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Breast Cancer
Colon
Cancer
Laparoscopic Cholecystectomy (Gallbladder)
Breast Biopsies
Customized Circular Cutting Device Lowers
Re-Excision Rate for Breast Cancer
(updated June 2008)
Hernias-
Recurrence Rates (updated July 2007)
5-Year Survival Rate
for Breast Cancer Patients
DeKalb Surgical
Associates has implemented a method of continuous
outcomes assessment for a variety of clinical
indicators. One of these indicators looks at the
long-term survival of patients with breast cancer.
Overall five year survival for our patients is over 78%.
This data has been compared to published data for
Georgia from the National Cancer Data Bank, and is shown
below, and includes patients from 1985-1991. Also shown
is the 5-year survival for all DeKalb Medical Center
patients.
Data for patients with
Stage II breast cancer from 1997-98 shows similar
results for this sub-group. This is the most recent
data available for looking at 5-year survival rates.
National comparison data for this time period is not yet
available, so the national data shown (NCDB, which
stands for “National Cancer Data Base”) is from
1995-96. The other comparison is with all other Stage
II breast cancer patients treated at Dekalb Medical
Center during the 1997-98 time period. The 5-year
survival for our patients is 87% compared with 80% for
all other patients at DeKalb Medical Center.
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5-Year Survival Rate for
Colon Cancer Patients
Survival for patients
with colon cancer is another important indicator which
we monitor. For patients at DeKalb Surgical Associates,
the overall 5 year observed survival rate is over 63%.
In the past, all patients
undergoing surgery for removal of a colon cancer had to
go through a bowel cleansing, just like they have for a
colonoscopy. But more recent studies have shown that
this is often unnecessary. Most patients can be
discharged from the hospital within about five days, and
sometimes even less. Patients usually are allowed
liquids even in the evening following surgery.
Laparoscopic techniques are often utilized, depending on
the location and size of the cancer.
Very few colon cancer
patients require a colostomy with current surgical
techniques. Low rectal lesions (close to the anus) can
be removed through the anus if localized, and cancers
higher up can usually be removed through an abdominal
incision, re-connecting the colon down very low, close
to the anus.
The American Cancer
Society has set a goal of reducing the incidence of
colon cancer by 50% by the year 2015. In order to reach
this goal, the routine use of colonoscopy or flexible
sigmoidoscopy screening must be fully implemented.
Current recommendations are for screening colonoscopy in
all patients beginning at age 50, and every 10 years
thereafter. For African American patients and in
patients with a family history of colon cancer,
screening should begin at age 45.
Our web site provides
more information about colon polyps and cancer under the
patient information tab.
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Low
Conversion Rate for Laparoscopic Cholecystectomy
In 2002, the surgeons at
DeKalb Surgical Associates performed 169 laparoscopic
cholecystectomies. Indications for surgery included:
chronic cholecystitis and other chronic conditions in
59%, acute cholecystitis in 28%, and biliary
pancreatitis in 13%. The median length of stay was < 1
day. For patients with acute cholecystitis the average
length of stay was 3.8 days. Although return to work
was not analyzed, most patients return to their usual
activities in 5-10 days after an elective procedure.
There were only 2 cases
in which the conversion to an open cholecystectomy was
necessary, and in both cases this was for severe acute
cholecystitis. This represents a conversion percentage
of only 1.2%, which compares extremely well with
published reports, most of which are in the 5-10%
range. There were no cases of common bile duct injury.
Intra-operative cholangiography was performed in 30%, on
a selective basis. Four percent of patients had common
bile duct stones, which were treated either with
laparoscopic common bile duct exploration, or with
post-operative ERCP.
Not all patients who are
referred with gallstones undergo surgery. Patients with
atypical symptoms undergo further evaluation looking for
other pathology, such as peptic ulcer disease,
esophageal reflux, or irritable bowel syndrome. In
patients whose symptoms are correlated with other
pathology, surgery is not recommended unless more
typical symptoms develop.
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Breast
Biopsy Data
We reviewed all of the
breast biopsies performed on our patients for the year
2002. All in all, 445 biopsies were performed,
including FNA’s, core biopsies, stereotactic biopsies,
and excisional biopsies. There were 82 patients
diagnosed with breast cancer, including 11 (13%) with
non-invasive disease. One patient had bilateral
cancer. The diagnosis was made by needle biopsy in 73
(88%), usually at the first office visit, utilizing
ultrasound for localization as needed, thereby allowing
for a rapid diagnosis, and subsequent definitive
surgical treatment with a single operative procedure.
