Reoperation Rates for Breast Conservation Surgery for Breast Cancer at KKH

Breast conserving surgery (BCS) is one of the surgical options available to the patient. In 2013, 35.9% of the patients operated on for breast cancer at KKH opted to undergo BCS.

BCS seeks to achieve the excision of a cancer with adequate margins while maintaining an acceptable cosmetic outcome. BCS has been found to confer the same survival rate for breast cancer when compared to patients who have undergone a mastectomy.

One of the possible outcomes with BCS is the need for repeat surgery in the event of close or involved surgical margins. Mastectomy gets around this problem by removing almost all the breast tissue such that margins are rarely close or involved.

The reported reoperation rates for close or involved surgical margins vary widely because of the following reasons:

• Different selection and exclusion criteria for patients who undergo BCS
• Difference in tumour biology
• Difference in patient characteristics (e.g. Breast size)
• Different definitions of what constitutes a close margin
• Different ways of managing a close or involved margin (i.e. Some may not be asked to go for reoperation)

Quoted figures for repeat surgery were as high as 48.6%1. A large English study involving 55 297 women found an overall reoperation rate of 20.0%2, although there were significant variations in this rate according to geographic location (10th and 90th centiles 12.2% and 30.2%), and tumour biology (18.0% for isolated invasive disease, compared to 29.5% for carcinoma in situ).

References:

1. Waljee JF, Hu ES, Newman LA, Alderman AK. Predictors of re-excision among women undergoing breast-conserving surgery for cancer. Ann Surg Oncol. 2008;15(5):1297-1303
2. Jeevan R, Cromwell DA, Trivella M, et al. Reoperation rates after breast conserving surgery for breast cancer among women in England: retrospective study of hospital episode statistics. BMJ. 2012;345:e4505.