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Gowda S, Blackburn A. Modified Clavien-Dindo classification for microsurgical breast reconstruction. J Plast Reconstr Aesthet Surg 2024; 94:27-29. [PMID: 38733714 DOI: 10.1016/j.bjps.2024.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Accepted: 05/01/2024] [Indexed: 05/13/2024]
Affiliation(s)
- Siri Gowda
- Department of Plastic Surgery, Queen Victoria Hospital, East Grinstead, United Kingdom.
| | - Adam Blackburn
- Department of Plastic Surgery, Queen Victoria Hospital, East Grinstead, United Kingdom
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Wanis KN, Kuerer HM, Sun SX, Hunt KK, Glencer AC, Teshome M, Lucci A, Weiser R, Johnson H, Smith BD, Gutierrez AM, Shaitelman SF, Arun BK. Clinical Outcomes for BRCA Pathogenic Variant Carriers With Breast Cancer Undergoing Breast Conservation. JAMA Netw Open 2024; 7:e2418486. [PMID: 38916888 PMCID: PMC11200147 DOI: 10.1001/jamanetworkopen.2024.18486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 04/19/2024] [Indexed: 06/26/2024] Open
Abstract
Importance Although most women with BRCA-associated breast cancer choose bilateral mastectomy, current guidelines support breast-conserving therapy as an option. As the indications for genetic testing expand and targeted therapies emerge, understanding the outcomes of breast-conserving therapy in the population of patients choosing breast conservation is important. Objective To describe the clinical outcomes of women with BRCA-associated breast cancer who were treated with breast-conserving therapy, including the risks of ipsilateral and contralateral cancer events and bilateral mastectomy-free survival. Design, Setting, and Participants This cohort study conducted at a single-institution academic national comprehensive cancer center included 172 women identified from a prospectively maintained database who had pathogenic BRCA1/2 variants and were treated with breast-conserving therapy from January 1, 1977, to December 31, 2021. Main Outcomes and Measures Clinical and pathologic characteristics for patients with BRCA1 and BRCA2 were compared, and estimates of overall survival, bilateral mastectomy-free survival, distant disease-free survival, risk of ipsilateral breast cancer, and risk of contralateral cancer were computed. Results The cohort included 172 women (mean [SD] age, 47.1 [11.7] years), with 42 (24.4%) receiving a diagnosis of breast cancer prior to 40 years of age. Compared with BRCA2 variant carriers (80 [46.5%]), women with BRCA1 variants (92 [53.5%]) were younger at breast cancer diagnosis and tended to have more advanced tumors, which were more likely to be hormone receptor negative and higher grade. At a median follow-up of 11.8 years (IQR, 5.7-18.2 years), estimates of 10-year survival and risk were: overall survival, 88.5% (95% CI, 83.1%-94.2%); bilateral mastectomy-free survival, 70.7% (95% CI, 63.3%-78.9%); risk of an ipsilateral breast cancer event, 12.2% (95% CI, 5.8%-18.2%); and risk of contralateral cancer, 21.3% (95% CI, 13.3%-28.6%). Risks continued to increase after 10 years of follow-up. Conclusions and Relevance In this cohort study, although women with breast cancer and pathogenic BRCA1/2 variants treated with breast-conserving therapy had above-average risks of ipsilateral and contralateral breast cancer events, most did not have another cancer event and remained bilateral mastectomy free. These findings may be useful for informing patients with BRCA variants choosing breast conservation.
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Affiliation(s)
| | - Henry M. Kuerer
- Department of Breast Surgical Oncology, MD Anderson Cancer Center, Houston, Texas
| | - Susie X. Sun
- Department of Breast Surgical Oncology, MD Anderson Cancer Center, Houston, Texas
| | - Kelly K. Hunt
- Department of Breast Surgical Oncology, MD Anderson Cancer Center, Houston, Texas
| | - Alexa C. Glencer
- Department of Breast Surgical Oncology, MD Anderson Cancer Center, Houston, Texas
| | - Mediget Teshome
- Department of Breast Surgical Oncology, MD Anderson Cancer Center, Houston, Texas
| | - Anthony Lucci
- Department of Breast Surgical Oncology, MD Anderson Cancer Center, Houston, Texas
| | - Roi Weiser
- Department of Breast Surgical Oncology, MD Anderson Cancer Center, Houston, Texas
| | - Helen Johnson
- Department of Breast Surgical Oncology, MD Anderson Cancer Center, Houston, Texas
| | - Benjamin D. Smith
- Department of Breast Radiation Oncology, MD Anderson Cancer Center, Houston, Texas
| | | | - Simona F. Shaitelman
- Department of Breast Radiation Oncology, MD Anderson Cancer Center, Houston, Texas
| | - Banu K. Arun
- Department of Breast Medical Oncology, MD Anderson Cancer Center, Houston, Texas
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Catanuto G, Virzì D, Latino M, Musmeci N, Fichera D, Balafa K, Cannata I, Rocco N, Marino M, Castiglione G, Caruso F. One-Stage Implant-Based Breast Reconstruction With Polyurethane-Coated Device: Standardized Assessment of Outcomes. Aesthet Surg J 2024; 44:491-498. [PMID: 37738139 DOI: 10.1093/asj/sjad301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 09/06/2023] [Accepted: 09/19/2023] [Indexed: 09/24/2023] Open
Abstract
BACKGROUND Nipple-sparing mastectomies (NSMs) and implant-based breast reconstructions have evolved from 2-stage reconstructions with tissue expansion and implant exchange to direct-to-implant procedures. In this study, we tested safety and efficacy of polyurethane-based implants according to standard assessment tools. OBJECTIVES This study aimed to test safety and feasibility of polyurethane-coated implants with standardized assessment employing internationally acknowledged evaluation criteria. METHODS Cases of NSMs followed by breast reconstruction in 1 stage with immediate prepectoral polyurethane-coated implant placement were retrospectively reviewed. Preoperative characteristics of the population have been collected. Adherence to quality assurance criteria of the Association of Breast Surgery-British Association of Plastic Reconstructive and Aesthetic Surgeons was verified. Complications were assessed with the Clavien Dindo classification, modified for the breast. Rippling, implant rotation, and malposition were also evaluated. RESULTS Sixty-three consecutive patients underwent 74 NSMs and immediate breast reconstruction with micro polyurethane foam-coated anatomic implants. In 5 cases we had unplanned readmissions with return to the operating room under general anesthesia (6.7%) and implant loss within 3 months from breast reconstruction (5 implants, 6.7%). Postoperative complications according to Clavien Dindo were grade 1 in 6 cases (8.1%), grade 2 in 3 cases (4%), and 3b in 5 cases (6.7%). CONCLUSIONS Polyurethane-coated implants may prevent rotation and malposition and capsular contracture in the short term. Unplanned readmission rates and implant loss rates in the short term may be slightly higher.See the abstract translated into Hindi, Portuguese, Korean, German, Italian, Arabic, Chinese, and Taiwanese online here: https://doi.org/10.1093/asj/sjad301. LEVEL OF EVIDENCE: 4
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Virzì D, Caruso F, Castiglione G, Marino M, Latino M, Cunsolo G, Cinquerrui A, Gioco R, Balafa K, Rapisarda M, Rocco N, Catanuto G. Thoraco-dorsal artery perforator flap for totally autologous primary breast reconstruction. Assessment of feasibility with standard reporting scales. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:106988. [PMID: 37500311 DOI: 10.1016/j.ejso.2023.106988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 07/10/2023] [Accepted: 07/16/2023] [Indexed: 07/29/2023]
Abstract
This study reports on feasibility and applicability of totally autologous primary breast reconstructions based on TDAP flaps using a standard set of internationally approved reporting scales. We reviewed 15 cases in patients with a good donor area in the back not suitable for implant or free flaps reconstructions. Complications according to Clavien Dindo were: 1 Grade 1 (seroma in the back). The ABS-BAPRAS quality assurance indicators 10, 11, and 12 were entirely fulfilled. No pedicled flap loss occurred; no unplanned return to theatre and no unplanned readmission within 3 months. Breast-related quality of life values are reported at 3 months and one year in four domains of the BREAST Q v. 2.0 (breast reconstruction post-op questionnaire). At 1 year the mean Q-score for satisfaction with breast was 70.5, for psychosocial well-being was 72.3; for sexual well-being was 58.8; for physical well-being (chest wall) was 70.60. The TDAP based totally autologous breast reconstruction reported to be a feasible and safe alternative to implant based or free flaps reconstructions according to consolidate international outcome reporting measures.
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Affiliation(s)
- Dario Virzì
- Humanitas Istituto Clinico Catanese Contrada Cubba Marletta 2, Misterbianco, CT, Italy
| | - Francesco Caruso
- Humanitas Istituto Clinico Catanese Contrada Cubba Marletta 2, Misterbianco, CT, Italy
| | - Gaetano Castiglione
- Humanitas Istituto Clinico Catanese Contrada Cubba Marletta 2, Misterbianco, CT, Italy
| | - Mariagloria Marino
- Humanitas Istituto Clinico Catanese Contrada Cubba Marletta 2, Misterbianco, CT, Italy
| | - Marco Latino
- Humanitas Istituto Clinico Catanese Contrada Cubba Marletta 2, Misterbianco, CT, Italy
| | - Gaetano Cunsolo
- Humanitas Istituto Clinico Catanese Contrada Cubba Marletta 2, Misterbianco, CT, Italy
| | - Ada Cinquerrui
- Humanitas Istituto Clinico Catanese Contrada Cubba Marletta 2, Misterbianco, CT, Italy
| | - Rossella Gioco
- Humanitas Istituto Clinico Catanese Contrada Cubba Marletta 2, Misterbianco, CT, Italy
| | - Konstantina Balafa
- Humanitas Istituto Clinico Catanese Contrada Cubba Marletta 2, Misterbianco, CT, Italy
| | - Martina Rapisarda
- Humanitas Istituto Clinico Catanese Contrada Cubba Marletta 2, Misterbianco, CT, Italy
| | - Nicola Rocco
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy; Fondazione G.Re.T.A. (Group for Reconstructive and Therapeutic Advancements) ETS, Italy.
