahan
authors.affiliation: Department of Surgical Oncology, Sindi Ahluwalia Hawkins Centre for the Southern Interior, BC Cancer Agency, Kelowna, BC, Canada. cbaliski@bccancer.bc.ca.|Department of Surgery, University of British Columbia, Vancouver, BC, Canada. cbaliski@bccancer.bc.ca.
authors.forename: C
authors.initials: C
authors.lastname: Baliski
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery*; D018270:Carcinoma, Ductal, Breast / Q000473:pathology / Q000601:surgery*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000473:pathology / Q000601:surgery*; D018275:Carcinoma, Lobular / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D000072662:Margins of Excision; D015412:Mastectomy, Segmental / Q000706:statistics & numerical data; D008875:Middle Aged; D018365:Neoplasm, Residual; D012086:Reoperation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D000071077:Surgical Oncology / Q000706:statistics & numerical data*; D047368:Tumor Burden