Surgical confidence when operating among residents in surgery - a cross-sectional study (SCAR study).

BACKGROUND: Self-confidence, is one of the critical variables influencing surgical resident's abilities, and lack of confidence maybe a reason for not entering medical practice immediately. Measuring the level of confidence of senior surgical residents (SSRs) is a crucial step in assessing preparedness to practice. In this study, we aim to measure their confidence level and the factors that might contribute to it. METHODS: Cross-sectional survey conducted at King Abdulaziz University Hospital on SSRs in Saudi Arabia (SA). We approached 142 SSRs, 127 responded. Statistical analysis was performed using RStudio v 3.6.2. Descriptive statistics were performed using counts and percentages for categorical variables and using mean ± standard deviation for continuous variables. Multivariate linear regression (t-statistics) was used to assess the factors associated with confidence in performing essential procedures, while the association between demographics and residency-related factor with the number of completed cases was tested using Chi-square. The level of significance was determined as 0.05. RESULTS: Response rate was 89.4%. Among surveyed residents, 66% had completed < 750 cases as a primary surgeon. More than 90% of SSRs were confident in performing appendectomy, open inguinal hernia repair, laparoscopic cholecystectomy, and trauma laparotomy, while 88% were confident in being on-call in level-I trauma center. No difference was noted in confidence level in relation to the number of performed cases. Residents from the Ministry of Health accounted for 56.3% of the study population and showed a higher confidence level compared to others. 94% of SSRs plan to pursue fellowship training program. CONCLUSION: The study showed that the confidence of SSRs in performing common general surgery procedures was as expected. However, it's important to recognize that confidence doesn't necessarily reflect competence. Considering the majority of SSRs planned to pursue fellowship training programs, it may be time to consider changing the structure of surgical training in SA to a modular format to allow earlier and more intensive exposure.

Patient handoffs among general surgery residents in Saudi Arabia: a cross-sectional study.

BACKGROUND: Communication failure is a common cause of adverse events. An essential element of communication among health care providers is patient handoff. Patient handoff is defined as a practice whereby a health care provider transfers a patient's care information to another health care provider to ensure the patient's safety and continuity of care. To explore this practice, we assessed patient handoffs among general surgery residents in Saudi Arabia. METHODS: A cross-sectional survey was conducted with individuals in accredited general surgery residency programs in Saudi Arabia between 2020 and 2021. RESULTS: Participants comprised 118 general surgery residents: 66 (57.3%) were female; 67 (72.8%) did not receive any formal training on patient handoff; and 35 (38.8%) reported that they were sometimes interrupted during the patient handoff process. The most common reason for such interruptions was medical personnel paging. Furthermore, 60 (68.1%) general surgery residents stated that these interruptions led to a decreased quality of effective communication, 39 (44.3%) believed it led to decreased quality of patient care, 63 (71.5%) believed it led to the loss of some information related to patient handoff, and 16 (18.1%) believed it led to patient harm. Finally, 31 (34.4%) general surgery residents believed that the existing handoff system at their institutions neither adequately protected the patients' safety nor allowed for continuity of care, and 51 (68%) reported that their institution did not have a standardized protocol for the verbal patient handoff process. There was a higher proportion of patients with minor harm among residents who did not, rarely or sometimes received verbal or written hand off instructions compare to those who did so always or most of the time (67% vs. 49%, respectively). CONCLUSION: The patient handoff process among general surgery residents in Saudi Arabia is subjective and is not standardized, and if not addressed, may lead to patient harm. Standardizing this process is paramount to improve patient safety.

Role models as a factor influencing career choice among female surgical residents in Saudi Arabia: a cross-sectional study.

BACKGROUND AND PURPOSE: Role models in the medical field are professional and experienced persons whose actions unconsciously inspire juniors to strive to be like them. To our knowledge, no studies have examined whether having a female surgical role model has influenced women to pursue a surgical career in Saudi Arabia. Hence, we sought to evaluate whether identifying role models in surgery influences career choice and defined the ideal qualities of a surgical role model as perceived by newly qualified doctors. METHODS: We employed a cross-sectional, survey- based study design, conducted between June 2020 and January 2021, in which female surgical residents completed a questionnaire about their perceptions and influence of role models in general surgery specialty at the time they pursue a career in surgery. RESULTS: A total of 51 respondents completed the questionnaire. The majority of them (78.4%) had a role model and (19.6%) indicated that their role model was a female. Of those who had a role model, (67.5%) agreed that they experienced a positive influence on their surgical career choice. Clinical and operation skills were reported as the most remarkable factor to be considered in their role models. Working directly with a male surgical consultant and female surgical residents imprinted a positive influence but this did not reach a statistical significance. CONCLUSION: The findings of this article contribute empirically to the strong effects of the same-sex role models and highlight the curial role of surgical residents in influencing female's career choices in general surgery as an achievable and attainable domain. Which encourage the creation of national mentorship programs and exploring more in barriers for pursuing a surgical career.

