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Prospective study of surgical site infections in breast cancer surgery – Does wire localisation increase infection risk?
S48 sessions were freed up for imagers to assess urgent 2WW referrals, equivalent to over 200 outpatient appointments saved. Conclusions: IOUS was safe. This data suggests a lower re-excision rate for IOUS versus WGL with no excess in specimen size. As well as service delivery and cost advantages, patients were spared a 30-minute journey from the localisation site as well as an improved perioperative journey. http://dx.doi.org/10.1016/j.ejso.2017.01.183
P131. Are patients eligible for breast conserving surgery in early and locally-advanced breast cancer choosing mastectomy? Sina Hossaini, Eleanore Massey, Asma Al-Allak, Richard Hunt, Fiona Court, Claire Fowler, James Bristol, Sarah Vestey Department of Breast Surgery, Gloucester Royal Hospital, Gloucestershire, UK Introduction: Latest research suggests breast conserving surgery (BCS) with radiotherapy is as safe as mastectomy, with cosmetic and psychological advantages. Patient preference is sometimes the reason given for variability in mastectomy rates; we wanted to review regionally how many patients eligible for BCS were choosing mastectomy. Methods: A retrospective electronic hospital records review of all mastectomy procedures performed in Gloucestershire from October 2015 to March 2016 was undertaken. The unit manages circa 650 cancers per year, offering reconstructive and oncoplastic surgery. Demographics and indication for proceeding with mastectomy were identified. Results: 80 patients underwent mastectomy in six months: 26 for proportionality of disease relative to breast-size (Within this group: 2 males (BCS unfeasible), 11 downsizing of DCIS / diffuse nodular invasive lobular carcinoma not possible, 6 inadequate response to neoadjuvant chemotherapy / hormone therapy for BCS); 7 completion after failed BCS (4 patients had 2 re-excisions); 13 for recurrent disease in an irradiated breast; 19 for multicentric disease; 8 for risk-reduction; 1 where radiotherapy following BCS contraindicated due to pulmonary fibrosis; 6 for patient preference (1 had a previous contralateral mastectomy, 2 chose mastectomy despite successful neoadjuvant downstaging chemotherapy, 1 to simplify treatment due to co-morbidities). Conclusions: Mastectomy was chosen for non-medical reasons by six patients; few patients eligible for BCS opt for mastectomy. The message that BCS is as safe as mastectomy may be getting through; efforts to further reduce mastectomy rates may be limited by the current available treatments for early and locally advanced breast cancer. http://dx.doi.org/10.1016/j.ejso.2017.01.184
P132. Prospective study of surgical site infections in breast cancer surgery e Does wire localisation increase infection risk? Roisin Corcoran, Conor Toale, Brian O’Connell, Anna Heeney, Terence Boyle, Dhafir Al-Azawi, Elizabeth Connolly St James Hospital, Dublin, Ireland Introduction: Post-operative surgical site infections (SSIs) are a common complication in breast surgery, and can lead to increased morbidity, patient distress, longer in-hospital stay, and delay of adjuvant therapies. In this study, a prospective database was compiled of all patients undergoing breast cancer surgery in St James’ Hospital over a 6-year period from 2010e2016. We sought to identify risk factors for infection in our cohort of patients, which may highlight areas of practice that can be improved in order to minimise the risk of SSI. Methods: There were a total of 1,450 patients included. Patients were subdivided based on operation type. A total of 968 patients (68%) underwent breast conserving surgery. Within the BCS group, 591 patients (61%) had wire localisation and 377 patients (39%) had non wire guided
ABSTRACTS procedures. There were 450 patients (31%) in the mastectomy group, 99 of these operations included reconstruction (22% of mastectomy patients). Results: There were a total of 77 (5.4%) surgical site infections. Of the 967 BCS patients, 34 had SSIs (4%). Within the BCS group SSIs, 16 were post wire guided BCS (3%) and 15 were post non wire guided procedures (4%). There were 39 SSIs after mastectomy without reconstruction (11%). Post reconstructive surgery there were 5 infections (5%). Conclusion: On univariate analysis guide-wire use was not associated with post-operative infection (p ¼ 0.3636). On comparison of SSI in BCS vs mastectomy, on univariate analysis mastectomy was associated with a significantly higher risk of post operative infection (p ¼ <0.0001). http://dx.doi.org/10.1016/j.ejso.2017.01.185