| | - Giuseppe Catanuto
- Humanitas Istituto Clinico Catanese Contrada Cubba Marletta 2, Misterbianco, CT, Italy; Fondazione G.Re.T.A. (Group for Reconstructive and Therapeutic Advancements) ETS, Italy
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Chia CLK, Sae-Lim C, Lai HW, Chandrachamnong K, Huang HI, Chen DR, Chen ST. Single-port three-dimensional (3D) endoscopic-assisted breast surgery-preliminary results and patient-reported satisfaction in 145 breast cancer and gynecomastia cases. World J Surg Oncol 2023; 21:335. [PMID: 37880770 PMCID: PMC10601236 DOI: 10.1186/s12957-023-03191-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 09/17/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND Minimal-accessed (robotic and endoscopic) breast cancer surgery is increasingly performed due to better cosmetic results and acceptable oncological outcomes. This study aims to demonstrate the clinical safety and patient-reported cosmetic satisfaction of single-port three-dimensional endoscopic-assisted breast surgery (S-P 3D EABS), which is our new endoscopic surgical innovation, in both malignant and benign breast conditions. METHODS Patients who underwent S-P 3D EABS from 1 August 2018 to 31 July 2022 in a single institution were enrolled. Clinical outcomes of this procedure were retrospectively reviewed, and the patient-reported cosmetic satisfaction was evaluated by a questionnaire and reported herein. RESULTS During the study period, 145 patients underwent 164 procedures of S-P 3D EABS. One hundred fifty (91.5%) procedures were endoscopic-assisted nipple-sparing mastectomy (S-P 3D E-NSM; 117 therapeutic procedures for breast cancer, 13 prophylactic mastectomies, 20 procedures for gynecomastia). Fourteen (8.5%) procedures of endoscopic-assisted breast-conserving surgery (S-P 3D E-BCS) were performed (12 S-P 3D E-BCS, 2 S-P 3D E-BCS with 3D videoscope-assisted partial breast reconstruction, which was 1 case of latissimus dorsi flap and 1 case of omental flap). The mean operative time was 245 ± 110 min in S-P 3D E-NSM and 260 ± 142 min in S-P 3D E-BCS. The mean intraoperative blood loss was 49.7 ± 46.9 ml in S-P 3D E-NSM and 32.8 ± 17.5 ml in S-P 3D E-BCS. Subnipple biopsy showed positive malignancy in 3 (2.6%) S-P 3D E-NSM patients. None of the S-P 3D E-BCS patients found margin involvement; however, 3 (2.6%) reported margin involvement in S-P 3D E-NSM patients. Thirty-two complications were found (24.6%): 7 (5.3%) transient nipple-areolar complex (NAC) ischemia, 7 (5.3%) partial NAC necrosis, 1 (0.7%) total NAC necrosis, and 1 (0.7%) implant loss. During the mean follow-up time of 34 months, there were 2 (1.5%) patients with locoregional recurrence, 9 (6.9%) distant metastasis, and 2 (1.5%) mortality. 78.6% (77/98) of patients answering the cosmetic-evaluated questionnaire reported good and excellent overall satisfaction. CONCLUSIONS S-P 3D EABS is a novel surgical innovation, which is able to perform safely in either malignant or benign breast conditions and offer promising cosmetic results.
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Affiliation(s)
- Clement Luck Khng Chia
- Department of Surgery, Breast Surgery Service, Khoo Teck Puat Hospital, Singapore, Singapore
| | - Chayanee Sae-Lim
- Department of Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Hung-Wen Lai
- Department of Surgery, Endoscopic & Oncoplastic Breast Surgery Center, Changhua Christian Hospital, 135 Nanxiao Street, Changhua, 500, Taiwan.
- Department of Surgery, Division of General Surgery, Changhua Christian Hospital, Changhua, Taiwan.
- Comprehensive Breast Cancer Center, Changhua Christian Hospital, Changhua, Taiwan.
- Minimal Invasive Surgery Research Center, Changhua Christian Hospital, Changhua, Taiwan.
- Kaohsiung Medical University, Kaohsiung, Taiwan.
- Division of Breast Surgery, Yuanlin Christian Hospital, Yuanlin, Taiwan.
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan.
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
| | - Korawan Chandrachamnong
- Department of Surgery, Division of Breast Surgery, Police General Hospital, Bangkok, Thailand
| | - Hsin-I Huang
- Department of Information Management, National Sun-Yat-Sen University, Kaohsiung, Taiwan
| | - Dar-Ren Chen
- Department of Surgery, Division of General Surgery, Changhua Christian Hospital, Changhua, Taiwan
- Comprehensive Breast Cancer Center, Changhua Christian Hospital, Changhua, Taiwan
| | - Shou-Tung Chen
- Department of Surgery, Division of General Surgery, Changhua Christian Hospital, Changhua, Taiwan
- Comprehensive Breast Cancer Center, Changhua Christian Hospital, Changhua, Taiwan
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6
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Pösteki G. Does rapid discharge after breast cancer surgery have an impact on wound healing and complications? COVID-19 pandemic experience. Int Wound J 2023; 20:3255-3261. [PMID: 37194655 PMCID: PMC10502246 DOI: 10.1111/iwj.14205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 04/12/2023] [Indexed: 05/18/2023] Open
Abstract
The COVID-19 pandemic has challenged the health systems worldwide. Because of high volume of COVID-19 patients, all hospitals in our region were re-configured as COVID-19 centres and elective surgery procedures were cancelled. Our clinic was the only active centre in the region and grave increase in our patient volume urged our clinic to modify our discharge protocol. This retrospective study included all breast cancer patients underwent mastectomy and/or axillary dissection, in the Breast Surgery Clinic of Kocaeli State Hospital, a regional pandemic hospital, between December 2020 and January 2021. Patients were mostly discharged the day of surgery with drains because of congestion, while some of the patients had traditional stay, when beds were available. The patients were evaluated postoperatively (the first 30 days) in terms of wound complications, Clavien-Dindo classification grade, satisfaction, presence of pain and nausea, and treatment costs during the follow-up period of the study. Outcomes were compared between early discharged patients and patients who had traditional long stay. Compared with long-stay patients, in the early discharged group, postoperative wound complications was significantly lower (P < .01) with significant cost savings. There were no significant changes in variables such as surgery type, ASA class, satisfaction, need for additional medication and Clavien-Dindo between the groups. Adaptation to an early discharge protocol for breast cancer surgeries may be an efficient way of practicing surgery in a pandemic. Early discharge with drains may be beneficial for patients.
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Affiliation(s)
- Gökhan Pösteki
- Department of General SurgeryKocaeli State HospitalİzmitTurkey
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Maggi N, Rais D, Nussbaumer R, Levy J, Schwab FD, Kurzeder C, Heidinger M, Weber WP. The American Society of Breast Surgeons classification system for oncoplastic breast conserving surgery independently predicts the risk of delayed wound healing. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:107032. [PMID: 37619374 DOI: 10.1016/j.ejso.2023.107032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 08/05/2023] [Accepted: 08/14/2023] [Indexed: 08/26/2023]
Abstract
INTRODUCTION Oncoplastic breast conserving surgery (OBCS) aims to provide safe and satisfying surgery for breast cancer patients. The American Society of Breast Surgeons (ASBrS) classification system is based on volumetric displacement cut-offs (level I for <20% of breast volume; level II for 20-50%). It aims to facilitate communication among treating physicians and patients. Here, we investigate whether the extent of OBCS as classified by ASBrS independently predicts postoperative complications. MATERIALS AND METHODS This retrospective analysis of a prospectively maintained database included patients with stage I-III breast cancer who underwent OBCS between 03/2011 and 12/2020 at a Swiss university hospital. Outcomes included short-term (≤30 days) complications and chronic (>30 days) pain after surgery. Multivariate logistic regression models were used to identify independent predictors. RESULTS In total, 439 patients were included, 314 (71.5%) received ASBrS level I surgery, and 125 (28.5%) underwent ASBrS level II surgery. ASBrS level II was found to be an independent predictor of delayed wound healing (odds ratio [OR] 9.75, 95% confidence intervals (CI) 2.96-32.10). However, ASBrS level did not predict chronic postoperative pain (incidence rate ratio [IRR] 1.20, 95%CI 0.85-1.70), as opposed to age (IRR 1.19, 95%CI 1.11-1.27 per 5 years decrease), and weight disorders (underweight [BMI <18.5] vs. normal weight [BMI 18.5 < 25]: IRR 4.02, 95%CI 1.70-9.54; obese [BMI ≥30] vs. normal weight: IRR 2.07, 95%CI 1.37-3.13). CONCLUSION ASBrS level II surgery predicted delayed wound healing, warranting close clinical follow-up and prompt treatment to avoid delays in adjuvant therapy.
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Affiliation(s)
- Nadia Maggi
- Breast Center, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland; University of Basel, Petersplatz 1, 4001, Basel, Switzerland.
| | - Daniel Rais
- University of Basel, Petersplatz 1, 4001, Basel, Switzerland.
| | - Rahel Nussbaumer
- Breast Center, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland.
| | - Jeremy Levy
- Breast Center, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland.
| | - Fabienne D Schwab
- Breast Center, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland; University of Basel, Petersplatz 1, 4001, Basel, Switzerland.
| | - Christian Kurzeder
- Breast Center, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland; University of Basel, Petersplatz 1, 4001, Basel, Switzerland.
| | - Martin Heidinger
- Breast Center, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland; University of Basel, Petersplatz 1, 4001, Basel, Switzerland.
| | - Walter P Weber
- Breast Center, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland; University of Basel, Petersplatz 1, 4001, Basel, Switzerland.
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Casella D, Fusario D, Pesce AL, Marcasciano M, Lo Torto F, Luridiana G, De Luca A, Cuomo R, Ribuffo D. Portable Negative Pressure Wound Dressing in Oncoplastic Conservative Surgery for Breast Cancer: A Valid Ally. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1703. [PMID: 37893421 PMCID: PMC10607983 DOI: 10.3390/medicina59101703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 09/13/2023] [Accepted: 09/22/2023] [Indexed: 10/29/2023]
Abstract
Background and Objectives: The use of oncoplastic techniques has spread widely in the last decade, with an expansion of the indications and demonstration of excellent oncological safety profiles. A potential downside may be the increased complication rates, which could influence the timing of adjuvant therapy. To date, there is increasing evidence that negative pressure therapy on closed wounds can reduce complication rates after surgery. From this perspective, we tested the use of portable negative pressure wound dressings (NPWDs) in oncoplastic surgery to minimize early post-operative admissions to the outpatient clinic and prevent surgical complications. Materials and Methods: An observational prospective cohort study was conducted on a population of patients who underwent quadrantectomy and wise-pattern reduction mammoplasty for breast cancer. The primary objective of the study is represented by the evaluation of the impact of NPWD on post-operative outcomes in an oncoplastic surgery setting. Patients enrolled between January 2021 and January 2023 were divided into two groups, the conventional dressing (CD) group and the NPWD group, by a simple randomization list. Results: A total of 100 patients were enrolled, with 52 in the CD group and 48 in the NPWD group. The use of NPWD significantly reduced the wound dehiscence rate (2.0% vs. 7.7% p = 0.002) and the number of one-month postoperative admissions to our clinic (3.8 ± 1.1 vs. 5.7 ± 1.3 p = 0.0009). Although not significant, it is possible to note a trend of reduction of clinically relevant postoperative total complications in patients treated with NPWDs. Conclusions: NPWDs may represent a useful tool in the post-surgical management of complex oncoplastic procedures, ensuring less wound dehiscence. Furthermore, the use of these dressings led to a significant reduction in admissions to the clinic, promoting a lower use of resources by hospitals and effective prevention of possible complications.
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Affiliation(s)
- Donato Casella
- Department of Medicine, Surgery and Neurosciences, University of Siena, 53100 Siena, Italy; (D.C.); (A.L.P.); (R.C.)
| | - Daniele Fusario
- Department of Medicine, Surgery and Neurosciences, University of Siena, 53100 Siena, Italy; (D.C.); (A.L.P.); (R.C.)
| | - Anna Lisa Pesce
- Department of Medicine, Surgery and Neurosciences, University of Siena, 53100 Siena, Italy; (D.C.); (A.L.P.); (R.C.)
| | - Marco Marcasciano
- Unit of Plastic and Reconstructive Surgery, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy;
| | - Federico Lo Torto
- Department of Plastic Reconstructive and Aesthetic Surgery, Sapienza Università di Roma, 00185 Rome, Italy; (F.L.T.); (D.R.)
| | - Gianluigi Luridiana
- Unit of Oncologic and Breast Surgery, A.R.N.A.S Brotzu, Businco Oncologic Hospital, 09047 Cagliari, Italy;
| | | | - Roberto Cuomo
- Department of Medicine, Surgery and Neurosciences, University of Siena, 53100 Siena, Italy; (D.C.); (A.L.P.); (R.C.)
| | - Diego Ribuffo
- Department of Plastic Reconstructive and Aesthetic Surgery, Sapienza Università di Roma, 00185 Rome, Italy; (F.L.T.); (D.R.)
