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Liu J, He G, Zhang H, Yahya MM. A new surgical modality for breast reconstruction in patients with breast cancer: a case report and literature review. Gland Surg 2023; 12:1318-1325. [PMID: 37842525 PMCID: PMC10570977 DOI: 10.21037/gs-23-5] [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: 01/03/2023] [Accepted: 07/27/2023] [Indexed: 10/17/2023]
Abstract
Background Breast preservation can considerably improve the postoperative living quality of breast cancer patients. Through this study, we proposed a novel, safe, and effective surgical modality for breast preservation in patients with early breast cancer. Case Description Herein, we present a case report of a patient with early-stage breast cancer (T1cN0M0), who underwent skin-sparing nipple areola hypodermic gland resection combined with primary breast reconstruction using silicone implants. The patient was administered with general anesthesia, and the implants were inserted using a insufflation-free suspension and hook suspension under the pectoralis major muscle. The patient was followed up on postoperative days 1, 2, 7, 14, 30, 60, and 100 to check for any complications, such as upper limb edema, paresthesia, or flap necrosis. The patient experienced no complications. No obvious surgical scars or axillary surface infections were observed. The patient was satisfied with the surgical outcome, and this treatment approach reduced her treatment costs by approximately USD 2,600. Conclusions The new surgical procedure for breast reconstruction considerably improved the quality of life of the patient; no postoperative complications such as skin flap necrosis, paresthesia, or upper limb edema were experienced by the patient; and the treatment costs were reduced. In addition, this method effectively overcomes the concerns related to axillary space instability and limited operative space, rendering it worthy of promotion in clinical practice.
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Affiliation(s)
- Jiaqi Liu
- Universiti Sains Malaysia, Kelantan, Malaysia
- Department of Breast and Thyroid Surgery, Zibo Central Hospital, Zibo, China
| | - Guijin He
- Department of Second Breast Surgery, Shengjing Hospital of China Medical University, Shenyang, China
| | - Huihui Zhang
- Department of Breast and Thyroid Surgery, Zibo Central Hospital, Zibo, China
| | - Maya Mazuwin Yahya
- Breast Cancer Awareness and Research Unit, Hospital Universiti Sains Malaysia, Kelantan, Malaysia
- Department of Surgery, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kelantan, Malaysia
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Liu J, He G, Zhang Y, Wong MPK, Chu J, Kong L, Yahya MM. Feasibility analysis of treating breast cancer patients with breast-conserving surgery via a periareolar incision combined with non-lipolytic suspension-type mastoscopy. Sci Rep 2023; 13:12129. [PMID: 37495629 PMCID: PMC10372002 DOI: 10.1038/s41598-023-39199-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 07/21/2023] [Indexed: 07/28/2023] Open
Abstract
The purpose is to analyze and compare postoperative recovery and complication incidence between a periareolar incision combined with Suspension-type Mastoscopic Axillary Lymph Node Dissection (SMALND) and traditional inflated Mastoscopic Axillary Lymph Node Dissection (MALND). This was a randomized trial conducted from June 1, 2020, to April 30, 2022, in the Department of Second Breast Surgery, Shengjing Hospital of China Medical University, and the Department of Thyroid and Breast Surgery, Zibo Central Hospital, in accordance with the criteria of inclusion and exclusion. Overall, 126 patients diagnosed and treated for early-stage breast cancer were selected to undergo periareolar-incision breast-conserving surgery. Those patients who underwent periareolar-incision surgery combined with SMALND formed the observation group (SMALND Group), while those who underwent periareolar-incision surgery combined with traditional inflation became MALND Group. In the two groups, paired data "t" was used to examine, analyze, and compare the postoperative daily drainage volume and drain removal time, while paired data "χ2" was used to examine, analyze, and compare the incidences of postoperative upper limb edema and paresthesia. There were 64 cases in the SMALND Group and 62 cases in the MALND Group. Between the two clusters, no differences were found in age, clinical staging, BMI, and breast cancer classification (P > 0.05). The intraoperative surgery time of the SMALND Group was 43.37 ± 6.27 min while that of the MALND Group was longer: 45.72 ± 4.25 min (P < 0.05). The intraoperative hemorrhage volume of the SMALND Group was 88.33 ± 16.79 ml, less than that of the MALND Group: 96.76 ± 26.85 ml (P < 0.05). The postoperative axillary mean daily drainage volume of the SMALND Group was 38.17 ± 5.55 ml, less than that of the MALND Group: 40.72 ± 7.25 ml (P < 0.05). The drain removal time of the SMALND Group was 7.50 ± 1.60, less than that of the MALND Group: 9.00 ± 1.80 (P < 0.05). The upper limb edema incidence rate of the SMALND Group was 3.12% (2/64) and had no obvious difference from the MALND Group, which was 4.83% (3/62) (P = 0.62). The paresthesia incidence rate of the SMALND Group was 18.75% (12/64), while that of the MALND Group was 17.7% (11/62), without an obvious difference (P = 0.88). For axillary lymph node dissection, the use of non-lipolytic suspension-type mastoscopy has reduced the intraoperative hemorrhage volume of patients, shortened surgery time and postoperative recovery time, saved treatment expenses for patients, and avoided complications such as hypercapnia and subcutaneous emphysema caused by traditional inflated mastoscopic surgery. Moreover, it has not increased the incidence of postoperative upper limb edema and paresthesia, supporting its safety and effectiveness.