P133. Factors affecting positive excision margins Nikki Green, Darren Scroggie, Pippa Leighton, Asmaa Al-Allak, James Bristol, Clare Fowler, Richard Hunt, Eleanore Massey, Sarah Vestey, Fiona Court Breast Surgery Department, Gloucestershire Hospitals NHS Foundation Trust, UK Introduction: The majority of patients presenting with a breast cancer undergo breast conserving surgery. Literature reports of re-excision rates vary although are often reported up to 20e25%. There are multiple factors affecting re-excision rates. Our aim was to investigate the re-excision rates in our breast unit and the factors accounting for this. Methods: All patients undergoing breast conserving surgery in a 1 year period (2015e16) in a single breast unit were included (symptomatic and screen detected). Data was collected in a database including number of reexcisions, number of positive margins (<1mm), size on palpation, disease at the margin, pre-invasive and invasive imaging and pathology size and pathology of re-excisions. Results: Over a 1 year period 454 patients underwent breast conserving operations with 99 (21.8%) requiring at least 1 re-excision. The second and third re-excision rates were 17.2% and 11.8%. The mean difference between imaging and pathology size was 10.1mm (range e 48 to 92mm). 70 out of 99 specimens were larger on pathology than expected. 46 specimens were 50% larger than expected on imaging, 31 of these were 100% larger than expected. In patients with palpable disease the mean difference in size (where documented) from pathology was 18.8mm, including non-invasive disease. The re-excision specimens were clear of disease in 56.1% of patients. Conclusions: This study demonstrates that there are multiple factors involved in the increased risk of positive excision margins, including underestimation on imaging size and palpation size. Palpation size is often unreliable. http://dx.doi.org/10.1016/j.ejso.2017.01.186
P134. Case vignettes on primary management of breast cancer in older patients: results of a national survey Yasmin Jauhari1, Carmen Tsang1, Jibby Medina1, David Dodwell2, Kieran Horgan2, David Cromwell1 1 Clinical Effectiveness Unit, London, UK 2 Leeds Teaching Hospital NHS Trust, Leeds, UK Introduction: Older patients with breast cancer (BC) present clinicians with challenging management decisions. As part of the National Audit of Breast Cancer in Older Patients (NABCOP), we explored key patient factors in clinical decision making for primary management of early invasive BC in patients aged >75 years.
P131. Are patients eligible for breast conserving surgery in early and locally-advanced breast cancer choosing mastectomy? Sina Hossaini, Eleanore Massey, Asma Al-Allak, Richard Hunt, Fiona Court, Claire Fowler, James Bristol, Sarah Vestey Department of Breast Surgery, Gloucester Royal Hospital, Gloucestershire, UK Introduction: Latest research suggests breast conserving surgery (BCS) with radiotherapy is as safe as mastectomy, with cosmetic and psychological advantages. Patient preference is sometimes the reason given for variability in mastectomy rates; we wanted to review regionally how many patients eligible for BCS were choosing mastectomy. Methods: A retrospective electronic hospital records review of all mastectomy procedures performed in Gloucestershire from October 2015 to March 2016 was undertaken. The unit manages circa 650 cancers per year, offering reconstructive and oncoplastic surgery. Demographics and indication for proceeding with mastectomy were identified. Results: 80 patients underwent mastectomy in six months: 26 for proportionality of disease relative to breast-size (Within this group: 2 males (BCS unfeasible), 11 downsizing of DCIS / diffuse nodular invasive lobular carcinoma not possible, 6 inadequate response to neoadjuvant chemotherapy / hormone therapy for BCS); 7 completion after failed BCS (4 patients had 2 re-excisions); 13 for recurrent disease in an irradiated breast; 19 for multicentric disease; 8 for risk-reduction; 1 where radiotherapy following BCS contraindicated due to pulmonary fibrosis; 6 for patient preference (1 had a previous contralateral mastectomy, 2 chose mastectomy despite successful neoadjuvant downstaging chemotherapy, 1 to simplify treatment due to co-morbidities). Conclusions: Mastectomy was chosen for non-medical reasons by six patients; few patients eligible for BCS opt for mastectomy. The message that BCS is as safe as mastectomy may be getting through; efforts to further reduce mastectomy rates may be limited by the current available treatments for early and locally advanced breast cancer. http://dx.doi.org/10.1016/j.ejso.2017.01.184