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van de Voort EMF, Struik GM, Birnie E, Sinke RHJA, Verver D, van Streun SP, Macco M, Verhoef C, Klem TMAL. Implementation of vacuum-assisted excision as a management option for benign and high-risk breast lesions. Br J Radiol 2023; 96:20220776. [PMID: 37171394 PMCID: PMC10321268 DOI: 10.1259/bjr.20220776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 02/02/2023] [Accepted: 03/14/2023] [Indexed: 05/13/2023] Open
Abstract
OBJECTIVE Previous studies have shown that vacuum-assisted excision (VAE) is a safe and effective alternative for surgical excision (SE) of benign breast lesions. However, the use of VAE in high-risk lesions is controversial and guidelines are ambiguous. This study describes the impact of the implementation of VAE in terms of management and outcomes compared to a cohort before implementation. METHODS A single centre retrospective study with two cohorts: 'before' and 'after' implementation of VAE was performed. All patients with a benign or high-risk lesion treated by VAE or SE between 2016 and 2019 were included. Excision, complication, and upgrade rates were compared between both cohorts. Cox regression was used for the evaluation of recurrences and re-excisions. RESULTS The overall excision rate of all benign and high-risk lesions was comparable in both cohorts (17% vs 16%, p = 0.700). After implementation, benign lesions were significantly more often managed by VAE (101/151, 67%, p < 0.001). Re-excision, recurrence, and complication rates were low and comparable between cohorts (4.3% vs 3.9%, p > 0.999; 3.0 vs 2.0%, p = 0.683; 3.4 vs 6.6%, p = 0.289, respectively). CONCLUSION SE could safely be replaced by VAE in 58% of patients treated for a benign or high-risk lesion. With this shift in management, the use of operating rooms and general anaesthesia can safely be omitted in this patient group. Further research on high-risk lesions is warranted since our data are exploratory. ADVANCES IN KNOWLEDGE This study provides supportive data for the use of VAE as a management option for both benign (up to 5 cm) and high-risk lesions. Outcomes on re-excision, recurrence should be confirmed in prospective studies especially in high-risk lesions.
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Affiliation(s)
| | | | | | - Renata HJA Sinke
- Department of Pathology, Franciscus Gasthuis & Vlietland, Kleiweg, Rotterdam, Netherlands
| | | | | | - Maura Macco
- Department of Radiology, Franciscus Gasthuis & Vlietland, Kleiweg, Rotterdam, Netherlands
| | - C. Verhoef
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Doctor Molewaterplein, Rotterdam, Netherlands
| | - Taco MAL Klem
- Department of Surgery, Franciscus Gasthuis, Rotterdam, Netherlands
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10
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Koppiker C, Joshi S, Mishra R, Kelkar DA, Chigurupati P, Joshi A, John J, Kadu S, Bagdia A, Thakkar D, Deshmukh C, Allampati H, Sharan G, Dhar U, Nare S, Nagarkar S, Busheri L, Varghese B, Pai M. Therapeutic mammoplasty: a "wise" oncoplastic choice-lessons from the largest single-center cohort from Asia. Front Oncol 2023; 13:1131951. [PMID: 37124516 PMCID: PMC10141318 DOI: 10.3389/fonc.2023.1131951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 03/06/2023] [Indexed: 05/02/2023] Open
Abstract
Introduction The majority of breast cancer patients from India usually present with advanced disease, limiting the scope of breast conservation surgery. Therapeutic mammoplasty (TM), an oncoplastic technique that permits larger excisions, is quite promising in such a scenario and well suited to breast cancer in medium-to-large-sized breasts with ptosis and in some cases of large or multifocal/multicentric tumors. Here, we describe our TM cohort of 205 (194 malignant and 11 benign) patients from 2012 to 2019 treated at a single surgeon center in India, the largest Asian dataset for TM. Methods All patients underwent treatment after careful discussions by a multidisciplinary tumor board and patient counseling. We report the clinicopathological profiles and surgical, oncological, cosmetic, and patient-related outcomes with different TM procedures. Results The median age of breast cancer patients was 49 years; that of benign disease patients was 41 years. The breast cancer cohort underwent simple (n = 84), complex (n = 71), or extreme (n = 44) TM surgeries. All resection margins were analyzed through intra-operative frozen-section assessment with stringent rad-path analysis protocols. The margin positivity rate was found to be 1.4%. A majority of the cohort was observed to have pT1-pT2 tumors, and the median resection volume was 180 cc. Low post-operative complication rates and good-to-excellent cosmetic scores were observed. The median follow-up was 39 months. We observed 2.07% local and 5.7% distal recurrences, and disease-specific mortality was 3.1%. At median follow-up, the overall survival was observed to be 95.9%, and disease-free survival was found to be 92.2%. The patient-reported outcome measures (PROMs) showed good-to-excellent scores for all types of TMs across BREAST-Q domains. Conclusion We conclude that in India, a country where women present with large and locally advanced tumors, TM safely expands the indications for breast conservation surgery. Our results show oncological and cosmetic outcomes at acceptable levels. Most importantly, PROM scores suggest improved overall wellbeing and better satisfaction with the quality of life. For patients with macromastia, this technique not only focuses on cancer but also improves self-image and reduces associated physical discomfort often overlooked by women in the Indian setting. The popularization of this procedure will enable Indian patients with breast cancer to receive the benefits of breast conservation.
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Affiliation(s)
- Chaitanyanand Koppiker
- Orchids Breast Health Centre, Prashanti Cancer Care Mission, Pune, India
- Centre for Translational Cancer Research: A Joint Initiative of Indian Institute of Science Education and Research (IISER), Pune and Prashanti Cancer Care Mission (PCCM), Pune, India
- International School of Oncoplastic Surgery, Pune, India
- Jehangir Hospital, Pune, India
- *Correspondence: Chaitanyanand Koppiker,
| | - Sneha Joshi
- Centre for Translational Cancer Research: A Joint Initiative of Indian Institute of Science Education and Research (IISER), Pune and Prashanti Cancer Care Mission (PCCM), Pune, India
| | - Rupa Mishra
- Centre for Translational Cancer Research: A Joint Initiative of Indian Institute of Science Education and Research (IISER), Pune and Prashanti Cancer Care Mission (PCCM), Pune, India
| | - Devaki A. Kelkar
- Centre for Translational Cancer Research: A Joint Initiative of Indian Institute of Science Education and Research (IISER), Pune and Prashanti Cancer Care Mission (PCCM), Pune, India
| | | | - Anjali Joshi
- Centre for Translational Cancer Research: A Joint Initiative of Indian Institute of Science Education and Research (IISER), Pune and Prashanti Cancer Care Mission (PCCM), Pune, India
| | - Jisha John
- Centre for Translational Cancer Research: A Joint Initiative of Indian Institute of Science Education and Research (IISER), Pune and Prashanti Cancer Care Mission (PCCM), Pune, India
| | - Shweta Kadu
- Centre for Translational Cancer Research: A Joint Initiative of Indian Institute of Science Education and Research (IISER), Pune and Prashanti Cancer Care Mission (PCCM), Pune, India
| | | | - Deepti Thakkar
- International School of Oncoplastic Surgery, Pune, India
| | - Chetan Deshmukh
- Orchids Breast Health Centre, Prashanti Cancer Care Mission, Pune, India
| | | | - Gautam Sharan
- Department of Radiation Oncology, Inlaks and Budhrani Hospital, Pune, India
| | - Upendra Dhar
- Orchids Breast Health Centre, Prashanti Cancer Care Mission, Pune, India
- Jehangir Hospital, Pune, India
| | - Smeeta Nare
- Orchids Breast Health Centre, Prashanti Cancer Care Mission, Pune, India
- Centre for Translational Cancer Research: A Joint Initiative of Indian Institute of Science Education and Research (IISER), Pune and Prashanti Cancer Care Mission (PCCM), Pune, India
| | - Sanket Nagarkar
- Centre for Translational Cancer Research: A Joint Initiative of Indian Institute of Science Education and Research (IISER), Pune and Prashanti Cancer Care Mission (PCCM), Pune, India
| | - Laleh Busheri
- Orchids Breast Health Centre, Prashanti Cancer Care Mission, Pune, India
| | - Beenu Varghese
- Orchids Breast Health Centre, Prashanti Cancer Care Mission, Pune, India
| | - Mugdha Pai
- Orchids Breast Health Centre, Prashanti Cancer Care Mission, Pune, India
- Centre for Translational Cancer Research: A Joint Initiative of Indian Institute of Science Education and Research (IISER), Pune and Prashanti Cancer Care Mission (PCCM), Pune, India
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11
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Joukainen S, Laaksonen E, Vanninen R, Kaarela O, Sudah M. Dual-Layer Rotation: A Versatile Therapeutic Mammoplasty Technique. Ann Surg Oncol 2022; 29:6716-6727. [PMID: 35711016 PMCID: PMC9492593 DOI: 10.1245/s10434-022-11977-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 05/16/2022] [Indexed: 11/23/2022]
Abstract
Background Multifocal or complex breast lesions are a challenge for breast-conserving surgery, particularly surgery in small breasts or those located in the upper inner quadrant. The dual-layer rotation technique exploits the idea of manipulating the skin and glandular tissue in separate layers to fill the resection cavity via vertical mammoplasty if skin excision is not required, except in the central area. Methods The authors performed a retrospective review of consecutive breast cancer patients who underwent DLR mammoplasty between 2017 and 2019 at a single institution. Clinical data, reoperations, surgical complications, delays in adjuvant treatments, and the need for late revisional surgery were evaluated. Aesthetic outcomes were evaluated objectively and subjectively from photographs. Results The study included 46 breasts of 40 patients. Tumors were located in the UIQ (30%, 14/46) or in multiple quadrants (22%, 10/46). One third (33%, 13/40) of the patients had a small breast cup size (A–B). Negative margins were primarily achieved in 45 of the 46 breasts. Major complications occurred in three patients, who needed reoperation, and adjuvant therapy was delayed for one of these patients. Late refinement surgery was needed for two patients. The objective and subjective aesthetic outcomes were good or excellent regardless of the tumor position. Conclusion As a novel oncoplastic approach, DLR mammoplasty offers a one-step procedure to treat selected breast cancer patients with challenging resection defects due to different breast sizes or lesion locations. The technique preserves the breast’s natural appearance.
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Affiliation(s)
- Sarianna Joukainen
- Division of Plastic Surgery, Department of Surgery, Kuopio University Hospital, Kuopio, Finland.
| | - Elina Laaksonen
- Division of Plastic Surgery, Department of Surgery, Kuopio University Hospital, Kuopio, Finland
| | - Ritva Vanninen
- Diagnostic Imaging Center, Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland.,Cancer Center of Eastern Finland, University of Eastern Finland, Kuopio, Finland
| | - Outi Kaarela
- Division of Plastic Surgery, Department of Surgery, Kuopio University Hospital, Kuopio, Finland
| | - Mazen Sudah
- Diagnostic Imaging Center, Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland
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12
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Pellicciaro M, Materazzo M, Buonomo C, Vanni G. Feasibility and Oncological Safety of Axillary Reverse Mapping in Patients With Locally Advanced Breast Cancer and Partial Response After Neoadjuvant Chemotherapy. In Vivo 2021; 35:2489-2494. [PMID: 34182535 DOI: 10.21873/invivo.12529] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 03/03/2021] [Accepted: 04/18/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND/AIM Axillary reverse mapping (ARM) aims to identify and preserve arm drainage in order to prevent lymphedema following axillary lymph node dissection. Oncological-safety and feasibility are still debated, especially in patients with locally-advanced breast cancer (LABC). We report the first case of the AXMAP 1.0 study performed in our Institution. PATIENTS AND METHODS A 52-year-old patient with a triple-negative LABC and partial response to neoadjuvant chemotherapy underwent axillary lymph-node dissection using fluorescence ARM. RESULTS Two lymph-nodes draining the ipsilateral upper arm were identified and were not preserved due to suspicion of malignancy. Pathological examination confirmed the presence of malignancy in both lymph nodes. CONCLUSION Further studies should be designed in order to validate the oncological safety of this technique, especially in patients with LABC requiring neoadjuvant chemotherapy.
