Does practice make perfect? Resident experience with breast surgery influences excision adequacy.

Area of Science:

• Oncology
• Surgical Oncology
• Breast Surgery

Background:

• Adequacy of breast-conserving surgery (BCS) is determined by surgical margins.
• The impact of resident involvement on margin status is debated.
• Clinicopathologic features influence margin status in BCS.

Purpose of the Study:

• To evaluate the influence of resident involvement on surgical margin adequacy in BCS.
• To assess the association between clinicopathologic characteristics and margin status.
• To determine if resident experience impacts BCS outcomes.

Main Methods:

• Retrospective review of 502 BCS cases for malignancy from 2009-2012.
• Analysis of clinicopathologic features and resident involvement.
• Evaluation of margin status in relation to resident experience.

Main Results:

• Overall positive margin rate was 30%, not linked to resident involvement.
• Interns from July-September showed significantly lower positive margin rates.
• Positive margins were more frequent in a resident's initial cases compared to later cases.

Conclusions:

• Resident level alone does not affect BCS adequacy.
• Surgical experience gained during a rotation is associated with reduced positive margins.
• Experience over time improves surgical outcomes in BCS.