可触及和不可触及乳腺癌的保乳治疗：外科住院医师无论经验如何都能胜任这项工作吗？
Breast-conserving therapy for palpable and nonpalpable breast cancer: can surgical residents do the job irrespective of experience?
作者信息
Cleffken Berry, Postelmans Job, Olde Damink Steven, Nap Marius, Schreutelkamp Ineke, van der Bijl Hans
机构信息
Department of Surgery, Academic Hospital Maastricht, Maastricht, The Netherlands.
Department of Surgery, Academic Hospital Maastricht, P.O. Box 5800, 6202, AZ, Maastricht, The Netherlands.
出版信息
World J Surg. 2007 Sep;31(9):1731-1736. doi: 10.1007/s00268-007-9176-2.
BACKGROUND
The aim of this study was to evaluate the influence of operative experience in obtaining tumor-free margins in breast-conserving therapy. In the case of palpable breast cancers, lumpectomies can safely be performed by any surgical resident. For nonpalpable breast cancers, lumpectomies should be treated only by senior residents or attending surgeons, even if supervision during the operation is given by an attending surgeon for junior residents. Radicality of breast carcinoma excision, defined by the tumor-free margin of the removed specimen has been determined to be the major prognostic factor for local recurrence. The aim of this study was to evaluate the influence of operative experience in obtaining tumor-free margins in breast-conserving therapy (BCT). Can lumpectomy for breast carcinoma be performed by surgical residents safely?
METHODS
All lumpectomies for breast carcinoma between 1999 and 2003 were included out of a prospective database of a single institution. Radicality of resection and patient and histopathologic tumor characteristics were analyzed for 660 lumpectomies. Operative experience of the surgeon performing the lumpectomy was staged as junior residents (JR, years 1-3 in residency), senior residents (SR; years 4-6 in residency), and attending surgeon (AS).
RESULTS
A significant difference in obtaining tumor-free margins for palpable tumors was found between ASs (81%) vs. SRs assisted by another resident (92%). For nonpalpable tumors, a significant difference was found in two groups: (1) SRs assisted by another surgical resident (86%) vs. JRs assisted by another surgical resident (61%) and (2) ASs (83%) vs. JRs assisted by another resident (61%) or assisted by an AS (73%).
CONCLUSION
Surgical residents can safely perform BCT in patients with palpable breast cancer. The level of experience has no statistical significance for palpable tumors in a high-volume center. Nonpalpable lesions should be treated only by SRs or ASs.
背景
本研究旨在评估手术经验对保乳治疗中获得切缘阴性的影响。对于可触及的乳腺癌，任何外科住院医师均可安全地实施肿块切除术。对于不可触及的乳腺癌，即使初级住院医师在手术中有主治医生监督，肿块切除术也应由高级住院医师或主治医生实施。已确定以切除标本的切缘阴性来定义的乳腺癌切除彻底性是局部复发的主要预后因素。本研究的目的是评估手术经验对保乳治疗（BCT）中获得切缘阴性的影响。外科住院医师能否安全地实施乳腺癌肿块切除术？
方法
从单一机构的前瞻性数据库中纳入1999年至2003年间所有乳腺癌肿块切除术病例。对660例肿块切除术的切除彻底性以及患者和组织病理学肿瘤特征进行分析。实施肿块切除术的外科医生的手术经验分为初级住院医师（JR，住院第1 - 3年）、高级住院医师（SR；住院第4 - 6年）和主治医生（AS）。
结果
在获得可触及肿瘤的切缘阴性方面，主治医生（81%）与由另一名住院医师协助的高级住院医师（92%）之间存在显著差异。对于不可触及的肿瘤，两组间存在显著差异：（1）由另一名外科住院医师协助的高级住院医师（86%）与由另一名外科住院医师协助的初级住院医师（61%）；（2）主治医生（83%）与由另一名住院医师协助的初级住院医师（61%）或由主治医生协助的初级住院医师（73%）。
结论
外科住院医师可以安全地对可触及乳腺癌患者实施保乳治疗。在大容量中心，经验水平对可触及肿瘤无统计学意义。不可触及的病变应由高级住院医师或主治医生治疗。
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