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Breast-Conserving Surgery for Invasive Breast Cancer

Breast-Conserving Surgery for Invasive Breast Cancer

Despite recent improvements in imaging technology, pathology assessments, and the use of systemic therapy, there is still controversy regarding the optimal margin width in breast-conserving surgery. About 25% of patients with invasive breast cancer return to the operating room after undergoing lumpectomy to obtain more widely clear margins. In about half of these cases, the margin is free of cancer cells, defined as no ink on tumor. However, it has long been believed that a larger amount of normal breast tissue might reduce the risk of local recurrence. Recommendations for Breast-Conserving Surgery In 2014, the Society of Surgical Oncology (SSO) and the American Society of Radiation Oncology (ASTRO) released recommendations for breast-conserving surgery with whole-breast irradiation in stage I and II invasive breast cancer. “A definitive guideline can help minimize the use of unnecessary surgery while maintaining the excellent outcomes that have been achieved with lumpectomy and radiation therapy,” explains Monica M. Morrow, MD, FACS, who co-chaired the consensus panel that developed the recommendations. To develop the SSO-ASTRO guidelines, leaders in surgical, radiation, and medical oncology as well as pathology and patient advocacy considered a meta-analysis of margin width and ipsilateral breast tumor recurrence (IBTR). The panel conducted a systematic review of 33 studies that included 28,162 patients as the primary evidence base. The panel recommended against the routine removal of larger amounts of healthy breast tissue beyond having no cancerous cells touching the edge of lumpectomy specimens. This recommendation was made regardless of patient age as well as for women with the more aggressive, triple-negative cancer types. “The standard definition of negative margins should be having no ink...
Substance Use in Anesthesiology Residents

Substance Use in Anesthesiology Residents

Substance use disorders are a serious public health issue, and physicians are not immune to these problems. “Anesthesiologists have long been considered at risk for substance use disorders because of their access to potent drugs, such as opioids,” explains David O. Warner, MD. Few studies, however, have explored the epidemiology of these disorders in physicians in general and anesthesiologists in particular. Current estimates have been based on surveys and reports from clinicians as well as physician health programs, but these data have limitations. “The long-term outcomes of substance use disorders in physicians are not known,” says Dr. Warner. “Gathering more data on substance use disorders can help educate us about preventing and managing these problems.” Compelling New Data on Outcomes of Substance Use In a retrospective study published in JAMA, Dr. Warner and colleagues described the incidence and outcomes of substance use disorders among anesthesiology residents in the United States who entered training between 1975 and 2009. The study included 44,612 residents who contributed 177,848 resident-years for analysis. “One important goal was to inform residency program directors and others about the long-term outcomes for anesthesiology residents who experience substance use disorders. We also wanted to better inform both individual treatment decisions and overall policies,” Dr. Warner says. According to the results, the incidence of substance use disorders increased over the study period, and relapse rates did not appear to improve. Overall, 0.86% of anesthesiology residents entering primary training from 1975 to 2009 had evidence of substance use disorders during their training. Of the residents involved in the study, 384 experienced substance use disorders during training, with an overall incidence...
Paralyzed Surgeon Overcomes the Odds to Re-enter the OR

Paralyzed Surgeon Overcomes the Odds to Re-enter the OR

After a devastating health diagnosis, major spinal surgery and paralysis from the waist down, no one would have blamed Ted Rummel, DO, if he had decided to retire and lead a low-key life. But a lot of people would have been surprised, most of all Dr. Rummel. Read more about Dr. Rummel at www.makemedicinebetter.org. Source: BJC...
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