Awareness and attitudes toward epilepsy among medical and allied healthcare students - A survey study in a teaching hospital in Jeddah.

PURPOSE: Epilepsy affects individuals of all ages and genders and places high physical, mental, financial, and social burdens on these individuals. In Saudi Arabia, its prevalence is 6.5 cases per 1000 individuals. Physicians and healthcare professionals have a key role in increasing the knowledge and awareness of the general population about epilepsy. The purpose of this study was to assess the level of awareness of different aspects of epilepsy, such as, presentation; causes; social aspects of epilepsy in school, work, and social life; treatment options; and attitudes toward epilepsy of students at King Abdulaziz University (KAU) in medical and allied healthcare specialties. We also aimed to assess if the level of knowledge and attitude improves throughout the study years by comparing preclinical-year students to clinical-year students. METHOD: This cross-sectional study included 255 participants from multiple health specialties studying at KAU. Surveys from prior validated publications were used. We divided the respondents into two categories (preclinical [2nd, 3rd, 4th-year students] and clinical [5th, 6th, and internship year]) to evaluate if knowledge and attitude are different among these two groups. RESULTS: In general, medical students had more awareness than did students from other specialties about what to do if someone was having a seizure. A total of 17.3% of medical students answered that they would put a spoon or cloth in the mouth of someone having a seizure, whereas 21% of nursing students thought this answer was appropriate (p = .04). The proportion of clinical-year students who were knowledgable of the symptoms and causes of epilepsy was significantly higher than that of students in preclinical years (p < .0001). Only 12.3% of the clinical-year students thought epilepsy was an untreatable disease versus 35.5% of preclinical-year students (p = .02). Interestingly, nursing students had the highest percentage of respondents who answered yes to surgical options (p = .009) (57.9%, n = 11), followed by dental students (50%, n = 6), medical students (46.4%, n = 78), and finally clinical pharmacy students (45.5%, n = 20). CONCLUSION: The level of awareness among medical students was higher than that among students of other specialties, with progressive improvement over the study years. However, knowledge about surgical options was minimal. Thus, further emphasis is needed in teaching and educational campaigns, particularly for allied healthcare students.

Risk of second primary malignancies in women with breast cancer: Results from the European prospective investigation into cancer and nutrition (EPIC).

Women with a diagnosis of breast cancer are at increased risk of second primary cancers, and the identification of risk factors for the latter may have clinical implications. We have followed-up for 11 years 10,045 women with invasive breast cancer from a European cohort, and identified 492 second primary cancers, including 140 contralateral breast cancers. Expected and observed cases and Standardized Incidence Ratios (SIR) were estimated using Aalen-Johansen Markovian methods. Information on various risk factors was obtained from detailed questionnaires and anthropometric measurements. Cox proportional hazards regression models were used to estimate the role of risk factors. Women with breast cancer had a 30% excess risk for second malignancies (95% confidence interval-CI 18-42) after excluding contralateral breast cancers. Risk was particularly elevated for colorectal cancer (SIR, 1.71, 95% CI 1.43-2.00), lymphoma (SIR 1.80, 95% CI 1.31-2.40), melanoma (2.12; 1.63-2.70), endometrium (2.18; 1.75-2.70) and kidney cancers (2.40; 1.57-3.52). Risk of second malignancies was positively associated with age at first cancer, body mass index and smoking status, while it was inversely associated with education, post-menopausal status and a history of full-term pregnancy. We describe in a large cohort of women with breast cancer a 30% excess of second primaries. Among risk factors for breast cancer, a history of full-term pregnancy was inversely associated with the risk of second primary cancer.

Reproductive factors and risk of mortality in the European Prospective Investigation into Cancer and Nutrition; a cohort study.