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Affiliation(s)
- Jiaqi Liu
- Universiti Sains Malaysia, USM Health Campus, Kubang Kerian, Kota Bharu, Kelantan, Malaysia
| | - Guijin He
- Department of Second Breast Surgery, Shengjing Hospital of China Medical University, Shenyang, Liao Ning, China
| | - Yiwen Zhang
- Changchun University of Chinese Medicine, Changchun, JiLin, China
| | - Michael Pak-Kai Wong
- Department of Surgery, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, 16150, Kubang Kerian, Kelantan, Malaysia
- Department of Surgery, Hospital Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Jun Chu
- Breast and Thyroid Department, Zibo Central Hospital, Zibo, Shandong, China
| | - Linna Kong
- Breast and Thyroid Department, Zibo Central Hospital, Zibo, Shandong, China
| | - Maya Mazuwin Yahya
- Department of Surgery, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, 16150, Kubang Kerian, Kelantan, Malaysia.
- Breast Cancer Awareness And Research Unit (BestARi), Hospital Universiti Sains, Kubang Kerian, Kelantan, Malaysia.
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Yao CC, Liu C, Xian J. Comparison of single-pore non-liposuction near-infrared laparoscopy with conventional open surgery for axillary sentinel lymph node biopsy in patients with early breast cancer: a single-center, small-sample retrospective study. World J Surg Oncol 2023; 21:66. [PMID: 36849976 PMCID: PMC9972847 DOI: 10.1186/s12957-023-02942-w] [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: 11/23/2022] [Accepted: 02/11/2023] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND This study aimed to compare the effects of single-pore non-liposuction near-infrared (NIR) endoscopic surgery and traditional open surgery for axillary sentinel lymph node biopsy (SLNB) in patients with early breast cancer (EBC). METHODS The clinical pathological data of 61 patients with EBC who underwent axillary SLNB using indocyanine green (ICG) combined with carbon nanoparticle suspension (CNS) were retrospectively collected. Thirty patients received SLNB through single-pore non-liposuction NIR endoscopic surgery (endoscopic group), and the remaining 31 received SLNB through open-incision surgery (open group). The success rate, operation time, volume of intraoperative bleeding, postoperative axillary drainage, axillary extubation time, and the occurrence of postoperative complications were compared between the groups along with the total number of sentinel lymph nodes (SLNs), luminous SLNs, stained SLNs, and the pathological positivity rate of the SLNs. RESULTS All patients underwent SLNB with a 100% success rate. SLNB operation times of the endoscopic group were longer than those of the open group (t = 3.963, P = 0.000), and the volume of axillary drainage was inferior (t = 3.035, P = 0.004). However, there were no differences in the intraoperative bleeding volumes, axillary extubation times, and postoperative complications (P > 0.05). In the Open group, the mean number of SLNs was 5.12 ± 2.16, and the pathological positivity rate was 13.53%; in the Endoscopic group, these numbers were 4.89 ± 1.73 and 12.39%. The mean number of SLNs detected (t = 0.458, P = 0.649) and the pathological positivity rates (χ2 = 0.058, P = 0.810) did not differ between the two groups. All 61 patients were followed for a median of 14.6 months. There were no local recurrences or distant metastases. CONCLUSIONS Our single-center results reveal that single-hole non-liposuction NIR endoscopic axillary SLNB is not inferior to open SLNB and may be an appropriate option for patients with early breast cancer who desire breast preservation with fewer incisions. TRIAL REGISTRATION This retrospective study was "retrospectively registered" at the Sixth Affiliated Hospital of South China University of Technology (no. 2020105) and in National Medical Research Registration and Archival Information System ( https://www.medicalresearch.org.cn , number: MR-44-21-004727).