There were 69
stereotactic biopsies performed, for microcalcifications
in 49, and for a nodular or asymmetric density in 20.
Cancer was identified in 16 (23%). In 9 of these 16
patients (56%), the cancer was non-invasive.
Of the 82 patients with
breast cancer, 7 refused treatment or went elsewhere.
Of the remaining 75 patients, 66 (88%) underwent
breast-conserving surgery. Compared to published data,
this is a remarkably high percentage. In many reported
series, particularly in the southeastern United States,
conservative surgery rates are typically only about
50%. Sentinel node biopsy was routinely used in all of
these patients for clinically node negative disease.
Mastectomy was recommended in the other 9 patients
because of either a large tumor size, more than one
cancer in the breast, strong family history, or involved
margins on attempted breast-conserving surgery.
The average tumor size,
including those with DCIS (non-invasive cancer), was 1.8
cm, with a median size of 1.3 cm. Thirty-seven percent
of patients had tumors less than or equal to 1 cm in
size.
In summary, prompt and accurate evaluation of breast
problems constitutes a major focus for DeKalb Surgical
Associates. We are committed to providing a timely and
cost-effective diagnosis, with a high priority for
breast conservation and sentinel node biopsy for
patients diagnosed with cancer.
Customized Circular
Cutting Device Lowers Re-excision Rate for Breast Cancer
(updated June 2008)
Women with breast cancer
can be overwhelmed with anxiety from the very moment
they learn of their diagnosis. Fortunately for most
women at DeKalb Surgical, the diagnosis is made early,
with a correspondingly good prognosis. We then give
extra effort to achieve a maximum cure with a minimum of
surgery.
Particular emphasis must
be given to obtaining clear margins around the lump of
cancer. This is essential in assuring a low risk of
local recurrence in the breast. If the margins are not
clear, the patient must undergo either a re-excision, or
a mastectomy. For most surgeons, anywhere from 20% to
over 50% of their patients must have a second procedure
to obtain clear margins. Mastectomy rates may run as
high as 60%.
We have focused on this
issue at DeKalb Surgical Associates over the past 3
years. As a result, our re-excision rate for breast
cancer patients undergoing breast conserving surgery is
only 14%. The primary method for achieving these
superior results if the use of a customized circular
surgical cutting device (designed and patent pending by
Dr. Kennedy) that standardizes the specimen removal,
allowing for more precise assessment of the surgical
margins. As a corollary, our mastectomy rate is also
remarkably low, at only 5%, excluding patients who
present with advanced disease. Use of this instrument
also meshes nicely with a new technique for radiation
therapy, using a MammoSite balloon. Our experience with
this method of partial breast irradiation has been
extremely favorable. Here is a
link to more information.
By minimizing the need
for additional surgery, our patients complete their
treatment more quickly. This helps to reduce the
anxiety that comes with the diagnosis, allowing them to
resume their daily routine.
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Hernia Repair-
Recurrence Rate
(updated August 2010)
DeKalb Surgical Associates routinely follows up patients
who have previously undergone inguinal hernia repairs to
monitor for recurrence. Below are summaries of these
questionnaire results, with the most recent summary
listed first. If you just want the final result, our
cumulative recurrence risk for all hernia repairs is
1.5% based on all repairs done, and 2.7%, based on only
those patients who responded to the questionnaire.
In November 2009, we once again sent out a questionnaire
to our hernia patients from 2 years ago. Of the entire
group, there were 3 confirmed hernias out of 166 repairs
(1.8%). Of those who responded, the confirmed hernia
recurrence rate is 2.6% (3/116).
Compared to the previous follow-ups conducted in
November 2001, July 2003, and 2006, and 2007,response
rate was good, at 65%. If the results of the five
surveys are combined, there are 14 confirmed recurrences
out of a total of 929 repairs, for a rate of 1.4%, and a
rate of 2.68% (14/523) for only those who responded.
Six of the 14 confirmed recurrences were done
laparoscopically.
If only the non-laparoscopic repairs are considered, the
recurrence rate for the five combined surveys is 0.9%
(8/870), and 1.65% (8/483) of only those who responded.
If only the laparoscopic repairs are considered, the
corresponding recurrence rates for the three combined
surveys are 10.2% (6/59) and 15% (6/40), respectively.