BACKGROUND: Reproductive events are associated with important physiologic changes, yet little is known about how reproductive factors influence long-term health in women. Our objective was to assess the relation of reproductive characteristics with all-cause and cause-specific mortality risk. METHODS: The analysis was performed within the European Investigation into Cancer and Nutrition prospective cohort study, which enrolled >500,000 women and men from 1992 to 2000, who were residing in a given town/geographic area in 10 European countries. The current analysis included 322,972 eligible women aged 25-70 years with 99 % complete follow-up for vital status. We assessed reproductive characteristics reported at the study baseline including parity, age at the first birth, breastfeeding, infertility, oral contraceptive use, age at menarche and menopause, total ovulatory years, and history of oophorectomy/hysterectomy. Hazard ratios (HRs) and 95 % confidence intervals (CIs) for mortality were determined using Cox proportional hazards regression models adjusted for menopausal status, body mass index, physical activity, education level, and smoking status/intensity and duration. RESULTS: During a mean follow-up of 12.9 years, 14,383 deaths occurred. The HR (95 % CI) for risk of all-cause mortality was lower in parous versus nulliparous women (0.80; 0.76-0.84), in women who had ever versus never breastfed (0.92; 0.87-0.97), in ever versus never users of oral contraceptives (among non-smokers; 0.90; 0.86-0.95), and in women reporting a later age at menarche (≥15 years versus <12; 0.90; 0.85-0.96; P for trend = 0.038). CONCLUSIONS: Childbirth, breastfeeding, oral contraceptive use, and a later age at menarche were associated with better health outcomes. These findings may contribute to the development of improved strategies to promote better long-term health in women.

Distant learning and primary school teacher burnout: Assessing the effect during coronavirus disease (COVID-19) in Jeddah, Saudi Arabia, 2021.

BACKGROUND: Teaching is indeed a very stressful occupation. Owing to the novel coronavirus SARS-CoV-2, certain changes were made in education in Saudi Arabia. A switch to a 100% distant learning in some courses was implemented, thereby increasing the burden on teachers. The aim of this study was to assess the level of burnout and the impact of distant learning on burnout in primary school teachers during the pandemic. MATERIALS AND METHODS: This cross-sectional study recruited 295 primary school teachers in Jeddah City, Saudi Arabia. Data were collected using self-administered questionnaire having two parts: the first part included questions on sociodemographic charecteristics and the second part included questions related to distant learning and the Arabic version of the Maslach Burnout Inventory. Chi-square test was used to assess association between burnout and various factors. For comparison of mean scores by various factors, analysis of variance (ANOVA) was performed. RESULTS: A high level of burnout was perceived by 48.4% of the teachers in the dimension of emotional exhaustion, 26.4% in the depersonalization dimension, and 60% in the reduced personal accomplishment dimension. Teachers in the public school showed a higher burnout score than teachers in the private schools. The teachers in 40-50 age group had higher scores than the teachers with other age groups. There were no significant differences in terms of gender and years of experience. A higher proportion of teachers working in private schools had higher personal accomplishment than teachers working in Government schools (P = 0.01). Regarding personal accomplishment and depersonalization subscales, there were differences between the different types of schools. The teachers who believed "distance/E-learning was difficult" had lower personal accomplishment score. CONCLUSION: According to the study, primary teachers in Jeddah suffer from burnout. More programs should be implemented to deal with teacher burnout and more research focusing on these groups should be done.

The Impact of Nursing Education on Emergency Bedside External Ventricular Drain Insertion for Patients With Acute Hydrocephalus.

Objectives Acute hydrocephalus is a neurosurgical emergency that requires immediate intervention. With emergency external ventricular drain (EVD) insertion and management, such rapid intervention can be a safe bedside procedure. Nurses play an integral role in patient management. Thus, this study aims to assess the knowledge, attitudes, and practices of nurses from different departments regarding bedside EVD insertion in patients with acute hydrocephalus. Methods EVD and intracranial pressure (ICP) monitoring competency checklists were developed, and a quasi-experimental, single-group, pre/post-test study was conducted at a university hospital in Jeddah, Saudi Arabia, in January 2018 during an educational program. The neurosurgery team determined program efficacy using pre/post-questionnaires. All attendees who agreed to fill in the pre- and post-survey and whose data were complete were included in the study. Results Of the 140 nurses who participated in the study, the data of 101 were analyzed. Knowledge level improved significantly between the pre- and post-test; for example, when asked about administering antibiotics before EVD insertion, the pre-test correct response rate of 65% increased to 94% in the post-test (p<0.001), and 98% considered the session informative. However, the attitude toward bedside EVD insertion did not change after the teaching sessions. Conclusion This study emphasizes the importance of ongoing nursing education, hands-on training, and strict adherence to an EVD insertion checklist to achieve successful bedside management of patients with acute hydrocephalus.