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Affiliation(s)
- Cheng-cai Yao
- grid.79703.3a0000 0004 1764 3838Sixth Affiliated Hospital of South China University of Technology, and Sixth Clinical College of South China University of Technology, Foshan, 528225 People’s Republic of China
| | - Changchun Liu
- grid.79703.3a0000 0004 1764 3838Department of Breast Surgery, Sixth Affiliated Hospital of South China University of Technology, and Sixth Clinical College of South China University of Technology, Foshan, 528225 People’s Republic of China
| | - Jiayi Xian
- grid.79703.3a0000 0004 1764 3838Department of Breast Surgery, Sixth Affiliated Hospital of South China University of Technology, and Sixth Clinical College of South China University of Technology, Foshan, 528225 People’s Republic of China
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Wan A, Liang Y, Chen L, Wang S, Shi Q, Yan W, Cao X, Zhong L, Fan L, Tang P, Zhang G, Xiong S, Wang C, Zeng Z, Wu X, Jiang J, Qi X, Zhang Y. Association of Long-term Oncologic Prognosis With Minimal Access Breast Surgery vs Conventional Breast Surgery. JAMA Surg 2022; 157:e224711. [PMID: 36197680 PMCID: PMC9535498 DOI: 10.1001/jamasurg.2022.4711] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 07/16/2022] [Indexed: 01/11/2023]
Abstract
Importance Minimal access breast surgery (MABS) has been used in breast cancer management. However, long-term prognostic data associated with MABS vs conventional breast surgery (CBS) are lacking. Objective To investigate long-term therapeutic outcomes associated with MABS vs CBS for breast cancer management. Design, Setting, and Participants In this single-center retrospective cohort study, 9184 individuals were assessed for inclusion. After exclusions, 2412 adult female individuals were included who were diagnosed with stage 0 to III breast cancer, underwent unilateral breast surgery between January 2004 and December 2017, and had no distant metastasis or history of severe underlying disease. Propensity score matching was performed to minimize selection bias. Data were analyzed from January 1, 2004, to December 31, 2019. Exposures MABS or CBS. Main Outcomes and Measures Data on demographic and tumor characteristics and long-term outcomes were collected and analyzed. Results This study included 2412 patients (100% female; median [IQR] age, 44 [40-49] years). Of these, 603 patients underwent MABS (endoscopic, endoscopy-assisted, or robot-assisted procedures in 289, 302, and 12 patients, respectively) and 1809 patients underwent CBS. The median follow-up time was 84 months (93 in the MABS group and 80 months in the CBS group). Intergroup differences were not significant for the following parameters: 10-year local recurrence-free survival (93.3% vs 96.3%; hazard ratio [HR], 1.39; 95% CI, 0.86-2.27; P = .18), regional recurrence-free survival (95.5% vs 96.7%; HR, 1.38; 95% CI, 0.81-2.36; P = .23), and distant metastasis-free survival (81.0% vs 82.0%; HR, 0.95; 95% CI, 0.74-1.23; P = .72). The 5-, 10-, and 15-year disease-free survival rates in the MABS group were 85.9%, 72.6%, and 69.1%, respectively. The corresponding rates in the CBS group were 85.0%, 76.6%, and 70.7%. The intergroup differences were not significant (HR, 1.07; 95% CI, 0.86-1.31; P = .55). The 5-, 10-, and 15-year overall survival rates in the MABS group were 92.0%, 83.7%, and 83.0%, respectively. The corresponding rates in the CBS group were 93.6%, 88.7%, and 81.0%. The intergroup differences were not significant (HR, 1.29; 95% CI, 0.97-1.72; P = .09). Post hoc subgroup analysis showed no significant intergroup differences in disease-free survival. Conclusions and Relevance In this cohort study, long-term outcomes following MABS were not significantly different from those following CBS in patients with early-stage breast cancer. MABS may be a safe and feasible alternative in this patient population.
