Ranganathan B, Milovancev M, Mehrkens L, Townsend KL. Intersurgeon agreement in determining 3 cm surgical margins of subcutaneous tumors in dogs.
Vet Surg 2021;
50:1573-1578. [PMID:
34536030 DOI:
10.1111/vsu.13724]
[Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 08/16/2021] [Accepted: 08/26/2021] [Indexed: 01/15/2023]
Abstract
OBJECTIVE
To evaluate intersurgeon agreement in performing a 3 cm wide surgical excision for subcutaneous malignancies in dogs.
STUDY DESIGN
Prospective, blinded, randomized, clinical study.
ANIMALS
Client-owned dogs with subcutaneous tumors undergoing curative-intent, wide surgical excision between April 2019 to March 2020.
METHODS
Four surgeons, instructed to perform a 3 cm wide excision, each sequentially indicated their proposed skin incision locations around subcutaneous tumors, without knowledge of the other surgeons' proposed incisions. A tripod-mounted camera and laser positioning system were used to photograph each surgeon's proposed margin length. A random-effects model was used to estimate the standard deviation of margin lengths that would be expected from a random sample of surgeons.
RESULTS
Each of the four surgeons provided 33 independent radial measurements from 11 tumors (six soft tissue sarcomas and five mast cell tumors), for a total of 132 radial measurements. No individual surgeon consistently proposed longer or shorter margin incision locations. The prediction interval for a future margin measurement was 6 mm, implying that the 95% confidence interval of an individual surgeon's margin length would be within ±6 mm of the mean margin length from a random sample of surgeons.
CONCLUSION
Ninety-five percent of surgeons would be expected to deliver a surgical dose between 2.4-3.6 cm, for a theoretically uniform surgical dose of 3 cm wide margins.
CLINICAL SIGNIFICANCE
Surgical doses are likely to vary at clinically relevant levels among surgeons, complicating design and interpretation of studies attempting to identify an ideal surgical dose.
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