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Affiliation(s)
- Marco Pellicciaro
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | - Marco Materazzo
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy;
| | - Chiara Buonomo
- Department of Emergency and Admission, Critical Care Medicine, Pain Medicine and Anesthetic Science, Policlinico Tor Vergata University, Rome, Italy
| | - Gianluca Vanni
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
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13
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Rizzi SKLA, Haddad CAS, Giron PS, Figueira PVG, Estevão A, Elias S, Nazário ACP, Facina G. Exercise Protocol With Limited Shoulder Range of Motion for 15 or 30 Days After Conservative Surgery for Breast Cancer With Oncoplastic Technique: A Randomized Clinical Trial. Am J Clin Oncol 2021; 44:283-290. [PMID: 33731646 DOI: 10.1097/coc.0000000000000811] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The objective is to evaluate the effect of limiting shoulder range of motion (ROM) for 15 or 30 days on surgical complications and on shoulder ROM, pain, and upper limb function of breast cancer patients following conservative oncoplastic surgery. MATERIALS AND METHODS A randomized clinical trial was conducted with 60 women with breast cancer who underwent conservative oncoplastic surgery. The day after surgery, all patients started an exercise protocol with shoulder exercises limited to 90 degrees. Two weeks after surgery they were randomized into Free ROM Group (n=30) or Limited ROM Group (n=30). The Free ROM Group was allowed to perform shoulder exercises with unlimited ROM; the Limited ROM Group continued with shoulder movement restricted at 90 degrees until 30 days after surgery, at which time they were also allowed free ROM. The primary outcome was the incidence of postoperative complications (dehiscence, seroma, infection, and necrosis) and secondary outcomes were shoulder ROM, pain, and upper limb function. RESULTS No difference in the incidence of postoperative scar complications between groups was noted. There was no difference between the groups in shoulder joint amplitude, pain, or upper limb function. CONCLUSIONS The free ROM exercise protocol 15 days post surgery was safe concerning cicatricial complications.
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Affiliation(s)
| | | | - Patrícia S Giron
- Department of Gynecology, Federal University of São Paulo (UNIFESP), São Paulo
| | | | - Amanda Estevão
- Department of Gynecology, Federal University of São Paulo (UNIFESP), São Paulo
| | - Simone Elias
- Department of Gynecology, Federal University of São Paulo (UNIFESP), São Paulo
| | - Afonso C P Nazário
- Department of Gynecology, Federal University of São Paulo (UNIFESP), São Paulo
| | - Gil Facina
- Department of Gynecology, Federal University of São Paulo (UNIFESP), São Paulo
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14
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Materazzo M, Vanni G, Pellicciaro M, Anemona L, Servadei F, Giacobbi E, Farinaccio A, Pistolese CA, Perretta T, Chiocchi M, Bruno V, Tacconi F, Sadri A, De Majo A, Di Pasquali C, Meucci R, Santori F, Cotesta M, Buonomo OC. Case Report: Early Breast Cancer Recurrence Mimicking BIA-ALCL in a Patient With Multiple Breast Procedures. Front Surg 2021; 8:606864. [PMID: 33768110 PMCID: PMC7985528 DOI: 10.3389/fsurg.2021.606864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 02/18/2021] [Indexed: 12/02/2022] Open
Abstract
Breast reconstruction plays a fundamental role in the therapeutic process of breast cancer treatment and breast implants represents the leading breast reconstruction strategy. Breast Implant Associated-Anaplastic Large Cell Lymphoma (BIA-ALCL), locoregional recurrence in the skin flap, and skin flap necrosis are well-known complications following mastectomy and immediate breast reconstruction (IBR). We report a case of locoregional cancer recurrence in the mastectomy flap mimicking BIA-ALCL, in a patient who underwent 6 breast procedures in four facilities across 15 years including immediate breast reconstruction with macrotextured breast implants. Despite the rate and onset of the disease, clinicians should be aware of BIA-ALCL. Due to the risk of false negative results of fine needle aspiration, clinical suspicion of BIA-ALCL should drive clinicians' choices, aside from cytological results. In the present case, surgical capsulectomy of the abnormal periprosthesic tissue revealed locoregional recurrence.
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Affiliation(s)
- Marco Materazzo
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | - Gianluca Vanni
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | - Marco Pellicciaro
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | - Lucia Anemona
- Anatomic Pathology, Department of Experimental Medicine, Policlinico Tor Vergata University, Rome, Italy
| | - Francesca Servadei
- Anatomic Pathology, Department of Experimental Medicine, Policlinico Tor Vergata University, Rome, Italy
| | - Erika Giacobbi
- Anatomic Pathology, Department of Experimental Medicine, Policlinico Tor Vergata University, Rome, Italy
| | - Andrea Farinaccio
- Department of Cardiothoracic Anesthesia, Tor Vergata University Hospital, Rome, Italy
| | - Chiara Adriana Pistolese
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Policlinico Tor Vergata University, Rome, Italy
| | - Tommaso Perretta
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Policlinico Tor Vergata University, Rome, Italy
| | - Marcello Chiocchi
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Policlinico Tor Vergata University, Rome, Italy
| | - Valentina Bruno
- Section of Gynecology and Obstetrics, Academic Department of Biomedicine and Prevention, University Tor Vergata, Rome, Italy
| | - Federico Tacconi
- Division of Thoracic Surgery, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | - Amir Sadri
- Plastic Surgery, Great Hormond Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Adriano De Majo
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | - Camilla Di Pasquali
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | - Rosaria Meucci
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Policlinico Tor Vergata University, Rome, Italy
| | - Francesca Santori
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | - Maria Cotesta
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | - Oreste Claudio Buonomo
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
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15
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Gulis K, Rydén L, Bendahl PO, Svensjö T. Cosmetic Outcomes and Symmetry Comparison in Patients Undergoing Bilateral Therapeutic Mammoplasty for Breast Cancer. World J Surg 2021; 45:1433-1441. [PMID: 33527159 PMCID: PMC8026409 DOI: 10.1007/s00268-020-05941-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2020] [Indexed: 12/01/2022]
Abstract
Background Breast-reduction techniques are increasingly used in oncoplastic breast surgery. Bilateral therapeutic mammoplasty has the benefit of decreasing breast volume, enabling resection of larger tumors, and the potential to assure good postoperative symmetry. The aims of this study were to objectively asses the cosmetic outcomes of therapeutic mammoplasty in patients with breast cancer, using the breast cancer conservative treatment cosmetic results (BCCT.core) software, to compare this score with the surgeon’s score and the patient’s assessment, and to evaluate if other defined parameters have an impact on cosmetic outcomes. The secondary aim was to compare breast symmetry pre- and postoperatively. Materials and Methods We enrolled 146 consecutive patients with primary breast cancer who underwent therapeutic mammoplasty between 2011 and 2018 in Kristianstad Central Hospital, Sweden. We retrospectively collected data from patients’ records. We analyzed the BCCT.core score using postoperative photographs to objectively evaluate cosmetic outcomes on a four-grade scale and compared with preoperative photographs to evaluate symmetry. Cosmetic outcomes were also assessed subjectively by patients and surgeons, using a 10-point Likert scale. Results The majority of patients (89%) had good or excellent BCCT.core scores, which correlated with surgeons’ scores, rs = − 0.22 (p < 0.001). Overall, patients were more satisfied with the cosmetic outcomes than the surgeons (p < 0.001). Evidence supporting an association between the defined clinicopathological variables, for example, tumor size, and cosmetic outcomes, was weak. Conclusion Therapeutic mammoplasty yields a very good cosmetic outcome, evaluated both by subjective and objective measurements. Importantly, symmetry can be improved in patients with asymmetry. Supplementary information The online version contains supplementary material available at (10.1007/s00268-020-05941-0).
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Affiliation(s)
- K Gulis
- Department of Clinical Sciences Lund, Division of Surgery, Lund University, Lund, Sweden.
- Department of Surgery, Kristianstad Central Hospital, 29133, Kristianstad, Sweden.
| | - L Rydén
- Department of Clinical Sciences Lund, Division of Surgery, Lund University, Lund, Sweden
- Department of Clinical Sciences Lund, Division of Oncology, Lund University, Lund, Sweden
| | - P O Bendahl
- Department of Clinical Sciences Lund, Division of Oncology, Lund University, Lund, Sweden
| | - T Svensjö
- Department of Surgery, Kristianstad Central Hospital, 29133, Kristianstad, Sweden
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16
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Kawasaki Y, Park S, Miyamoto K, Ueki R, Kariya N, Tatara T, Hirose M. Modified model for predicting early C-reactive protein levels after gastrointestinal surgery: A prospective cohort study. PLoS One 2020; 15:e0239709. [PMID: 32970767 PMCID: PMC7514002 DOI: 10.1371/journal.pone.0239709] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 09/12/2020] [Indexed: 11/19/2022] Open
Abstract
Background Postoperative serum concentration of C-reactive protein (CRP) is one of the objective quantitative indices integrating the effects of preoperative and intraoperative variables. Higher levels of CRP after gastrointestinal surgery are associated with major postoperative complications. To develop a model for predicting CRP levels on postoperative day (POD) 1 in surgical patients both with and without serious conditions and comorbidities, we modified the previous formula for prediction of CRP levels on POD1, and assessed the accuracy of our modified predictive formula for CRP levels. Material and methods Consecutive patients of all ages undergoing gastrointestinal surgery under general anesthesia were enrolled in this single-institution prospective cohort study. We developed a modified predictive formula in a calculation cohort. Next, associations between measured CRP levels on POD1, predicted CRP levels on POD1 using the previous and modified models, and major complications after surgery were examined in a validation cohort. Results We obtained the following model in the calculation cohort (n = 222): Modified model for predicting CRP levels on POD1 (mg•dL-1) = -10.13 + 0.0025 Duration of surgery (min) + 15.9 Mean Nociceptive Response (NR) + 0.66 Preoperative CRP level (mg•dL-1). In the validation cohort (n = 440), there was a significant association between measured and predicted CRP levels on POD1 (P < 0.001) No significant difference between the measured and predicted CRP levels using the modified model was observed (P = 0.847). There were also significant associations between the predicted CRP levels and major complications after surgery. Conclusion CRP levels predicted using duration of surgery, mean NR, and preoperative CRP levels are likely identical to measured CRP levels on POD1, being associated with major complications after gastrointestinal surgery.
