Oncoplastic breast conserving surgery: is there a need for standardization? Results of a nationwide survey

IntroductionThe NABON Breast Cancer Audit showed that more than 70% of the Dutch women undergoing surgery for breast cancer (BC) maintained their breast contour by breast conserving surgery (BCS) or by immediate reconstruction after ablative surgery. The proportion of oncoplastic surgery applied in patients undergoing breast conserving treatment (BCT) remains unknown. The aim of our study was to assess the need for standardization of oncoplastic breast conserving surgery (OPBCS) in an attempt to enable measurement of the quality of OPBCS.Methods To gain a better understanding of current practice in OPBCS we sent a questionnaire to all breast surgeons in the Netherlands who are member of the breast surgery working group (n=134). ResultsA total of 60 breast surgeons, representing different hospitals in the Netherlands, responded. 61.7% of the breast surgeons performed BCS in 60%-100% of their patients. 68.3% responded that BCS was performed using OPS techniques in up to 40% of their patients. OPBCS was defined as level I volume displacement by 45.2% of the breast surgeons and as BCS performed by a breast surgeon and plastic surgeon together by 32.3% of the breast surgeons. 94.5% indicated that there is a need for standardization of the definition of OPBCS in the Netherlands. ConclusionThis study demonstrates that OPBCS is a major part of daily clinical practice of Dutch breast surgeons treating BC patients. Despite of this, there is no clear definition of OPS in BCT in the Netherlands. Only after standardization, a classification code and quality indicator can be initiated for OPBCS. Ultimately, this will facilitate improvement in quality of BC care

Supplementary Material for: Oncoplastic breast conserving surgery: is there a need for standardization? Results of a nationwide survey

Introduction The NABON Breast Cancer Audit showed that more than 70% of the Dutch women undergoing surgery for breast cancer (BC) maintained their breast contour by breast conserving surgery (BCS) or by immediate reconstruction after ablative surgery. The proportion of oncoplastic surgery applied in patients undergoing breast conserving treatment (BCT) remains unknown. The aim of our study was to assess the need for standardization of oncoplastic breast conserving surgery (OPBCS) in an attempt to enable measurement of the quality of OPBCS. Methods To gain a better understanding of current practice in OPBCS we sent a questionnaire to all breast surgeons in the Netherlands who are member of the breast surgery working group (n=134). Results A total of 60 breast surgeons, representing different hospitals in the Netherlands, responded. 61.7% of the breast surgeons performed BCS in 60%-100% of their patients. 68.3% responded that BCS was performed using OPS techniques in up to 40% of their patients. OPBCS was defined as level I volume displacement by 45.2% of the breast surgeons and as BCS performed by a breast surgeon and plastic surgeon together by 32.3% of the breast surgeons. 94.5% indicated that there is a need for standardization of the definition of OPBCS in the Netherlands. Conclusion This study demonstrates that OPBCS is a major part of daily clinical practice of Dutch breast surgeons treating BC patients. Despite of this, there is no clear definition of OPS in BCT in the Netherlands. Only after standardization, a classification code and quality indicator can be initiated for OPBCS. Ultimately, this will facilitate improvement in quality of BC care

Patients with Crohn's disease have longer post-operative in-hospital stay than patients with colon cancer but no difference in complications' rate

BACKGROUNDRight hemicolectomy or ileocecal resection are used to treat benign conditions like Crohn's disease (CD) and malignant ones like colon cancer (CC).AIMTo investigate differences in pre- and peri-operative factors and their impact on post-operative outcome in patients with CC and CD.METHODSThis is a sub-group analysis of the European Society of Coloproctology's prospective, multi-centre snapshot audit. Adult patients with CC and CD undergoing right hemicolectomy or ileocecal resection were included. Primary outcome measure was 30-d post-operative complications. Secondary outcome measures were post-operative length of stay (LOS) at and readmission.RESULTSThree hundred and seventy-five patients with CD and 2,515 patients with CC were included. Patients with CD were younger (median = 37 years for CD and 71 years for CC (P < 0.01), had lower American Society of Anesthesiology score (ASA) grade (P < 0.01) and less comorbidity (P < 0.01), but were more likely to be current smokers (P < 0.01). Patients with CD were more frequently operated on by colorectal surgeons (P < 0.01) and frequently underwent ileocecal resection (P < 0.01) with higher rate of de-functioning/primary stoma construction (P < 0.01). Thirty-day post-operative mortality occurred exclusively in the CC group (66/2515, 2.3%). In multivariate analyses, the risk of post-operative complications was similar in the two groups (OR 0.80, 95%CI: 0.54-1.17; P = 0.25). Patients with CD had a significantly longer LOS (Geometric mean 0.87, 95%CI: 0.79-0.95; P < 0.01). There was no difference in re-admission rates. The audit did not collect data on post-operative enhanced recovery protocols that are implemented in the different participating centers.CONCLUSIONPatients with CD were younger, with lower ASA grade, less comorbidity, operated on by experienced surgeons and underwent less radical resection but had a longer LOS than patients with CC although complication's rate was not different between the two groups