Department of Surgery, Maricopa Medical Center, Hogan Building, 2nd Floor, 2601 E Roosevelt Street, Phoenix, AZ, 85008, USA.
Arizona Cancer Center, University of Arizona, Tucson, AZ, USA.
Breast Cancer Res Treat. 2019 Oct;177(3):561-568. doi: 10.1007/s10549-019-05344-3. Epub 2019 Jul 10.
The current study was performed to determine if awareness of the potential affect of residents could affect margin status.
Retrospective review of all patients who underwent lumpectomy from July 2006 to May 2017 was evaluated. The effect of surgical residents' participation and their technical ability was evaluated to determine the effect on margin status. Logistic regression analysis was performed to determined factors which affect margin status.
Of 444 patients, 14% of patients had positive margins. The positive margin rate was lower during the second time period after the effect of technical ability of the residents was known 12% versus 19% (p = 0.10). Greater participation by the attending surgeon (32% vs. 21%) occurred in the second time period. In multivariate logistic regression analysis, operations done by residents with satisfactory technical skills or attending surgeon were less likely to have positive margins than those done by residents with unsatisfactory technical skills (OR 0.19, 95% CI 0.10-0.38; p = 0.0001). With mean follow-up of 48 months, 1.4% had local recurrences as a first event.
Technically ability of residents appears to affect margin status after lumpectomy. Increased intervention by the attending surgeon can improve this outcome.
本研究旨在确定对住院医师潜在影响的认识是否会影响切缘状态。
回顾性分析 2006 年 7 月至 2017 年 5 月期间所有接受保乳手术的患者。评估手术住院医师的参与及其技术能力的影响，以确定对切缘状态的影响。采用逻辑回归分析确定影响切缘状态的因素。
在 444 例患者中，有 14%的患者存在阳性切缘。在住院医师技术能力的影响被知晓后的第二期，阳性切缘率较低，为 12%，而第一期为 19%（p=0.10）。第二期手术时，主治外科医生的参与度更高（32%比 21%）。多变量逻辑回归分析显示，技术熟练的住院医师或主治外科医生进行的手术发生阳性切缘的可能性低于技术不熟练的住院医师（OR 0.19，95%CI 0.10-0.38；p=0.0001）。平均随访 48 个月后，有 1.4%的患者首次出现局部复发。
住院医师的技术能力似乎会影响保乳手术后的切缘状态。主治外科医生的更多干预可以改善这一结果。