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Affiliation(s)
- Yui Kawasaki
- Department of Anesthesiology and Pain Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Soonhee Park
- Department of Anesthesiology and Pain Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Kazunori Miyamoto
- Department of Anesthesiology and Pain Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Ryusuke Ueki
- Department of Anesthesiology and Pain Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Nobutaka Kariya
- Department of Anesthesiology and Pain Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Tsuneo Tatara
- Department of Anesthesiology and Pain Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Munetaka Hirose
- Department of Anesthesiology and Pain Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
- * E-mail:
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17
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Brorson F, Thorarinsson A, Kölby L, Elander A, Hansson E. Early complications in delayed breast reconstruction: A prospective, randomized study comparing different reconstructive methods in radiated and non-radiated patients. Eur J Surg Oncol 2020; 46:2208-2217. [PMID: 32807615 DOI: 10.1016/j.ejso.2020.07.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 06/25/2020] [Accepted: 07/08/2020] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND There is little high-quality scientific evidence identifying the best and safest methods for delayed breast reconstruction, with most previous studies retrospective in nature. The primary aim was to compare early complication rates for two different breast-reconstructive methods in radiated and non-radiated patients, using a validated scale. The secondary aim was to identify predictors for complications. MATERIALS AND METHODS This study represents a clinical, randomized, prospective trial (ClinicalTrials.Gov identifier: NCT03963427), where the patients were divided into two study arms: non-radiated and radiated. In the non-radiated arm, patients were randomized to a one-stage lateral thoracodorsal flap with an implant or two-stage expander reconstruction. In the radiated arm, patients were randomized to a latissimus dorsi reconstruction combined with an implant or deep inferior epigastric artery perforator (DIEP) reconstruction. All adverse events were classified according to Clavien-Dindo and summarization of overall morbidity was performed by calculating the Comprehensive Complication Index score. The study was conducted from 2008 to 2020. RESULTS The complication frequencies were similar for the two surgical methods within each arm. In the non-radiated arm, risk factors for any complication were any comorbidities, and in the radiated arm, factors were a high body mass index and a contralateral operation. CONCLUSIONS The usage of the Clavien-Dindo scale in reconstructive surgery is feasible, but further validation is needed. In non-radiated patients, the frequencies of short-term complications were similar for lateral thoracodorsal flap and expander reconstruction, whereas in radiated patients, they were similar for DIEP and latissimus dorsi. The complication profile of the methods varied.
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Affiliation(s)
- Fredrik Brorson
- Department of Plastic Surgery, University of Gothenburg, The Sahlgrenska Academy, Institute of Clinical Sciences, Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - Andri Thorarinsson
- Department of Plastic Surgery, University of Gothenburg, The Sahlgrenska Academy, Institute of Clinical Sciences, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Lars Kölby
- Department of Plastic Surgery, University of Gothenburg, The Sahlgrenska Academy, Institute of Clinical Sciences, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Anna Elander
- Department of Plastic Surgery, University of Gothenburg, The Sahlgrenska Academy, Institute of Clinical Sciences, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Emma Hansson
- Department of Plastic Surgery, University of Gothenburg, The Sahlgrenska Academy, Institute of Clinical Sciences, Sahlgrenska University Hospital, Gothenburg, Sweden.
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18
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O'Connor RÍ, Kiely PA, Dunne CP. The relationship between post-surgery infection and breast cancer recurrence. J Hosp Infect 2020; 106:522-535. [PMID: 32800825 DOI: 10.1016/j.jhin.2020.08.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 08/06/2020] [Indexed: 02/06/2023]
Abstract
Breast cancer is the second most prevalent form of cancer in women worldwide, with surgery remaining the standard treatment. The adverse impact of the surgery remains controversial. It has been suggested that systemic factors during the postoperative period may increase the risk of recurrence, specifically surgical site infection (SSI). The aim of this review was to critically appraise current published literature regarding the influence of SSIs, after primary breast cancer surgery, on breast cancer recurrence, and to delve into potential links between these. This systematic review adopted two approaches: to identify the incidence rates and risk factors related to SSI after primary breast cancer surgery; and, secondly, to examine breast cancer recurrence following SSI occurrence. Ninety-nine studies with 484,605 patients were eligible in the SSI-focused searches, and 53 studies with 17,569 patients for recurrence-focused. There was a 13.07% mean incidence of SSI. Six-hundred and thirty-eight Gram-positive and 442 Gram-negative isolates were identified, with methicillin-susceptible Staphylococcus aureus and Escherichia coli most commonly identified. There were 2077 cases of recurrence (11.8%), with 563 cases of local recurrence, 1186 cases of distant and 25 cases which recurred both locally and distantly. Five studies investigated the association between SSI and breast cancer recurrence with three concluding that an association did exist. In conclusion, there is association between SSI and adverse cancer outcomes, but the cellular link between them remains elusive. Confounding factors of retrospective study design, surgery type and SSI definition make results challenging to compare and interpret. A standardized prospective study with appropriate statistical power is justified.
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Affiliation(s)
- R Í O'Connor
- School of Medicine, University of Limerick, Ireland; Health Research Institute, University of Limerick, Ireland; Bernal Institute, University of Limerick, Ireland
| | - P A Kiely
- School of Medicine, University of Limerick, Ireland; Health Research Institute, University of Limerick, Ireland; Bernal Institute, University of Limerick, Ireland; Centre for Interventions in Infection, Inflammation & Immunity (4i), University of Limerick, Limerick, Ireland
| | - C P Dunne
- School of Medicine, University of Limerick, Ireland; Health Research Institute, University of Limerick, Ireland; Centre for Interventions in Infection, Inflammation & Immunity (4i), University of Limerick, Limerick, Ireland.
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19
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Vanni G, Pellicciaro M, Materazzo M, Dauri M, D'angelillo RM, Buonomo C, De Majo A, Pistolese C, Portarena I, Mauriello A, Servadei F, Giacobbi E, Chiaravalloti A, Buonomo OC. Awake breast cancer surgery: strategy in the beginning of COVID-19 emergency. Breast Cancer 2020; 28:137-144. [PMID: 32734327 PMCID: PMC7391474 DOI: 10.1007/s12282-020-01137-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 07/16/2020] [Indexed: 01/09/2023]
Abstract
Introduction COVID-19 is a declared worldwide pandemic. In our country, due to shortage of hospitals and beds in intensive care unit, oncological and breast cancer (BC) resources are temporarily shifted to COVID-19 patients. In addition, risk of cross-infections should be considered in these frail patients. To accomplish more surgical procedures and to reduce the length of hospital stay (LOS), fast track awake BC surgery should be implemented. The aim of the study is to estimate the effects of surgical shift in our facility during the early COVID-19 outbreak. Materials and methods From 30th January 2020 to 30th of March 2020, 86 consecutive patients were retrospectively enrolled and divided into pre-COVID-19-BC and COVID-19-BC. Clinical parameters and anamnestic data were collected and analyzed. Surgical procedures, relative complications and type of anaesthesia were reported. The effect on surgical time (ST), operative room time (ORT) and length of stay (LOS) were described and examined. Results No statistical difference was found in complications rate, clinical data and surgical procedures (p > 0.05). Awake breast conservative surgery (BCS) was the most frequent procedure in COVID-19-BC (p = 0.006). A statistically significant decrease in ORT and LOS was reported in COVID-19-BC (p = 0.040 and p = 0.0015 respectively), while comparable time resulted for ST (p = 0.976). Mean ORT and LOS reduction were 20.79 min and 0.57 hospital bed days. Conclusion In the “COVID-19 era”, fast track awake breast surgery provides a reduction of ORT, LOS and potentially surgical treatment for a wider number of oncological patients.
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Affiliation(s)
- Gianluca Vanni
- Breast Unit, Department of Surgical Science, PTV Policlinico Tor Vergata University, Viale Oxford 81, 00133, Rome, RM, Italy
| | - Marco Pellicciaro
- Breast Unit, Department of Surgical Science, PTV Policlinico Tor Vergata University, Viale Oxford 81, 00133, Rome, RM, Italy.
| | - Marco Materazzo
- Breast Unit, Department of Surgical Science, PTV Policlinico Tor Vergata University, Viale Oxford 81, 00133, Rome, RM, Italy
| | - Mario Dauri
- Department of Emergency and Admission, Critical Care Medicine, Pain Medicine and Anesthetic Science, Policlinico Tor Vergata University, Viale Oxford 81, 00133, Rome, Italy
| | - Rolando Maria D'angelillo
- Radiotherapy Unit, Department of Oncology and Hematology, Policlinico Tor Vergata University, Viale Oxford 81, 00133, Rome, RM, Italy
| | - Chiara Buonomo
- Department of Emergency and Admission, Critical Care Medicine, Pain Medicine and Anesthetic Science, Policlinico Tor Vergata University, Viale Oxford 81, 00133, Rome, Italy
| | - Adriano De Majo
- Breast Unit, Department of Surgical Science, PTV Policlinico Tor Vergata University, Viale Oxford 81, 00133, Rome, RM, Italy
| | - Chiara Pistolese
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Policlinico Tor Vergata University, Viale Oxford 81, 00133, Rome, RM, Italy
| | - Ilaria Portarena
- Department of Oncology, Policlinico Tor Vergata University, Viale Oxford 81, 00133, Rome, RM, Italy
| | - Alessandro Mauriello
- Anatomic Pathology, Department of Experimental Medicine, Policlinico Tor Vergata University, Viale Oxford 81, 00133, Rome, RM, Italy
| | - Francesca Servadei
- Anatomic Pathology, Department of Experimental Medicine, Policlinico Tor Vergata University, Viale Oxford 81, 00133, Rome, RM, Italy
| | - Erica Giacobbi
- Anatomic Pathology, Department of Experimental Medicine, Policlinico Tor Vergata University, Viale Oxford 81, 00133, Rome, RM, Italy
| | - Agostino Chiaravalloti
- Department of Biomedicine and Prevention, Policlinico Tor Vergata University, Viale Oxford 81, 00133, Rome, RM, Italy.,IRCCS Neuromed, UOC Medicina Nucleare, Via Atinense 18, 86077, Pozzilli, IS, Italy
| | - Oreste Claudio Buonomo
- Breast Unit, Department of Surgical Science, PTV Policlinico Tor Vergata University, Viale Oxford 81, 00133, Rome, RM, Italy
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20
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Higuchi R, Yazawa T, Uemura S, Matsunaga Y, Ota T, Araida T, Furukawa T, Yamamoto M. Examination of Prognostic Factors Affecting Long-Term Survival of Patients with Stage 3/4 Gallbladder Cancer without Distant Metastasis. Cancers (Basel) 2020; 12:cancers12082073. [PMID: 32726993 PMCID: PMC7464443 DOI: 10.3390/cancers12082073] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 07/21/2020] [Accepted: 07/23/2020] [Indexed: 02/06/2023] Open
Abstract
In advanced gallbladder cancer (GBC) radical resection, if multiple prognostic factors are present, the outcome may be poor; however, the details remain unclear. To investigate the poor prognostic factors affecting long-term surgical outcome, we examined 157 cases of resected stage 3/4 GBC without distant metastasis between 1985 and 2017. Poor prognostic factors for overall survival and treatment outcomes of a number of predictable preoperative poor prognostic factors were evaluated. The surgical mortality was 4.5%. In multivariate analysis, blood loss, poor histology, liver invasion, and ≥4 regional lymph node metastases (LNMs) were independent prognostic factors for poor surgical outcomes; invasion of the left margin or the entire area of the hepatoduodenal ligament and a Clavien–Dindo classification ≥3 were marginal factors. The analysis identified outcomes of patients with factors that could be predicted preoperatively, such as liver invasion ≥5 mm, invasion of the left margin or the entire area of the hepatoduodenal ligament, and ≥4 regional LNMs. Thus, the five-year overall survival was 54% for zero factors, 34% for one factor, and 4% for two factors (p < 0.05). A poor surgical outcome was likely when two or more factors were predicted preoperatively; therefore, new treatment strategies are required for such patients.