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Affiliation(s)
- Andi Wan
- Department of Breast and Thyroid Surgery, Southwest Hospital, the First Affiliated Hospital of the Army Military Medical University, Chongqing, China
| | - Yan Liang
- Department of Breast and Thyroid Surgery, Southwest Hospital, the First Affiliated Hospital of the Army Military Medical University, Chongqing, China
| | - Li Chen
- Department of Breast and Thyroid Surgery, Southwest Hospital, the First Affiliated Hospital of the Army Military Medical University, Chongqing, China
| | - Shushu Wang
- Department of Breast and Thyroid Surgery, Southwest Hospital, the First Affiliated Hospital of the Army Military Medical University, Chongqing, China
| | - Qiyun Shi
- Department of Breast and Thyroid Surgery, Southwest Hospital, the First Affiliated Hospital of the Army Military Medical University, Chongqing, China
| | - Wenting Yan
- Department of Breast and Thyroid Surgery, Southwest Hospital, the First Affiliated Hospital of the Army Military Medical University, Chongqing, China
| | - Xiaozhen Cao
- Department of Breast and Thyroid Surgery, Southwest Hospital, the First Affiliated Hospital of the Army Military Medical University, Chongqing, China
| | - Ling Zhong
- Department of Breast and Thyroid Surgery, Southwest Hospital, the First Affiliated Hospital of the Army Military Medical University, Chongqing, China
| | - Linjun Fan
- Department of Breast and Thyroid Surgery, Southwest Hospital, the First Affiliated Hospital of the Army Military Medical University, Chongqing, China
| | - Peng Tang
- Department of Breast and Thyroid Surgery, Southwest Hospital, the First Affiliated Hospital of the Army Military Medical University, Chongqing, China
| | - Guozhi Zhang
- Department of Breast and Thyroid Surgery, Southwest Hospital, the First Affiliated Hospital of the Army Military Medical University, Chongqing, China
| | - Siyi Xiong
- Department of Breast and Thyroid Surgery, Southwest Hospital, the First Affiliated Hospital of the Army Military Medical University, Chongqing, China
| | - Cheng Wang
- Department of Breast and Thyroid Surgery, Southwest Hospital, the First Affiliated Hospital of the Army Military Medical University, Chongqing, China
| | - Zhen Zeng
- Department of Breast and Thyroid Surgery, Southwest Hospital, the First Affiliated Hospital of the Army Military Medical University, Chongqing, China
| | - Xiujuan Wu
- Department of Breast and Thyroid Surgery, Southwest Hospital, the First Affiliated Hospital of the Army Military Medical University, Chongqing, China
| | - Jun Jiang
- Department of Breast and Thyroid Surgery, Southwest Hospital, the First Affiliated Hospital of the Army Military Medical University, Chongqing, China
| | - Xiaowei Qi
- Department of Breast and Thyroid Surgery, Southwest Hospital, the First Affiliated Hospital of the Army Military Medical University, Chongqing, China
| | - Yi Zhang
- Department of Breast and Thyroid Surgery, Southwest Hospital, the First Affiliated Hospital of the Army Military Medical University, Chongqing, China
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Luo C, Wei C, Guo W, Yang J, Sun Q, Wei W, Wu S, Fang S, Zeng Q, Zhao Z, Meng F, Huang X, Zhang X, Li R, Ma X, Luo C, Yang Y. 17-Year Follow-up of Comparing Mastoscopic and Conventional Axillary Dissection in Breast Cancer: A Multicenter, Randomized Controlled Trial. Adv Ther 2022; 39:2961-2970. [PMID: 35486221 DOI: 10.1007/s12325-022-02152-y] [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: 02/19/2022] [Accepted: 03/28/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Longer follow-up was necessary to determine the exact value of mastoscopic axillary lymph node dissection (MALND). METHODS From January 1, 2003, to December 31, 2005, 1027 patients with breast cancer were randomly assigned to two groups: MALND and CALND (conventional axillary lymph node dissection); 996 eligible patients were enrolled. RESULTS The final cohort of 996 patients was followed for an average of 198 months. Events other than death differed significantly between the two cohorts (p = 0.0311; 46.3% in MALND and 53.2% in CALND, respectively). The sum of events other than death and deaths from other causes was much higher in the CALND (59.6%) than MALND (53.4%) group (p = 0.0494). The 17-year disease-free survival DFS rates were 36.7% for the MALND and 33.6% for the CALND group, respectively. There was a significant difference between the groups (p = 0.0306). Overall survival (OS) rates were 53.2% after MALND and 46.0% after CALND (p = 0.0119). MALND patients had much less axillary pain (p = 0.0000), numbness or paresthesia (p = 0.0000), arm mobility (p = 0.0000) and arm swelling on the operated side (p = 0.0000). Aesthetic appearance of the axilla was much better in the MALND than CALND group (p = 0.0000) at an average follow-up of 17 years. CONCLUSIONS The use of MALND in breast cancer surgery not only decreases the relapse and arm complications but also improves long-term survival of patients. Therefore, MALND should be one of the preferred approaches for breast cancer surgery when ALND is needed. TRIAL REGISTRATION INFORMATION The comparison of long-term outcomes of mastoscopic and conventional axillary lymph node dissection in breast cancer: a multicenter randomized control trial. ChiCTR-TRC-11001477, CHiCTR. First registration 08/14/2011.
