Surgeons’ Recommendation is the Factor in Determining the Breast Cancer Surgery Procedures: an Experience from Rural Hospital in Thailand

Document Type : Research Articles


1 Depatment of Surgery, King Chulalongkorn Memorial Hospital, Bangkok, Thailand.

2 Ratchaburi Hospital, Department of Surgery, Ratchaburi, Thailand.

3 Division of Head-Neck and Breast Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Thailand.


Introduction: The majority of breast cancer patients in rural hospital in developing countries still warrant for total
mastectomy. Surgeon advice regard surgical procedure is one of the most important factors in decision making. Our
study aims to compare the rate of breast-conserving surgery (BCS), mastectomy (MT) and mastectomy with immediate
breast reconstruction (MTIBR) between the surgeons who offer only MT (group A) and who offer BCS MT and MTIBR
(group B). Method: A retrospective cohort study was conducted at Ratchaburi hospital, Thailand from January 2010
to April 2014. We categorized patients into 2 groups (group A and B). Univariated analysis was selected to determine
the factors that associated with the breast surgery procedures. Results: From January 2010 to April 2014, we recruited
310 breast cancer patients, 221 patients (71.2%) were treated by surgeons in group A, 89 patients (28.7%) by surgeons
in group B. The choice of breast surgery is significantly different between 2 groups (P<0.001). In group A, 213 (96.3%)
patient had MT and only 3 (1.3%) BCS and 5 (2.2%) MTIBR. Whilst in group B, 58 (65.1%) patient had MT and
11 (12.3%) BCS and 20(22.4%) MTIBR. Choice of breast surgery in patients with stage 1,2,3 are significantly different
between 2 groups (P=0.004, <0.001, 0.025 respectively). Age is the only factor that significantly affects the choice
of surgery in the group B but not in group A. Conclusion: Surgeon’s competency and comprehensive preoperative
consultation by offering BCS, MT and MTIBR can affect the choice of surgical procedure for breast cancer patient.


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