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Affiliation(s)
- Ryota Higuchi
- Department of Surgery, Institute of Gastroenterology, Tokyo Women’s Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan; (R.H.); (T.Y.); (S.U.); (Y.M.)
| | - Takehisa Yazawa
- Department of Surgery, Institute of Gastroenterology, Tokyo Women’s Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan; (R.H.); (T.Y.); (S.U.); (Y.M.)
| | - Shuichirou Uemura
- Department of Surgery, Institute of Gastroenterology, Tokyo Women’s Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan; (R.H.); (T.Y.); (S.U.); (Y.M.)
| | - Yutaro Matsunaga
- Department of Surgery, Institute of Gastroenterology, Tokyo Women’s Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan; (R.H.); (T.Y.); (S.U.); (Y.M.)
| | - Takehiro Ota
- Department of Surgery, Ebara Hospital, 4-5-10 Higashiyukigaya, Ota-ku, Tokyo 145-0065, Japan;
| | - Tatsuo Araida
- Department of Surgery, Division of Gastroenterological Surgery, Tokyo Women’s Medical University, Yachiyo Medical Center, 477-96 Shinden, Oowada, Yachiyo-shi, Chiba 276-8524, Japan;
| | - Toru Furukawa
- Department of Investigative Pathology, Tohoku University Graduate School of Medicine, 2-1 Seiryomachi, Aoba-ku, Sendai 980-8575, Japan;
| | - Masakazu Yamamoto
- Department of Surgery, Institute of Gastroenterology, Tokyo Women’s Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan; (R.H.); (T.Y.); (S.U.); (Y.M.)
- Correspondence: ; Tel.: +81-3-3353-8111
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21
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Chang WF, Luo AJ, Yuan YF, Chen Y, Xin ZR, Xu SS. Perioperative Complications and Safety Evaluation of Robot-Assisted Radical Hysterectomy of Cervical Cancer After Neoadjuvant Chemotherapy. Cancer Manag Res 2020; 12:4483-4492. [PMID: 32606942 PMCID: PMC7305848 DOI: 10.2147/cmar.s243986] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Accepted: 05/22/2020] [Indexed: 12/24/2022] Open
Abstract
Purpose To evaluate the perioperative complications of patients with cervical cancer who are treated with robot-assisted radical hysterectomy (RRH) and to further evaluate the safety of patients undergoing NACT. Methods A total of 805 consecutive cervical cancer patients undergoing RRH were involved in this report. Their clinical characteristics were retrieved from hospital medical records. Perioperative complications were subdivided into intraoperative and postoperative complications, which were graded according to the Clavien-Dindo classification (CDC), and the complications of grade III and above were defined as severe complications. Furthermore, the two-level logistic regression model was used to estimate the risk factors of perioperative and severe complications and to further confirm the relationship between NACT and perioperative and severe complications. Results The perioperative complication rate and severe complications were 45.09% and 7.83%, respectively. Poorly differentiated tumor and NACT were identified as independent risk factors for perioperative complications by multifactor analysis. Furthermore, we concentrated on the relations between NACT and complications. The risk of perioperative complications of the group with NACT (OR = 11.08, 95% CI: 5.70-21.54) was significantly higher than the group without NACT, especially in postoperative complications (OR=17.65, 95% CI: 8.63-36.08), even after adjusting confounding factors. However, there was no statistically significant difference in terms of severe complications (OR=1.68, 95% CI: 0.64-4.41) and intraoperative complications (OR=0.51, 95% CI: 0.18-1.41). Moreover, as the times of NACT increase, the impact on perioperative complications is more pronounced. A similar trend was observed in postoperative complications, while this statistical difference was still not observed in intraoperative and severe complications. Conclusion This result demonstrates the feasibility and safety of RRH of cervical carcinoma after NACT in generally, since it only causes mild complications, not severe complications.
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Affiliation(s)
- Wei-Fu Chang
- Xiangya School of Public Health, Central South University, Changsha 410008, Hunan, People's Republic of China.,The Third Xiangya Hospital of Central South University, Changsha 410013, Hunan, People's Republic of China.,Key Laboratory of Medical Information Research, Central South University, Changsha 410013, Hunan, People's Republic of China
| | - Ai-Jing Luo
- Xiangya School of Public Health, Central South University, Changsha 410008, Hunan, People's Republic of China.,Key Laboratory of Medical Information Research, Central South University, Changsha 410013, Hunan, People's Republic of China.,The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, People's Republic of China
| | - Yi-Feng Yuan
- School of Life Sciences, Central South University, Changsha 410013, Hunan, People's Republic of China
| | - Yang Chen
- School of Life Sciences, Central South University, Changsha 410013, Hunan, People's Republic of China
| | - Zi-Rui Xin
- Key Laboratory of Medical Information Research, Central South University, Changsha 410013, Hunan, People's Republic of China.,School of Life Sciences, Central South University, Changsha 410013, Hunan, People's Republic of China
| | - Shuai-Shuai Xu
- Xiangya School of Public Health, Central South University, Changsha 410008, Hunan, People's Republic of China
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22
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Tejera Hernández AA, Vega Benítez VM, Rocca Cardenas JC, Ortega Pérez N, Rodriguez Ibarria N, Díaz Chico JC, García-Granados Alayón JJ, Pérez Correa P, Hernández Hernández JR. Complications and local relapse after intraoperative low-voltage X-ray radiotherapy in breast cancer. Ann Surg Treat Res 2020; 98:299-306. [PMID: 32528909 PMCID: PMC7263891 DOI: 10.4174/astr.2020.98.6.299] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 03/08/2020] [Accepted: 04/07/2020] [Indexed: 11/30/2022] Open
Abstract
Purpose To study those factors that influence the occurrence of surgical complications and local relapse in patients intervened for breast cancer and receiving intraoperative radiotherapy. Methods Observational study on patients intervened for breast cancer with conservative surgery and intraoperative radiotherapy with low-voltage X-ray energy source (INTRABEAM), from 2015 to 2017 with 24 months minimum follow-up. Variables possibly associated to the occurrence of postoperative complications were analyzed with the Student t-test and the Fisher exact test; P < 0.05 considered significant. Subsequently, the construction of multiple multivariate analysis models began, thus building a logistic regression analysis using the IBM SPSS Statistics ver. 23 software. Local relapse was described. Results The study included 102 patients, mean age of 61.2 years; mean global size of tumor, 12.2 mm. Complications occurred in 29.4%. Fibrosis was the most frequently observed complication, followed by postoperative seroma. Using a 45 mm or larger applicator were significantly associated with the occurrence of complications. Tumor size 2 cm or larger and reintervention showed borderline significant association. Only one case of local relapse was observed. Conclusion Certain factors may increase the risk of complication after the use of intraoperative radiotherapy. Using external complementary radiotherapy does not seem to increase the rate of complications. Select patients and the involvement of a multidisciplinary team are essential for achieving good results.
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Affiliation(s)
- Ana Alicia Tejera Hernández
- Faculty of Health Sciences, University of Las Palmas de Gran Canaria, Las Palmas, Spain.,General Surgery Department, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, Las Palmas, Spain
| | - Víctor Manuel Vega Benítez
- Faculty of Health Sciences, University of Las Palmas de Gran Canaria, Las Palmas, Spain.,General Surgery Department, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, Las Palmas, Spain
| | | | - Neith Ortega Pérez
- Faculty of Health Sciences, University of Las Palmas de Gran Canaria, Las Palmas, Spain.,General Surgery Department, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, Las Palmas, Spain
| | - Nieves Rodriguez Ibarria
- Faculty of Health Sciences, University of Las Palmas de Gran Canaria, Las Palmas, Spain.,Therapeutic Radiation and Oncology Department, Hospital Universitario de Gran Canaria Dr Negrin, Las Palmas, Spain
| | | | - Juan José García-Granados Alayón
- Faculty of Health Sciences, University of Las Palmas de Gran Canaria, Las Palmas, Spain.,Service of Radiophysics and Radiological Protection, Hospital Universitario Insular de Gran Canaria, Las Palmas, Spain
| | - Pedro Pérez Correa
- Faculty of Health Sciences, University of Las Palmas de Gran Canaria, Las Palmas, Spain.,General Surgery Department, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, Las Palmas, Spain
| | - Juan Ramón Hernández Hernández
- Faculty of Health Sciences, University of Las Palmas de Gran Canaria, Las Palmas, Spain.,General Surgery Department, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, Las Palmas, Spain
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23
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Effects of neoadjuvant chemotherapy on operative adverse events and chemotherapy and radiotherapy in patients undergoing immediate breast reconstruction. Breast Cancer 2020; 27:716-723. [PMID: 32162180 DOI: 10.1007/s12282-020-01065-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 02/17/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Immediate breast reconstruction (IBR) has been become a standard treatment for patients with breast cancer undergoing mastectomy. However, whether IBR is appropriate in patients undergoing neoadjuvant chemotherapy (NAC) is still unclear. Therefore, in this study we examined the rates of operative adverse events (AEs), risk factors for operative AEs, and effects on chemotherapy and radiotherapy of IBR with NAC. METHODS Between January 2012 and March 2018, 593 patients underwent IBR at the Aichi Cancer Center Hospital. We retrospectively obtained clinical data of all these patients from their medical records and identified 56 patients (65 breasts) who had received NAC (NAC group) and 537 patients (568 breasts) who had not (non-NAC group). We compared the rates of operative AEs, risk factors for operative AEs, chemotherapy-related AEs, and duration to radiotherapy between the NAC and non-NAC cohorts. RESULTS The rate of operative AEs was significantly higher in the NAC than the non-NAC group (35% vs. 22%, p < 0.05). However, axillary lymph node dissection was the most influential risk factor, and NAC was not identified as a risk factor for operative AEs in patients who had undergone IBR. Additionally, there were no statistically significant differences in chemotherapy-related AEs or interval between surgery and postoperative radiotherapy between the NAC and non-NAC groups. CONCLUSIONS NAC remains likely to contribute to increased postoperative AEs in patients undergoing IBR; however, it does not affect postoperative treatment and IBR is appropriate for patients undergoing NAC.
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24
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Majumdar JR, Vertosick EA, Cohen B, Assel M, Levine M, Barton-Burke M. Preoperative Anxiety in Patients Undergoing Outpatient Cancer Surgery. Asia Pac J Oncol Nurs 2019; 6:440-445. [PMID: 31572766 PMCID: PMC6696814 DOI: 10.4103/apjon.apjon_16_19] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 05/05/2019] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVE Our primary research aim was to determine the prevalence of preoperative anxiety in patients undergoing outpatient cancer surgery. Our secondary aim was to examine the association between preoperative anxiety and negative intraoperative and postoperative outcomes in patients undergoing outpatient cancer surgery, including increased anesthesia requirements, postoperative nausea and vomiting (PONV), extended overnight stay, total length of stay (LOS), transfer to hospital, surgical complications, and postoperative visits to urgent care centers (UCC). METHODS We conducted a retrospective cohort study to investigate the prevalence of preoperative anxiety and its association with postoperative outcomes in patients undergoing outpatient cancer surgery. Our retrospective cohort included 10,048 outpatient procedures performed on 8683 patients at a large comprehensive cancer center between January 1, 2016, and April 30, 2018. RESULTS The analysis included 8665 patients undergoing procedures at an outpatient facility over 16 months; 16.7% had preoperative anxiety. In patients with preoperative anxiety, higher rates of adverse outcomes were seen, including PONV (adjusted difference 1.8%, 95% confidence interval [CI] 0.12%, 3.4%, P = 0.029), unplanned overnight admission (adjusted difference 1.1%, 95% CI 0.07%, 2.0%, P = 0.021), and urgent care visits within 30 days (adjusted difference 1.5%, 95% CI 0.44%, 2.6%, P = 0.002). CONCLUSIONS Even assuming a causal relationship between preoperative anxiety and postoperative outcomes, preventing one instance of PONV would require treating at least 30 patients for anxiety, and preventing longer-term outcomes such as urgent care visits or readmissions within 30 days would require treating even larger numbers of patients. Future studies should attempt to elucidate the causal pathway between preoperative anxiety and postoperative adverse events in outpatients undergoing outpatient cancer surgery.
