ing with forward step-wise methodology for determining hazard ofmortality at 5-year follow-up.

RESULTS: The study included 174,471 patients with colon cancerand 37,789 patients with rectal cancer. For colon cancer, annualhospital case volume was less than 15 cases in 5.4%, 15-24 cases in11.2%, 25-44 cases in 27.7%, and greater than or equal to 45 cases in55.8%. For rectal cancer, hospital case volume was less than 15 casesin 5.1%, 15-24 cases in 10.6%, 25-44 cases in 26.9%, and greaterthan or equal to 45 cases in 57.4%. Lymph node evaluation and stageof disease in colon and rectal cancer was significantly affected byhospital volume (p�0.0001). However, hospital case volume was notfound to be a significant predictor of mortality at five years.

CONCLUSIONS: While annual hospital case volume has a signifi-cant impact on lymph node evaluation and stage of disease, it doesnot play a role in 5-year survival for colorectal cancer patients. Re-gionalization of care for colorectal cancer patients should not bebased on long term mortality.

Understanding the impact of reconstruction onquality of life during the breast cancer survivorshipperiodEmily Hu, MD, Andrea Pusic, MD, Jennifer Waljee, MD, MPH,Latoya Kuhn, MPH, Edwin Wilkins, MD,Amy Alderman, MD, MPHUniversity of Michigan, Ann Arbor, MI

INTRODUCTION: National utilization of breast reconstruction islow, with large disparities in racial and geographical use, implying apossible unmet need for vulnerable patients. But few studies comparelong-term patient-reported quality of life (QOL) between the recon-structed and unreconstructed populations. Our goal was to evaluatethe impact of reconstruction on QOL during the cancer survivorshipperiod.

METHODS: We surveyed 391 women diagnosed with breast cancersince 1977 (RR 70%): 144 unreconstructed and 247 reconstructedpatients. Patients scored their general QOL (scale 0-100) and theirbreast-related (psychosocial, physical and sexual well-being) QOL(5-point Likert scale). Multiple logistic regression was used to controlfor age, chemotherapy, radiation, recurrence, years post-mastectomy,and co-morbidities.

RESULTS: Overall QOL scores were high (unreconstructed82.4�18.2; reconstructed 83.6�18.1) and no significant differencewas found between the two groups. However, receipt of reconstruc-tion did affect breast-specific QOL. When asked how life is now,compared to before breast surgery, reconstructed patients were betteroff emotionally (OR 2.9), physically (OR 3.3), and sexually (OR 6.3)(p values �0.01).

CONCLUSIONS: Long-term self-reported general QOL is high af-ter breast cancer surgery, suggesting that women adapt well in thesurvivorship period. However, receipt of reconstruction is associatedwith higher emotional, physical and sexual well-being after breastsurgery. These valuable data suggest that that there may be a critical

need for improved advocacy for breast reconstruction in women whodesire reconstruction but have limited access.

Does reoperation following lumpectomy influencepatient-perceived aesthetic outcomes amongwomen with breast cancer?Jennifer F Waljee, MD, MPH, Emily Hu, MD,Lisa A Newman, MD, MPH, Amy K Alderman, MD, MPHUniversity of Michigan, Ann Arbor, MI

INTRODUCTION: Although breast conserving surgery (BCS) is ad-vocated for breast cancer treatment, many women require reopera-tion to achieve disease-free status. Because the effect of additionalprocedures on postoperative outcomes is unclear, we sought to de-termine the effect of reoperation on patient-reported breast aesthet-ics.

METHODS: We surveyed 947 women (response rate: 72.7%) whounderwent local excision of breast cancer between 1/2002-6/2006 atthe University of Michigan Medical Center, using the Breast CancerTreatment and Outcomes Survey (BCTOS) to rate breast asymme-try. We reviewed the medical record for reoperation, number of pro-cedures, and reason for reoperation. We used logistic regression toassess the correlation between reoperation and breast symmetry, ad-justing for patient characteristics, tumor size, and receipt of radiationtherapy.

RESULTS: In this sample, 52.6% of women required reoperation.Compared with those requiring one excision, women who under-went reoperation more frequently reported a significant difference intheir breast appearance (32.5% vs. 43.5%, p�0.005), and morefrequently desired reconstruction (5.8% vs. 11.2%, p�0.023).Women who underwent reoperation were more likely to cite differ-ences in breast size (p�0.006), shape (p�0.001), clothing fit(p�0.02), scarring (p�0.002), and breast height (p�0.004) com-pared with women who did not. In multivariate analysis, reoperation(OR�1.71, 95%CI:1.12-2.61), BMI �35kg/m2 (OR�2.12,95%CI:1.06-4.24), and postoperative complications (OR�2.65,95%CI:1.73-4.06) were significantly correlated with breast asymme-try.

CONCLUSIONS: Reoperation after lumpectomy yields significantdifferences in patient-reported aesthetic outcomes. Women facingreoperation should be counseled about these differences and offeredoncoplastic techniques, reconstruction, or breast prosthetics whenpossible.

Cost-effectiveness of laparoscopy versuslaparotomy for initial surgical evaluation andtreatment of potentially resectable hepaticcolorectal metastases: A decision analysisShelly T Karuna, MD, Richard Thirlby, MD, Thomas Biehl, MDVirginia Mason Medical Center, Seattle, WA

INTRODUCTION: Approximately 10-40% of colorectal cancer pa-tients with potentially resectable hepatic metastases are incorrectly

S70 Surgical Forum Abstracts J Am Coll Surg