Reoperation rates after breast conserving surgery for breast cancer among women in England: retrospective study of hospital episode statistics
Top Cited Papers
Open Access
- 12 July 2012
- Vol. 345 (jul12 2), e4505
- https://doi.org/10.1136/bmj.e4505
Abstract
Objectives To examine whether rate of reoperation after breast conserving surgery is associated with patients’ characteristics and investigate whether reoperation rates vary among English NHS trusts. Design Cohort study using patient level data from hospital episode statistics. Setting English NHS trusts. Participants Adult women who had breast conserving surgery between 1 April 2005 and 31 March 2008. Main outcome measure Reoperation rates after primary breast conserving surgery within 3 months, adjusted using logistic regression for tumour type, age, comorbidity, and socioeconomic deprivation. Tumours were grouped by whether a carcinoma in situ component was coded at the time of the primary breast conserving surgery. Results 55 297 women had primary breast conserving surgery in 156 NHS trusts during the three year period. 11 032 (20.0%, 95% confidence interval 19.6% to 20.3%) women had at least one reoperation. 10 212 (18.5%, 18.2% to 18.8%) had one reoperation only; of these, 5943 (10.7%, 10.5% to 11.0%) had another breast conserving procedure and 4269 (7.7%, 7.5% to 7.9%) had a mastectomy. Of the 45 793 women with isolated invasive disease, 8229 (18.0%) had at least one reoperation. In comparison, 2803 (29.5%) of the 9504 women with carcinoma in situ had at least one reoperation (adjusted odds ratio 1.9, 95% confidence interval 1.8 to 2.0). Substantial differences were found in the adjusted reoperation rates among the NHS trusts (10th and 90th centiles 12.2% and 30.2%). Conclusion: One in five women who had breast conserving surgery in England had a reoperation. Reoperation was nearly twice as likely when the tumour had a carcinoma in situ component coded. Women should be informed of this reoperation risk when deciding on the type of surgical treatment of their breast cancer.This publication has 28 references indexed in Scilit:
- Re-resection rates after breast-conserving surgery as a performance indicator: Introduction of a case-mix model to allow comparison between Dutch hospitalsEuropean Journal of Surgical Oncology, 2011
- Presence of an in situ component is associated with reduced biological aggressiveness of size-matched invasive breast cancerBritish Journal of Cancer, 2010
- Radiological and pathological size estimations of pure ductal carcinoma in situ of the breast, specimen handling and the influence on the success of breast conservation surgery: a review of 2564 cases from the Sloane ProjectBritish Journal of Cancer, 2010
- Standardized and reproducible methodology for the comprehensive and systematic assessment of surgical resection margins during breast-conserving surgery for invasive breast cancerBMC Cancer, 2009
- Obtaining Adequate Surgical Margins in Breast-Conserving Therapy for Patients with Early-Stage Breast Cancer: Current Modalities and Future DirectionsAnnals of Surgical Oncology, 2009
- Estimates of the cancer incidence and mortality in Europe in 2006Annals Of Oncology, 2007
- Association of Clinical and Pathologic Variables with Lumpectomy Surgical Margin Status after Preoperative Diagnosis or Excisional Biopsy of Invasive Breast CancerAnnals of Surgical Oncology, 2007
- The Role of Reexcision for Positive Margins in Optimizing Local Disease Control After Breast-Conserving Surgery for CancerThe Breast Journal, 2006
- Factors Associated With Residual Breast Cancer After Re-excision for Close or Positive MarginsAnnals of Surgical Oncology, 2004
- Blood pressure, stroke, and coronary heart disease *1Part 1, prolonged differences in blood pressure: prospective observational studies corrected for the regression dilution biasThe Lancet, 1990