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Affiliation(s)
- Jennifer Ross Majumdar
- Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Emily A. Vertosick
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Bevin Cohen
- Department of Nursing Research Memorial Sloan Kettering Cancer Center, New York, NY, USA
- School of Nursing, Columbia University, New York, NY, USA
| | - Melissa Assel
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Marcia Levine
- Department of Perioperative Services, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Margaret Barton-Burke
- Department of Nursing Research Memorial Sloan Kettering Cancer Center, New York, NY, USA
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25
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De-escalation of complexity in oncoplastic breast surgery: Case series from a specialized breast center. Breast 2019; 46:12-18. [DOI: 10.1016/j.breast.2019.04.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Revised: 03/17/2019] [Accepted: 04/08/2019] [Indexed: 11/21/2022] Open
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26
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Gardfjell A, Dahlbäck C, Åhsberg K. Patient satisfaction after unilateral oncoplastic volume displacement surgery for breast cancer, evaluated with the BREAST-Q™. World J Surg Oncol 2019; 17:96. [PMID: 31167659 PMCID: PMC6551885 DOI: 10.1186/s12957-019-1640-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Accepted: 05/27/2019] [Indexed: 11/11/2022] Open
Abstract
Background Oncoplastic breast-conserving surgery allows larger resections in unfavorable locations, with an improved chance of preserving esthetics. Indications and timing for potential contralateral surgery to obtain symmetry are not clear. The aim of this study was to evaluate patient satisfaction after unilateral oncoplastic volume displacement surgery, to investigate potential risk factors for lower patient satisfaction and to assess patient wish for contralateral surgery. Method A cohort of 144 women, consecutively treated for breast cancer with unilateral breast-conserving oncoplastic volume displacement surgery, followed by radiotherapy and with an unoperated contralateral breast, was sent the BREAST-Q™ breast-conserving therapy (BCT) and a study-specific questionnaire. In all, 120 women (83%) responded. For these women, the median value for resected specimen weight was 92 g (range 14–345) and for the estimated percentage of the breast volume excised 15% (range 3–35%). Results The median patient-reported score for “Satisfaction with breast” (BREAST-Q™ BCT) was 74/100. Factors associated with a score below median value in a simple logistic regression model adjusted for age and BMI were axillary clearance (OR 2.46, 95% CI 1.09–5.56), neoadjuvant chemotherapy (OR 3.26, 95% CI 1.15–9.24), and low breast density (OR 2.32 95% CI 1.02–5.29). Thirteen women (11%) were interested in contralateral surgery. Conclusion Most patients in this study cohort, who had undergone breast-conserving therapy with oncoplastic volume displacement techniques, were satisfied with their breasts without surgery to the contralateral breast. This indicates that contralateral surgery to achieve symmetry only should be performed after individual evaluation and as a delayed procedure.
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Affiliation(s)
- Anna Gardfjell
- Department of Surgery, Region Blekinge Hospital, Karlskrona, Sweden
| | - Cecilia Dahlbäck
- Department of Clinical Sciences Lund, Surgery, Skåne University Hospital, Lund University, Lund, Sweden
| | - Kristina Åhsberg
- Department of Clinical Sciences Lund, Surgery, Skåne University Hospital, Lund University, Lund, Sweden.
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27
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Ebner JJ, Mehra T, Gander T, Schumann P, Essig H, Zweifel D, Rücker M, Slankamenac K, Lanzer M. Novel application of the Clavien-Dindo classification system and the comprehensive complications index® in microvascular free tissue transfer to the head and neck. Oral Oncol 2019; 94:21-25. [PMID: 31178208 DOI: 10.1016/j.oraloncology.2019.05.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 03/11/2019] [Accepted: 05/05/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Julian Jakob Ebner
- Department of Oral and Maxillofacial Surgery, University Hospital Zurich (Head of Department Prof. Dr. Med. Dr. Med. Dent. Martin Rücker), Frauenklinikstrasse 24, CH-8091 Zurich, Switzerland.
| | - Tarun Mehra
- Medical Office, University Hospital Zurich, Rämistrasse 100, CH-8091 Zurich, Switzerland
| | - Thomas Gander
- Department of Oral and Maxillofacial Surgery, University Hospital Zurich (Head of Department Prof. Dr. Med. Dr. Med. Dent. Martin Rücker), Frauenklinikstrasse 24, CH-8091 Zurich, Switzerland
| | - Paul Schumann
- Department of Oral and Maxillofacial Surgery, University Hospital Zurich (Head of Department Prof. Dr. Med. Dr. Med. Dent. Martin Rücker), Frauenklinikstrasse 24, CH-8091 Zurich, Switzerland
| | - Harald Essig
- Department of Oral and Maxillofacial Surgery, University Hospital Zurich (Head of Department Prof. Dr. Med. Dr. Med. Dent. Martin Rücker), Frauenklinikstrasse 24, CH-8091 Zurich, Switzerland
| | - Daniel Zweifel
- Department of Oral and Maxillofacial Surgery, University Hospital Zurich (Head of Department Prof. Dr. Med. Dr. Med. Dent. Martin Rücker), Frauenklinikstrasse 24, CH-8091 Zurich, Switzerland
| | - Martin Rücker
- Department of Oral and Maxillofacial Surgery, University Hospital Zurich (Head of Department Prof. Dr. Med. Dr. Med. Dent. Martin Rücker), Frauenklinikstrasse 24, CH-8091 Zurich, Switzerland
| | - Ksenjia Slankamenac
- Department of Surgery and Transplantation, University Hospital Zurich, Rämistrasse 100, CH-8091 Zurich, Switzerland
| | - Martin Lanzer
- Department of Oral and Maxillofacial Surgery, University Hospital Zurich (Head of Department Prof. Dr. Med. Dr. Med. Dent. Martin Rücker), Frauenklinikstrasse 24, CH-8091 Zurich, Switzerland
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28
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Struik GM, Hoekstra N, Klem TM, Ghandi A, Verduijn GM, Swaak-Kragten AT, Schoonbeek A, de Vries KC, Sattler MA, Verhoef K, Birnie E, Pignol JP. Injection of radiopaque hydrogel at time of lumpectomy improves the target definition for adjuvant radiotherapy. Radiother Oncol 2018; 131:8-13. [PMID: 30773191 DOI: 10.1016/j.radonc.2018.11.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 10/14/2018] [Accepted: 11/04/2018] [Indexed: 12/29/2022]
Abstract
BACKGROUND AND PURPOSE During oncoplastic breast-conserving surgery (BCS), the surgical cavity is closed to reduce seroma formation. This makes the radiotherapy target definition using clips challenging, leading to poor inter-observer agreement and potentially geographical misses. We hypothesize that injecting a radiopaque hydrogel in the lumpectomy cavity before closure improves radiotherapy target definition and agreement between observers. MATERIALS AND METHODS Women undergoing BCS in a single university hospital were prospectively accrued in the study. Three to 9 ml of iodined PolyEthylene Glycol (PEG) hydrogel and clips were inserted in the lumpectomy cavity. A CT-scan was performed at 4 to 6 weeks. CT images of BCS patients with standard clips only were used as control group, matched on age, specimen weight, and distance between clips. Six radiation oncologists delineated the tumor bed volumes and rated the cavity visualization scores (CVS). The primary endpoint was the agreement between observers measured using a Conformity Index (Cx). RESULTS Forty-two patients were included, 21 hydrogel procedures and 21 controls, resulting in 315 observer pairs. The feasibility of the intervention was 100%. The median Cx was higher in the intervention group (Cx = 0.70, IQR [0.54-0.79]) than in the control group (Cx = 0.54, IQR [0.42-0.66]), p < 0.00, as were the CVS (3.5 [2.5-4.5] versus 2.5 [2-3.5], p < 0.001). The rate of surgical site infections was similar to literature. CONCLUSIONS The use of radiopaque PEG enables to identify the lumpectomy cavity, resulting in a high inter-observer agreement for radiotherapy target definition. This intervention is easy to perform and blend well into current practice.
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Affiliation(s)
- Gerson M Struik
- Franciscus Gasthuis and Vlietland, Department of Surgery, Rotterdam, the Netherlands; Erasmus MC, Department of Radiation Oncology, Rotterdam, the Netherlands
| | - Nienke Hoekstra
- Erasmus MC, Department of Radiation Oncology, Rotterdam, the Netherlands
| | - Taco M Klem
- Franciscus Gasthuis and Vlietland, Department of Surgery, Rotterdam, the Netherlands
| | - Ali Ghandi
- Franciscus Gasthuis and Vlietland, Department of Radiology, Rotterdam, the Netherlands
| | - Gerda M Verduijn
- Erasmus MC, Department of Radiation Oncology, Rotterdam, the Netherlands
| | | | - Alja Schoonbeek
- Erasmus MC, Department of Radiation Oncology, Rotterdam, the Netherlands
| | - Kim C de Vries
- Erasmus MC, Department of Radiation Oncology, Rotterdam, the Netherlands
| | - Margriet A Sattler
- Erasmus MC, Department of Radiation Oncology, Rotterdam, the Netherlands
| | - Kees Verhoef
- Erasmus MC, Department of Surgery, Rotterdam, the Netherlands
| | - Erwin Birnie
- Franciscus Gasthuis and Vlietland, Department of Statistics and Education, Rotterdam, the Netherlands
| | - Jean-Philippe Pignol
- Erasmus MC, Department of Radiation Oncology, Rotterdam, the Netherlands; Dalhousie University, Department of Radiation Oncology, Halifax, Canada.
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Wang WG, Babu SR, Wang L, Chen Y, Tian BL, He HB. Use of Clavien-Dindo classification in evaluating complications following pancreaticoduodenectomy in 1,056 cases: A retrospective analysis from one single institution. Oncol Lett 2018; 16:2023-2029. [PMID: 30008896 DOI: 10.3892/ol.2018.8798] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Accepted: 03/16/2018] [Indexed: 02/05/2023] Open
Abstract
The Clavien-Dindo (C-D) classification is a simple and feasible grading system of postoperative complications. The aim of the present study was to apply this system to retrospectively classify all types of post-pancreaticoduodenectomy (PD) complications (PPCs) and to systematically identify associated risk factors. Between January 2009 and December 2014, the C-D classification was applied to retrospectively classify PPCs for 1,056 patients who had undergone PD at the West China Hospital. Univariate and multivariate analyses were performed to link perioperative parameters and mortality with the severity of PPCs, which were subdivided into overall PPCs (Grade I-V), severe PPCs (Grade III-V) and mortality (Grade V). The number of patients with Clavien-Dindo grade I, II, IIIa, IIIb, IVa, IVb and V complications was 185 (17.5%), 128 (12.1%), 50 (4.7%), 25 (2.4%), 35 (3.3%), 19 (1.8%) and 33 (3.1%), respectively. A total of 475 (45.0%) patients experienced overall PPCs; 168 (15.9%) patients experienced severe PPCs; and 33 patients succumbed to mortality following PD. The following risk factors were identified following PD: Preoperative hypoproteinemia was correlated with all three subdivisions; obstructive jaundice was associated with severe PPCs and mortality; and older age was revealed to be an independent risk factor of mortality. A large retrospective study was performed in the present study and PD was correlated with a high occurrence of PPCs. The Clavien-Dindo system represents a broad applicable and feasible approach to evaluating PPCs in patients following PD. The independent risk factors of PPCs that were identified in the present study require further validation using the Clavien-Dindo classification in additional prospective studies.
