COMPARISON OF THE SURGICAL-PROCEDURES FOR BREAST-CONSERVING TREATMENTOF EARLY BREAST-CANCER IN 7 EORTC CENTERS

The aim of this study was to develop a standardised surgical report fo r breast-conserving procedures, supporting the systematic documentatio n of the different aspects of the surgery. The surgical procedure for tumourectomy and axillary clearance was translated into a series of st eps that could be quantitatively documented. This description was subm itted twice to a group of surgeons from different departments to ensur e that all steps that are considered to have relevance for outcome wer e included and that no superfluous data were collected. After two corr ective phases, a first test format was developed. Between February 199 3 and May 1994, seven surgical departments, participating in EORTC tri als, completed this questionnaire for a number of their patients. The data collected related to general information on the department, the t umour excision itself, the axillary dissection and, in a later phase, on pathology. 269 questionnaires (264 tumour excisions, 259 axillary d issections and 189 pathology reports) were collected and analysed. Eve n though the participating departments were involved in a single trial on breast-conserving surgery and had previously developed regular con tacts about the practical aspects of treatment, many differences were detected. In general, variations were found in the waiting time betwee n treatment prescription and execution, experience of the surgeon, dur ation of the procedure, and the use of prophylactic antibiotics. Also, in the practical execution of the procedure, major variations in the type of incision, width of tumour excision, closure of the breast tiss ue and skin, the use of frozen sections and the extent of the axillary dissection were found. The most relevant differences and their possib le consequences are discussed. It has been proven possible and feasibl e to document quantitatively a surgical procedure. The fact that withi n a group of surgeons participating in the same clinical trials, many differences in the surgical techniques are observed, stresses the need to reach a consensus on a stricter set of guidelines for breast-conse rving procedures and their documentation, especially when conducting c linical trials. Copyright (C) 1996 Elsevier Science Ltd