P132. Prospective study of surgical site infections in breast cancer surgery e Does wire localisation increase infection risk? Roisin Corcoran, Conor Toale, Brian O’Connell, Anna Heeney, Terence Boyle, Dhafir Al-Azawi, Elizabeth Connolly St James Hospital, Dublin, Ireland Introduction: Post-operative surgical site infections (SSIs) are a common complication in breast surgery, and can lead to increased morbidity, patient distress, longer in-hospital stay, and delay of adjuvant therapies. In this study, a prospective database was compiled of all patients undergoing breast cancer surgery in St James’ Hospital over a 6-year period from 2010e2016. We sought to identify risk factors for infection in our cohort of patients, which may highlight areas of practice that can be improved in order to minimise the risk of SSI. Methods: There were a total of 1,450 patients included. Patients were subdivided based on operation type. A total of 968 patients (68%) underwent breast conserving surgery. Within the BCS group, 591 patients (61%) had wire localisation and 377 patients (39%) had non wire guided
ABSTRACTS procedures. There were 450 patients (31%) in the mastectomy group, 99 of these operations included reconstruction (22% of mastectomy patients). Results: There were a total of 77 (5.4%) surgical site infections. Of the 967 BCS patients, 34 had SSIs (4%). Within the BCS group SSIs, 16 were post wire guided BCS (3%) and 15 were post non wire guided procedures (4%). There were 39 SSIs after mastectomy without reconstruction (11%). Post reconstructive surgery there were 5 infections (5%). Conclusion: On univariate analysis guide-wire use was not associated with post-operative infection (p ¼ 0.3636). On comparison of SSI in BCS vs mastectomy, on univariate analysis mastectomy was associated with a significantly higher risk of post operative infection (p ¼ <0.0001). http://dx.doi.org/10.1016/j.ejso.2017.01.185
P133. Factors affecting positive excision margins Nikki Green, Darren Scroggie, Pippa Leighton, Asmaa Al-Allak, James Bristol, Clare Fowler, Richard Hunt, Eleanore Massey, Sarah Vestey, Fiona Court Breast Surgery Department, Gloucestershire Hospitals NHS Foundation Trust, UK Introduction: The majority of patients presenting with a breast cancer undergo breast conserving surgery. Literature reports of re-excision rates vary although are often reported up to 20e25%. There are multiple factors affecting re-excision rates. Our aim was to investigate the re-excision rates in our breast unit and the factors accounting for this. Methods: All patients undergoing breast conserving surgery in a 1 year period (2015e16) in a single breast unit were included (symptomatic and screen detected). Data was collected in a database including number of reexcisions, number of positive margins (<1mm), size on palpation, disease at the margin, pre-invasive and invasive imaging and pathology size and pathology of re-excisions. Results: Over a 1 year period 454 patients underwent breast conserving operations with 99 (21.8%) requiring at least 1 re-excision. The second and third re-excision rates were 17.2% and 11.8%. The mean difference between imaging and pathology size was 10.1mm (range e 48 to 92mm). 70 out of 99 specimens were larger on pathology than expected. 46 specimens were 50% larger than expected on imaging, 31 of these were 100% larger than expected. In patients with palpable disease the mean difference in size (where documented) from pathology was 18.8mm, including non-invasive disease. The re-excision specimens were clear of disease in 56.1% of patients. Conclusions: This study demonstrates that there are multiple factors involved in the increased risk of positive excision margins, including underestimation on imaging size and palpation size. Palpation size is often unreliable. http://dx.doi.org/10.1016/j.ejso.2017.01.186
P134. Case vignettes on primary management of breast cancer in older patients: results of a national survey Yasmin Jauhari1, Carmen Tsang1, Jibby Medina1, David Dodwell2, Kieran Horgan2, David Cromwell1 1 Clinical Effectiveness Unit, London, UK 2 Leeds Teaching Hospital NHS Trust, Leeds, UK Introduction: Older patients with breast cancer (BC) present clinicians with challenging management decisions. As part of the National Audit of Breast Cancer in Older Patients (NABCOP), we explored key patient factors in clinical decision making for primary management of early invasive BC in patients aged >75 years.