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Affiliation(s)
- Wei-Guo Wang
- Department of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Shah Ram Babu
- Department of Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Li Wang
- Department of Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Yang Chen
- Department of Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Bo-Le Tian
- Department of Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Hong-Bo He
- Department of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
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Campbell EJ, Romics L. Oncological safety and cosmetic outcomes in oncoplastic breast conservation surgery, a review of the best level of evidence literature. BREAST CANCER (DOVE MEDICAL PRESS) 2017; 9:521-530. [PMID: 28831273 PMCID: PMC5552002 DOI: 10.2147/bctt.s113742] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Oncoplastic breast conservation surgery (OBCS) is increasingly becoming part of routine breast cancer surgical management. OBCS may be viewed as an extension of standard breast conservation surgery for resecting tumors of larger sizes without compromising on cosmetic outcome, or as an alternative to mastectomy. High quality evidence to support the oncological safety and benefits of OBCS is lacking. This review will focus on the best available level of evidence and address key issues regarding oncological safety in OBCS, such as tumor resection margins and re-excision rates, local recurrence and patient outcome, postoperative complications and adjuvant therapy delivery, and briefly discuss cosmetic outcome in OBCS. Comparative observational studies and systematic review report no poorer outcomes compared with standard breast conservation surgery. More evidence needs to be generated to support the oncological safety and improved aesthetic outcome. Prospective data collection will significantly contribute to the generation of stronger evidence.
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Affiliation(s)
| | - Laszlo Romics
- Department of Surgery, New Victoria Hospital Glasgow
- Department of Academic Surgery, Glasgow Royal Infirmary, Glasgow, Scotland, UK
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First international consensus conference on standardization of oncoplastic breast conserving surgery. Breast Cancer Res Treat 2017; 165:139-149. [DOI: 10.1007/s10549-017-4314-5] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 05/23/2017] [Indexed: 12/17/2022]
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Wijgman D, ten Wolde B, van Groesen N, Keemers-Gels M, van den Wildenberg F, Strobbe L. Short term safety of oncoplastic breast conserving surgery for larger tumors. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2017; 43:665-671. [DOI: 10.1016/j.ejso.2016.11.021] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 11/17/2016] [Accepted: 11/30/2016] [Indexed: 10/20/2022]
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Standard wide local excision or bilateral reduction mammoplasty in large-breasted women with small tumours: Surgical and patient-reported outcomes. Eur J Surg Oncol 2017; 43:636-641. [DOI: 10.1016/j.ejso.2016.10.027] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Revised: 10/11/2016] [Accepted: 10/31/2016] [Indexed: 11/19/2022] Open
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Bilateral mammoplasty for cancer: Surgical, oncological and patient-reported outcomes. Eur J Surg Oncol 2017; 43:68-75. [DOI: 10.1016/j.ejso.2016.08.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 08/10/2016] [Accepted: 08/10/2016] [Indexed: 11/22/2022] Open
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Winter R, Haug I, Lebo P, Grohmann M, Reischies FMJ, Cambiaso-Daniel J, Tuca A, Rienmüller T, Friedl H, Spendel S, Forbes AA, Wurzer P, Kamolz LP. Standardizing the complication rate after breast reduction using the Clavien-Dindo classification. Surgery 2016; 161:1430-1435. [PMID: 28043695 DOI: 10.1016/j.surg.2016.11.028] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 11/20/2016] [Accepted: 11/22/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND Published complication rates for breast reduction surgery, also known as reduction mammaplasty, vary between 4% and 54%. This wide range of complication rates could be attributable to the lack of a standardized classification of complications in plastic surgery. The aim of this study was to analyze our single-center complication rates after reduction mammaplasty using the Clavien-Dindo classification. METHODS We performed a retrospective chart review studying 804 patients between the ages of 18 and 81 years old who underwent breast reduction between 2005 and 2015 at our institution. Patients with a history of breast cancer, a previous breast operation, who did not undergo bilateral reduction mammaplasty, or who required systemic immunodeficiency/immunosuppressive drugs were excluded from our analysis. Complications were classified according to the Clavien-Dindo classification from Grades I to V. RESULTS A total of 486 patients met the inclusion criteria for the analysis. Patients had an age (mean ± standard deviation) of 39 ± 13 years and a body mass index of 26 ± 4 kg/m2. Median follow-up was 274 days (interquartile range: 90.5-378). The overall rate of complications of reduction mammaplasty was 63%, with the majority of those being Grades I (48%) and II (9%), comprising 92% of all the complications. Operative revisions were required in 6% (1% Grade IIIA and 5% Grade IIIB). There were no complications graded in categories IV and V. CONCLUSION Although complications occurred in more than half of the cases, the majority did not require operative reintervention. The Clavien-Dindo classification can classify the severity of complications and serve as a benchmark to compare complication rates between different practices. We believe that grading of complications should distinguish between those that do and do not require operative reinterventions.
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Affiliation(s)
- Raimund Winter
- Division of Plastic, Aesthetic, and Reconstructive Surgery, Medical University of Graz, Graz, Austria.
| | - Isabella Haug
- Division of Plastic, Aesthetic, and Reconstructive Surgery, Medical University of Graz, Graz, Austria
| | - Patricia Lebo
- Division of Plastic, Aesthetic, and Reconstructive Surgery, Medical University of Graz, Graz, Austria
| | - Martin Grohmann
- Division of Plastic, Aesthetic, and Reconstructive Surgery, Medical University of Graz, Graz, Austria
| | - Frederike M J Reischies
- Division of Plastic, Aesthetic, and Reconstructive Surgery, Medical University of Graz, Graz, Austria
| | - Janos Cambiaso-Daniel
- Division of Plastic, Aesthetic, and Reconstructive Surgery, Medical University of Graz, Graz, Austria
| | - Alexandru Tuca
- Division of Plastic, Aesthetic, and Reconstructive Surgery, Medical University of Graz, Graz, Austria
| | - Theresa Rienmüller
- Institute of Health Care Engineering with European Notified Body of Medical Devices, Graz University of Technology, Graz, Austria
| | - Herwig Friedl
- Institute of Statistics, Graz University of Technology, Graz, Austria
| | - Stephan Spendel
- Division of Plastic, Aesthetic, and Reconstructive Surgery, Medical University of Graz, Graz, Austria
| | - Abigail A Forbes
- University of Texas Medical Branch, School of Medicine, Galveston, TX
| | - Paul Wurzer
- Division of Plastic, Aesthetic, and Reconstructive Surgery, Medical University of Graz, Graz, Austria
| | - Lars-P Kamolz
- Division of Plastic, Aesthetic, and Reconstructive Surgery, Medical University of Graz, Graz, Austria; Research Unit for Safety in Health, Medical University of Graz, Graz, Austria
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Dave R, O'Connell R, Rattay T, Tolkien Z, Barnes N, Skillman J, Williamson P, Conroy E, Gardiner M, Harnett A, O'Brien C, Blazeby J, Potter S, Holcombe C. The iBRA-2 (immediate breast reconstruction and adjuvant therapy audit) study: protocol for a prospective national multicentre cohort study to evaluate the impact of immediate breast reconstruction on the delivery of adjuvant therapy. BMJ Open 2016; 6:e012678. [PMID: 27855106 PMCID: PMC5073644 DOI: 10.1136/bmjopen-2016-012678] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Immediate breast reconstruction (IBR) is routinely offered to improve quality of life for women with breast cancer requiring a mastectomy, but there are concerns that more complex surgery may delay the delivery of adjuvant oncological treatments and compromise long-term oncological outcomes. High-quality evidence, however, is lacking. iBRA-2 is a national prospective multicentre cohort study that aims to investigate the effect of IBR on the delivery of adjuvant therapy. METHODS AND ANALYSIS Breast and plastic surgery centres in the UK performing mastectomy with or without (±) IBR will be invited to participate in the study through the trainee research collaborative network. All women undergoing mastectomy ± IBR for breast cancer between 1 July and 31 December 2016 will be included. Patient demographics, operative, oncological and complication data will be collected. Time from last definitive cancer surgery to first adjuvant treatment for patients undergoing mastectomy ± IBR will be compared to determine the impact that IBR has on the time of delivery of adjuvant therapy. Prospective data on 3000 patients from ∼50 centres are anticipated. ETHICS AND DISSEMINATION Research ethics approval is not required for this study. This has been confirmed using the online Health Research Authority decision tool. This novel study will explore whether IBR impacts the time to delivery of adjuvant therapy. The study will provide valuable information to help patients and surgeons make more informed decisions about their surgical options. Dissemination of the study protocol will be via the Mammary Fold Academic and Research Collaborative (MFAC) and the Reconstructive Surgery Trials Network (RSTN), the Association of Breast Surgery (ABS) and the British Association of Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS). Participating units will have access to their own data and collective results will be presented at relevant surgical conferences and published in appropriate peer-reviewed journals.
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Affiliation(s)
- Rajiv Dave
- Nightingale Breast Unit, University Hospital of South Manchester NHS Foundation Trust, Manchester, UK
| | - Rachel O'Connell
- Department of Breast Surgery, The Royal Marsden NHS Foundation Trust, Sutton, UK
| | - Tim Rattay
- Department of Cancer Studies, Clinical Sciences Building, University of Leicester, Leicester, UK
| | - Zoe Tolkien
- Bristol Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Nicola Barnes
- Department of Breast Surgery, The Royal Marsden NHS Foundation Trust, Sutton, UK
| | - Joanna Skillman
- Department of Plastic Surgery, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Paula Williamson
- Department of Biostatistics, Clinical Trials Research Centre, University of Liverpool MRC North West Hub for Trials Methodology Research, University of Liverpool, Liverpool, UK
| | - Elizabeth Conroy
- Department of Biostatistics, Clinical Trials Research Centre, University of Liverpool MRC North West Hub for Trials Methodology Research, University of Liverpool, Liverpool, UK
| | - Matthew Gardiner
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Nuffield Orthopaedic Centre, Oxford, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
| | | | | | - Jane Blazeby
- Bristol Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Shelley Potter
- Bristol Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Chris Holcombe
- Linda McCartney Centre, Royal Liverpool and Broadgreen University Hospital, Liverpool, UK
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Colombo PE, Lefèvre M, Delmond L, Traore D, Jacot W, Mourregot A, Gutowski M, Bertrand MM, Rouanet P. Oncoplastic Resection of Breast Cancers Located in the Lower-Inner or Lower-Outer Quadrant with the Modified McKissock Mammaplasty Technique. Ann Surg Oncol 2015; 22 Suppl 3:S486-94. [DOI: 10.1245/s10434-015-4727-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Indexed: 11/18/2022]
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