Burnout, Stress, and Stimulant Abuse among Medical and Dental Students in the Western Region of Saudi Arabia: An Analytical Study.

Background: High levels of burnout, stress, and stimulant abuse have been reported among medical and dental students worldwide, with country-specific factors being contributors. The association, risk factors, and predictors of these three variables have not sufficiently been reported from Saudi Arabia, especially from the Western region. Objective: To determine the prevalence, association, and predictors of burnout, stress, and stimulant abuse among medical and dental students in the Western region of Saudi Arabia. Methods: This cross-sectional study included all second to sixth year medical and dental students enrolled at Taibah University, Madinah, Saudi Arabia, during the 2019-2020 academic year. A self-administered, closed online questionnaire was administered. Data regarding stress were elicited using Cohen's 10-item Self-Perceived Stress Scale and regarding burnout using the Oldenburg Burnout Inventory Student Version questionnaire. Multiple logistic regression model to identify the risk of burnout was conducted, and univariate and multiple linear regression models were carried out to identify the predictors of stress. Results: Of 1016 eligible students, 732 responded (medical: 511; dental: 221). About half of the students experienced burnout (51.5%), with both high disengagement (49%) and exhaustion (45%). Most participants (90.3%) experienced moderate levels of stress. Eight (1.1%) respondents had experienced stimulant abuse; there was a no significant association between stimulant abuse and burnout in the multivariate analysis. Stress, age, gender, body mass index, GPA, study field, smoking, family income, and birth order were significant predictors of burnout, while burnout, age, gender, GPA, and physical exercise were significant predictors of stress. Conclusion: The findings in this study highlight the need for policymakers to devise strategies that target early identification as well as reduction of the high levels of burnout and stress.

Programmable Versus Differential Pressure Ventriculoperitoneal Shunts for Pediatric Hydrocephalus: A 20-Year Single-Center Experience From Saudi Arabia.

Background Shunt malfunction is the most common complication after ventriculoperitoneal shunt (VPS) insertion for pediatric hydrocephalus. The incidence of shunt malfunction and the need for VPS revision may be related to the type of valve used in the shunt. Therefore, we aimed to compare the outcome of VPS in the pediatric age group stratified by differential pressure valves (DPV) and programmable shunt valves (PSV). Materials and methods This ethics-approved retrospective study was conducted at a tertiary care hospital in Saudi Arabia. We included 175 children with congenital hydrocephalus who underwent a shunt insertion or revision between 2003 and 2018 and followed them up to December 2022. The VPS complication and revision rates were compared with the patient's demographics and shunt valve types. The Kaplan-Meier method, log-rank test, and univariate and multivariate Cox proportional hazards regression were used to analyze several variables and subsequent shunt revisions. Results Females represented 52% of the study participants, and the mean age of the patients was 21.7 ± 38.4 months. The main indication for VPS was congenital hydrocephalus due to aqueductal stenosis (40%). The differential shunt valve was used in 78.9% and the PSV in 21.1% of the patients. Surgical complications occurred in 33.7% of the patients. Shunt malfunction and infection occurred in 16% and 11.4% of the patients, respectively. The VPS revision rate was significantly lower when PSV was used (odds ratio = 0.39, P < 0.05). Conclusion Overall, one-third of the studied pediatric cohort required shunt revision at some point during the 15-year follow-up. However, children with PSV had fewer revision rate-related complications compared to children with DPV during the first five years of follow-up.

Knowledge- and Experience-Based Perceptions of Radiation Therapists during the COVID-19 Outbreak.

Objective: To assess the perceived risks and impact of the COVID-19 outbreak on radiation therapists in Saudi Arabia. Methods: A questionnaire was distributed to all radiation therapists in the country. The questionnaire contained questions about demographic characteristics, the extent of the pandemic's impact on hospital resources, risk perception, work-life, leadership, and immediate supervision. The questionnaire's reliability was assessed using Cronbach's alpha; >0.7 was considered adequate. Results: Out of the 127 registered radiation therapists, 77 (60.6%) responded; 49 (63.6%) females; and 28 (36.4%) males. The mean age was 36.8 ± 12.5 years. Nine (12%) of the participants had a past experience with pandemics or epidemics. Further, 46 (59.7%) respondents correctly identified the mode of transmission of COVID-19. Approximately, 69% of the respondents perceived COVID-19 as more than a minor risk to their families and 63% to themselves. COVID-19 had an overall negative impact on work at the personal and organizational levels. However, there was a positive attitude toward organizational management during the pandemic in general; positive responses ranged from 66.2% to 82.4%. Ninety-two percent considered protective resources and 70% considered the availability of supportive staff to be adequate. Demographic characteristics were not significantly associated with the perceived risk. Conclusions: Despite the high perception of risk and negative impact on their work, radiation therapists conveyed a positive overall perception regarding resource availability, supervision, and leadership. Efforts should be made to improve their knowledge and appreciate their efforts.

