Srour Marissa K, Manguso Nicholas, Mirocha James, Chung Alice, Giuliano Armando E, Amersi Farin
Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California.
Research Institute, Clinical and Translational Science Institute (CTSI), Cedars-Sinai Medical Center, Los Angeles, California.
J Surg Educ. 2020 Jan-Feb;77(1):144-149. doi: 10.1016/j.jsurg.2019.07.014. Epub 2019 Aug 1.
Few studies examine the impact of surgical trainee involvement on tumor-free margins in breast conserving surgery (BCS). Our objective was to investigate the impact of resident and fellow involvement on positive margins rates following BCS for invasive breast cancer (BC).
We identified female patients who had BCS for BC between January 2005 to December 2015.
Tertiary care hospital.
Around 1089 patients were identified from a prospectively maintained database.
Of 1089 patients, mean age was 63 (range 43-99) years. Around 768 patients (70.1%) required preoperative localization, and 328 patients (29.9%) had a palpable cancer. Nonpalpable cancers had a smaller volume of specimen tissue excised (p = 0.0005) compared to palpable cancers, and no significant difference was observed in the positive margin rate between the nonpalpable group compared to the palpable group (24.7% nonpalpable vs. 25.3% palpable, p = 0.88). Nonpalpable cancer positive margin rates were 23.9% (n = 102/427) for cases performed by an attending surgeon, 25.0% (n = 15/60) with a junior resident (PGY 2-3), 28.6% (n = 8/28) with a senior resident (PGY 4-5), and 25.7% (n = 65/253) with a fellow, which were not statistically significant (p = 0.89). Palpable cancer positive margin rates were 27.6% (n = 47/170) for cases performed by an attending, 13.9% (n = 5/36) with an intern (PGY-1), 40.9% (n = 9/22) with a junior resident, 0% (n = 0/8) with a senior resident, and 23.9% (n = 22/92) with a fellow, which were also not significantly different (p = 0.07).
Resident and fellow participation in BCS for BC does not appear to impact the rate of positive margins.
很少有研究探讨外科住院医师参与保乳手术（BCS）对切缘无癌状态的影响。我们的目的是调查住院医师和专科住院医师的参与对浸润性乳腺癌（BC）保乳手术后切缘阳性率的影响。
我们确定了2005年1月至2015年12月期间接受保乳手术治疗乳腺癌的女性患者。
三级医疗医院。
从一个前瞻性维护的数据库中识别出约1089例患者。
1089例患者的平均年龄为63岁（范围43 - 99岁）。约768例患者（70.1%）需要术前定位，328例患者（29.9%）可触及肿块。与可触及肿块的癌症相比，不可触及肿块的癌症切除的标本组织体积较小（p = 0.0005），不可触及肿块组与可触及肿块组的切缘阳性率无显著差异（不可触及肿块组为24.7%，可触及肿块组为25.3%，p = 0.88）。由主治医生进行的不可触及肿块癌症病例的切缘阳性率为23.9%（n = 102/427），初级住院医师（PGY 2 - 3）参与的为25.0%（n = 15/60），高级住院医师（PGY 4 - 5）参与的为28.6%（n = 8/28），专科住院医师参与的为25.7%（n = 65/253），差异无统计学意义（p = 0.89）。可触及肿块癌症病例由主治医生进行的切缘阳性率为27.6%（n = 47/170），实习医师（PGY - 1）参与的为13.9%（n = 5/36），初级住院医师参与的为40.9%（n = 9/22），高级住院医师参与的为0%（n = 0/8），专科住院医师参与的为23.9%（n = 22/92），差异也无统计学意义（p = 0.07）。
住院医师和专科住院医师参与乳腺癌保乳手术似乎不会影响切缘阳性率。
