Moorthy Krishna, Asopa Vipin, Wiggins Elizabeth, Callam Michael
Breast Care Unit, Department of Surgery, Bedford Hospital, Bedford, MK42 9DJ, United Kingdom.
Am J Surg. 2004 Jul;188(1):45-8. doi: 10.1016/j.amjsurg.2003.11.041.
It is essential that surgical trainees obtain adequate operative experience without compromising patient outcome. The aim of this study was to compare the reexcision and local recurrence rates between consultants (attending surgeons) and surgical trainees (residents) after breast conservation surgery.
Prospective data were obtained from the local breast cancer registry for all patients who had breast-conservation surgery between 1994 and 2000. Reexcision was carried out if the margins were deemed inadequate after taking the clinical and pathologic features into consideration.
The primary operation (n = 505) was wide local excision = 377; wire-guided excisions = 107; and quadrantectomy = 21 patients. Sixty-five percent (n = 330) were operated on by consultants and 35% (n = 175) by residents. Second procedures (n = 137) were performed for involved margins in 95 and close margins in 31 patients. The patients in both groups were equally matched. The reexcision rate was similar for both groups of surgeons (P = 0.58). On multivariate analysis, the factors determining reexcision were nodal status, type of first procedure, and tumor type. The local recurrence rate was comparable in both groups (P = 0.33).
In patients with breast cancer treated by conservation surgery during a 7-year period, the reexcision and local recurrence rates were similar for both groups of surgeons.
外科住院医师必须获得足够的手术经验，同时又不影响患者的治疗结果。本研究的目的是比较保乳手术后顾问医师（主治外科医生）和外科住院医师（住院医生）的再次切除率和局部复发率。
从当地乳腺癌登记处获取1994年至2000年间所有接受保乳手术患者的前瞻性数据。在综合考虑临床和病理特征后，如果切缘被认为不充分，则进行再次切除。
初次手术（n = 505）包括广泛局部切除 = 377例；钢丝引导切除 = 107例；象限切除 = 21例患者。65%（n = 330）由顾问医师进行手术，35%（n = 175）由住院医生进行手术。137例二次手术中，95例因切缘受累，31例因切缘接近而进行。两组患者情况相当。两组外科医生的再次切除率相似（P = 0.58）。多因素分析显示，决定再次切除的因素为淋巴结状态、初次手术类型和肿瘤类型。两组的局部复发率相当（P = 0.33）。
在7年期间接受保乳手术治疗的乳腺癌患者中，两组外科医生的再次切除率和局部复发率相似。