Histopathological Patterns and Outcomes of Triple-Positive Versus Triple-Negative Breast Cancer: A Retrospective Study at a Tertiary Cancer Center.

Background One of the leading causes of cancer-related deaths in females under 45 years old is breast cancer (BC). The definition of triple-negative breast cancer (TNBC) is the lack of expression of estrogen receptors (ERs) as well as progesterone receptors (PRs) and Erb-B2 receptor tyrosine kinase 2 (HER2) gene amplification. Triple-positive breast cancer (TPBC), on the other hand, is defined as tumors expressing a high level of ER, PR, and HER2 receptors. This study aims to assess the phenotypes of TNBC and TPBC by comparing their individual clinical behavior patterns and prognosis throughout the course of the disease in a tertiary cancer center in the Kingdom of Saudi Arabia (KSA). Methods Our study is a retrospective study using electronic medical records (EMRs) to identify all female patients diagnosed with BC using the International Classification of Diseases-10 (ICD-10) codes (between C50 and C50.9). About 1209 cases with primary BC female patients were recognized based on histopathology reports. Further subclassification into TPBC and TNBC was performed. Statistical analysis was performed using Rv3.6.2 (R Studio, version 3.5.2, Boston, MA, USA). The descriptive data were presented as means and standard deviations (SD). Survival curves were approximated using the Kaplan-Meier method. The comparison between survival curves between both groups was achieved using the log-rank test. The multivariate model was constructed based on the identified predictors using univariate analysis. Results Univariate analysis of overall survival (OS) showed that mortality was higher in TNBC compared to TPBC (HR = 2.82, P-value <0.05). However, in a multivariate analysis, molecular subtypes did not show a significant effect on OS with a P-value of 0.94. We found that age at diagnosis has been associated with a 4% increase in mortality risk with a yearly rise in age. Conclusion In this limited retrospective cohort study, we found that TNBC may not be associated with a higher risk of death than TPBC. However, other factors, including age at diagnosis, surgical intervention, and lymphovascular invasion (LVI), have been observed to increase the risk of mortality. On the other hand, patients with TNBC were found to have a worse prognosis in terms of local recurrence. This information cannot be generalized to all patients with BC given the limitations of this study. Further, larger cohorts are needed to explore biological and treatment-related outcomes in patients with TNBC and TPBC.

Histopathological examination of cases with acute appendicitis, A retrospective study at King Abdulaziz University Hospital, Jeddah, Saudi Arabia.

Introduction: Appendicitis is one of the most prevalent abdominal emergencies globally. Despite the fact that acute appendicitis is a clinical diagnosis, preoperative imaging investigations are often conducted. Other disorders that might mimic acute appendicitis can occur in the appendix. The aim of this paper is to describe the histopathological findings of all appendectomy specimens. Methods: A retrospective study of 940 cases of appendectomy that were performed between 2010 and 2017 at King Abdulaziz University Hospital, Jeddah, Saudi Arabia were reviewed. The main outcome measured in this study is to describe the histopathological findings of all appendectomy specimens. The secondary outcomes measured in this study were the disease incidence in relation to age, and gender. Moreover, the accuracy of imaging diagnostic tools were also evaluated. Results: This study included 940 participants who underwent an appendectomy procedure. The patients' mean age was 23.4 years (±12.2), with a 3:2 male to female proportion. The incidence in males and females were 59.4% and 40.6%, respectively. Being male (p < 0.001), undergoing preoperative ultrasound (p < 0.001), having elevated white blood cells count (p < 0.001) was significantly associated with accurate diagnosis of acute appendicitis confirmed by histopathology. In this study, the negative cases of appendectomy that account for 14.4% were reported primarily as normal appendix with no inflammatory changes (7.44%) followed by other unexpected findings in the appendectomy specimen (3.93%) that included faecolith, granulomas, mucocele, endometriosis, food/fecal impaction, and schistosomiasis. Our study showed CT sensitivity as a diagnostic tool of acute appendicitis is 90.2%, and its accuracy is 89.4%, while US sensitivity is 46% and its accuracy is 52.4%. Conclusion: Histopathological evaluation after common procedures, such as appendectomy, is essential to avoid missing other pathologies in the appendix. Surgeons should be aware of the uncommon histopathology findings as some disorders call for additional management beyond appendectomy. The clinical details, radiological investigations including CT scan and histopathological diagnoses are required for better management in cases of appendicular lesions.