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Affiliation(s)
- Chengyu Luo
- Breast Surgery, Affiliated Beijing Anzhen Hospital, Capital Medical University, No 2, Anzhen Road, Chaoyang District, Beijing, 100029, China.
| | - Changsheng Wei
- Breast Surgery, Affiliated Beijing Anzhen Hospital, Capital Medical University, No 2, Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Wenbin Guo
- Breast Surgery, Affiliated Da Lian Hospital, Dalian Medical University, Dalian, China
| | - Jie Yang
- Breast Surgery, Affiliated Foshan Hospital, Zhongshan University, Fushan, China
| | - Qiuru Sun
- Breast Surgery, Affiliated Wei Hai Hospital, Medical College of Qingdao University, Qingdao, China
| | - Wei Wei
- Breast Surgery, Shenzhen Hospital, Beijing University, Shenzhen, China
| | - Shuhua Wu
- General Surgery, Heibei Concord Hospital, Hebei Medical University, Tangshan, China
| | - Shubing Fang
- Breast Surgery, Affiliated Hospital, Anhui Medical University, Hefei, China
| | - Qingliang Zeng
- General Surgery, Affiliated Hospital, Zunyi Medical College, Zunyi, China
| | - Zhensheng Zhao
- Breast Surgery, Affiliated Hospital, Capital Medical University Yanjing College, Shijianzhuang, China
| | - Fanjie Meng
- General Surgery, Huabei Petroleum General Hospital, University of Chinese Academy of Sciences, Cangzhou, China
| | - Xuandong Huang
- Breast Surgery, Affiliated Huaian Hospital, Nanjing Medical University, Huaian, China
| | - Xianlan Zhang
- Affiliated Hospital, Guilin Medical University Affiliated Hospital, Guilin, China
| | - Ruihua Li
- General Surgery, Affiliated Shunde Hospital, Guangdong Medical University, Shunde, China
| | - Xiufeng Ma
- Gansu Maternal and Child Care Center, Lanzhou, China
| | - Chaoying Luo
- Affiliated Xinjiang Kelamayi Central Hospital, Xinjiang Medical University, Kelamayi, China
| | - Yun Yang
- Department of Epidemiology and Health Statistics, Capital Medical University, Beijing, China
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Lv W, Ding B, Qian L, Wu W, Wen Y. Safety of Breast Cancer Mastoscopic Surgery from the Perspective of Immunity and Adipokines. J INVEST SURG 2021; 35:632-638. [PMID: 33998356 DOI: 10.1080/08941939.2021.1919945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background: This study was performed to explore the safety of breast cancer (BC) mastoscopic surgery from the perspective of immunity and adipokines. Method: A single-center, prospective, randomized controlled trial was carried out among 42 patients who had undergone surgery from December 2018 to July 2019. All patients were randomly divided into an open surgery group (n = 21) and a mastoscopic surgery group (n = 21). Flow cytometry was used to detect natural killer (NK), CD4+ T cells, CD8+ T cells, and regulatory T (Treg) cells in each group 1 d before surgery, 1 h after operation, and 1, 5, and 7 d after operation. The levels of serum leptin and adiponectin were detected by enzyme-linked immunosorbent assay before and after operation. Results: There were no significant differences in the percentages of NK (p = 0.984), CD4+ T (p = 0.591), Treg (p = 0.676), and CD8 + T (p = 0.341) lymphocytes between the two groups during the perioperative period. There were no significant differences in the levels of serum leptin and adiponectin before and after operation between the two groups (all p > 0.05). There were no significant differences between patients undergoing open surgery and mastoscopic surgery from the perspective of immunity and adipokines. Conclusion: Mastoscopic surgery is a suitable surgical choice for patients with BC.
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Affiliation(s)
- Wenzhi Lv
- Department of Breast and Thyroid Surgery, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Boni Ding
- Department of Breast and Thyroid Surgery, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Liyuan Qian
- Department of Breast and Thyroid Surgery, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Wei Wu
- Department of Breast and Thyroid Surgery, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Yanguang Wen
- Department of Breast and Thyroid Surgery, The Third Xiangya Hospital of Central South University, Changsha, China
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