Although these rates seem high, the recurrence rate for
the more recently done procedures appears to be lower.
Similar results have been published in surgical journals
where patients are randomized to either "open" repair or
laparoscopic repair, and in such studies, the recurrence
rate with the laparoscopic technique has been higher.
Nevertheless, there may be an advantage for the
laparoscopic technique, with less pain, and more rapid
return to usual activities.
Both techniques are utilized at DeKalb Surgical. You can
discuss the options in more detail during your
consultative visit. We aim to individualize your
treatment to provide an optimal outcome based on your
particular case.
(updated July 2007)
DeKalb Surgical
Associates routinely follows up patients who have
previously undergone inguinal hernia repairs to monitor
for recurrence. Below are summaries of these
questionnaire results, with the most recent summary
listed first. If you just want the final result, our
cumulative recurrence risk for all hernia repairs is
1.1% based on all repairs done, and 2.5%, based on only
those patients who responded to the questionnaire.
In July 2007, we once
again sent out a questionnaire to our hernia patients
from 2 years ago. Of the entire group, there were 6
confirmed hernias out of 291 repairs (2.06%). Of those
who responded, the confirmed hernia recurrence rate is
4.11% (6/146).
Compared to the previous
follow-ups conducted in November 2001, July 2003, and
2006, response rate was similar, at 53%. If the
results of the four surveys are combined, there are 11
confirmed recurrences out of a total of 763 repairs, for
a rate of 1.44%, and a rate of 2.54% (11/433) for only
those who responded. Three of the eleven confirmed
recurrences were done laparoscopically.
If only the
non-laparoscopic repairs are considered, the recurrence
rate for the four combined surveys is 1.11% (8/722), and
2.10% (8/381) of only those who responded. If only the
laparoscopic repairs are considered, the corresponding
recurrence rates for the three combined surveys are
7.32% (3/41) and 11.5% (3/26).
We have previously
identified a higher recurrence rate among patients
undergoing a laparoscopic repair, and the updated data
also reflects that finding. Both repair methods are
offered to our patients, "traditional" or laparoscopic,
although the majority of patients undergo an open
repair. Most often, this is done as an outpatient,
under local anesthesia with sedation. The laparoscopic
repair is also done as an outpatient, but under general
anesthesia. In most cases, the repair is reinforced
with mesh, which helps decrease the recurrence risk, as
well as the amount of pain experience after surgery.
Time out of work is variable, depending on the type of
work done, employer expectations, and your own
individual response to the surgery. For non-strenuous
(desk-type) jobs, many patients will be back at work
within three to seven days. For very heavy labor
(construction-type), the time off work may be up to four
weeks or more.
2006 results
In early 2006, we once again sent
out a questionnaire to our hernia patients from 2 years
ago. Of the entire group, there was 1 confirmed hernia
out of 176 repairs (0.57%). Of those who responded, the
confirmed hernia recurrence rate is 1.01% (1/99).
Compared to the previous
follow-ups conducted in November 2001, and fall of 2003,
response rate was similar, though slightly lower. The
percentage of patients responding was 53%. The response
rate for the last two surveys was 59% and 63%,
respectively. This survey was conducted several months
later for the entire group as an average, compared to
previous surveys, and this is the probable explanation
for the lower response rate.
If the results of the three
surveys are combined, there are 5 confirmed recurrences
out of a total of 494 repairs, for a rate of 1.01%, and
a rate of 1.74% (5/187) for only those who responded.
Two of the five confirmed recurrences were done
laparoscopically.
If only the non-laparoscopic
repairs are considered, the recurrence rate for the
three combined surveys is 0.68% (3/443), and 1.23%
(3/243) of only those who responded. If only the
laparoscopic repairs are considered, the corresponding
recurrence rates for the three combined surveys are 6.9%
(2/29) and 11.1% (2/18).
2003 results
Patients who had hernia repairs
between 18 and 36 months ago were contacted by mail or
telephone in the fall of 2003. Followup rate was 59%.
There were 159 patients with a
total of 180 hernia repairs (21 with bilateral repairs)
performed between October 1, 2000, and March 31, 2002.
There were 3 recurrences identified for a recurrence
rate of 1.7%. This recurrence rate compares very
favorably with published recurrence rates. If results
are combined with our previous 2 year survey, the
overall recurrence rate is 4/318, or 1.3%.
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