Body Microbiota and Its Relationship With Benign and Malignant Breast Tumors: A Systematic Review.

Breast cancer is the most frequent type of cancer as well as one of the main causes of cancer-related mortality in women. Human microbial dysbiosis, which has been related to a range of malignancies, is one of the variables that may impact the chance of developing breast disorders. In this review, we aimed to investigate the relationship between breast cancer and benign breast tumors with dysbiosis of the microbiome at different body sites. We performed a systematic review of MEDLINE, Scopus, Ovid, and Cochrane Library to identify original articles published until July 2020 that reported studies of breast disease and microbiota. Twenty-four original articles were included in the study, which looked at the features and changes in breast, gut, urine, lymph node, and sputum microbial diversity in patients with benign and malignant breast tumors. In breast cancer, the breast tissue microbiome demonstrated changes in terms of bacterial load and diversity; in benign breast tumors, the microbiome was more similar to a malignant tumor than to normal breast tissue. Triple-negative (TNBC) and triple-positive (TPBC) types of breast cancer have a distinct microbial pattern. Moreover, in breast cancer, gut microbiota displayed changes in the compositional abundance of some bacterial families and microbial metabolites synthesis. Our review concludes that breast carcinogenesis seems to be associated with microbial dysbiosis. This information can be further explored in larger-scale studies to guide new prophylactic, diagnostic, and therapeutic measures for breast cancer.

Locally Advanced Breast Cancer: Treatment Patterns and Predictors of Survival in a Saudi Tertiary Center.

Background  Breast cancer (BC) is the most common cancer in the Kingdom of Saudi Arabia (KSA) and the second leading cause of cancer-related mortality. About 40% of BC in KSA is locally advanced BC (LABC), which has been associated with poorer survival compared with early diagnosed BC. Objective To review the presentation and outcomes of LABC, including the characteristics of the disease, different treatment modalities, overall survival (OS), disease-free survival (DFS), and local recurrence in relation to different radiotherapy (RT) techniques. Methods  We retrospectively reviewed the medical records of 153 female patients with pathologically proven LABC diagnosed at King Abdulaziz University Hospital, Jeddah, KSA, between 2009 and 2017. We obtained data on patient demographics, stage of cancer at diagnosis, tumor characteristics (subtype and receptor status), type of surgery, systemic treatments received (hormonal, targeted therapy, and chemotherapy), RT variables, and recurrence and death dates. Data were analyzed to assess OS and DFS by using Kaplan-Meier analyses and the log-rank test. Univariate and multivariate Cox proportional hazard regression analyses were used to explore and identify factors associated with survival. Results  The median survival time in the study population was 9.16 years. Older age (65+ years) was associated with worse OS and DFS than was younger age (<65 years) (hazard ratio (HR) 3.20, 95% CI 1.48-6.90, P = 0.003 and HR 2.21, 95% CI 1.12-4.36, P = 0.022, respectively). Regarding the type of surgery, having a mastectomy was associated with worse OS and DFS than was having a lumpectomy (HR 2.44, 95% CI 0.97-6.12, P = 0.05 and HR 2.41, 95% CI 1.13-5.14, P = 0.023, respectively). Positive estrogen and progesterone receptor status was associated with better OS and DFS than was a negative estrogen or progesterone receptor status (HR 0.13, 95% CI 0.05-0.30, P < 0.001 and HR 0.21, 95% CI 0.11-0.41, P < 0.001, respectively). Patients who received RT had a lower risk of recurrence than did those who did not receive RT (P = 0.011). Moreover, three-dimensional conformal RT was associated with lower local recurrence than intensity-modulated RT or volumetric-modulated arc therapy (P = 0.003). Conclusion  Multiple factors can affect the OS and DFS in LABC. Younger patients, having hormone-positive disease, and undergoing lumpectomy were associated with better outcomes. Adjuvant RT may improve local control and the use of three-dimensional conformal RT was superior for local control. Prospective studies with larger sample sizes are needed to further highlight these findings and to assess the role of chemotherapy and targeted therapy in patients with LABC.