Wide Local Excision Reoperation Rates at Tameside General

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Wide Local Excision Re-operation Rates at Tameside General Hospital Katie Ludwig FY 1

Wide Local Excision Re-operation Rates at Tameside General Hospital Katie Ludwig FY 1

Background 50, 285 New cases of breast cancer - 2011 11, 716 deaths -

Background 50, 285 New cases of breast cancer - 2011 11, 716 deaths - 2012 78% - 10 year survival rates 27% preventable cases Source: Cancer Research UK

After Diagnosis 58% of women diagnosed with breast cancer opt for breast conserving surgery

After Diagnosis 58% of women diagnosed with breast cancer opt for breast conserving surgery 1 in 5 women with breast cancer who have opted for breast conserving surgery rather than mastectomy go on to have reoperation Source: British Medical Journal (2012)

Wide Local Excision (WLE) 2 mm radial margin of excision is recommended Microscopically review

Wide Local Excision (WLE) 2 mm radial margin of excision is recommended Microscopically review Consider re-excision if margin in <2 mm Source: NICE Guidelines (“Early and Locally Advanced Breast Cancer” 2009 )

Our Benchmark Study 156 NHS trusts 55, 297 women had breast conserving surgery 20%

Our Benchmark Study 156 NHS trusts 55, 297 women had breast conserving surgery 20% had at least one re-operation Reoperation rate - 29. 5% in carcinoma in situ, 18% isolated invasive cancer. 40% underwent further mastectomy Source: (BMJ “Reoperation rates after breast conserving surgery for breast cancer among women in England: retrospective study of hospital episode statistics” 2012)

Collection Method Anonymous data collected from Medway Between: 01/04/2012 - 21/08/2013 The study considered

Collection Method Anonymous data collected from Medway Between: 01/04/2012 - 21/08/2013 The study considered patients who had WLE then went onto have further re-excision Does not count subsequent operation to axilla Only included re-operations ipsilateral to original WLE due to histological finding of close borders and NOT early recurrence

Results 77 patient had WLE 14 (18%) had further surgery (mastectomy or further breast

Results 77 patient had WLE 14 (18%) had further surgery (mastectomy or further breast conserving surgery) 8 (57%) had further excision. 6 (43%) had mastectomy

Of the 14 that had further surgery 11 had bigger tumour on histology than

Of the 14 that had further surgery 11 had bigger tumour on histology than indicated on radiology 1 tumour was smaller on histological review 8 (57%) had cavity shaves on first operation In comparison: 17/63 (27%) who did not have reexcision had cavity shaves

Re-excision: Mastectomy vs. WLE 8 underwent further excision 6 had mastectomy after initial WLE

Re-excision: Mastectomy vs. WLE 8 underwent further excision 6 had mastectomy after initial WLE (43%) Reasons why patient had mastectomy: Two or more close margins on histology (2 cases) Extensive lymph node involvement (2 cases) Large tumour already excised and margins still close (1 case) One case of Squamous cell ca. extending posteriorly

Histology 8 had Invasive Ductal Carcinoma (IDC) 4 had IDC with Ductal Carcinoma In

Histology 8 had Invasive Ductal Carcinoma (IDC) 4 had IDC with Ductal Carcinoma In Situ (DCIS) on either on margin or foci away from main site. 1 case of mucinous carcinoma with DCIS foci away from main lesion 1 case of squamous cell carcinoma

Summary Re-operation rate: 18% Further operation: 43% - mastectomy, 57% - Further breast conserving

Summary Re-operation rate: 18% Further operation: 43% - mastectomy, 57% - Further breast conserving surgery Within the whole study: further excision rate is 10 % and mastectomy rate is 8%

Conclusions Nearly all had tumour sizes were underestimated on radiology Comparable re-operation rates with

Conclusions Nearly all had tumour sizes were underestimated on radiology Comparable re-operation rates with the cohort study Marginally higher mastectomy rates after initial operation Patients the risk of re-operation

Thank You Mr. N Rahman Mr. P Arora Mr. S Ellenbogen Mr. A Dhebri

Thank You Mr. N Rahman Mr. P Arora Mr. S Ellenbogen Mr. A Dhebri Mr. S Sabri

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