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Joo JH, Kim W, Nam J, Kim D, Kim HY, Jung YJ, Choo KS, Nam KJ, Nam SB, Kim JJ, Ki Y. Changing trends in the management of ductal carcinoma in situ in Republic of Korea: a comprehensive analysis using Health Insurance Review and Assessment data [2009-2020]. Gland Surg 2024; 13:131-143. [PMID: 38455345 PMCID: PMC10915430 DOI: 10.21037/gs-23-433] [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: 10/24/2023] [Accepted: 01/23/2024] [Indexed: 03/09/2024]
Abstract
Background Increasing rates of diagnosis of ductal carcinoma in situ (DCIS), given the widespread use of mammography, is a global trend. Various attempts have been made in the selection of surgical methods and application of radiation therapy (RT), and the prevalence of infectious diseases has also affected these attempts. This study aimed to investigate evolving treatment patterns and trends in the management of DCIS in South Korea. Methods We conducted a comprehensive search of the Korean Health Insurance Review and Assessment Service-National Patient Sample (HIRA-NPS) database and selected patients who underwent breast surgery following a DCIS diagnosis between 2009 and 2020. Based on this sample, the analyses were weighted according to the Korean population. We examined annual variations in mastectomy types, reconstructive procedures, and RT utilization from a multidisciplinary perspective. Results In our weighted sample, 43,780 patients with DCIS underwent surgery, with a consistent annual increase of 10%. The proportion of lumpectomy procedures increased from 56.7% to 65.4%, showing a greater growth rate than that of total mastectomies (TMs). Following the availability of reconstruction data in 2015, shifts have emerged toward a preference for implant-based autologous tissue reconstruction. As we transitioned to the latter part of our study, the trend was marked by the increasing adoption of hypofractionated RT and omission of RT. Of the patients who underwent lumpectomy in 2020, 25.6% adopted hypofractionated RT and 53.8% omitted RT. This transformation was particularly evident among older patients, individuals treated in metropolitan areas, and those treated in small-sized healthcare facilities. Conclusions Our study sheds light on the changing landscape of DCIS treatment in South Korea incorporating perspectives from surgeons, plastic surgeons, and radiation oncologists. We observed an increase in the rates of lumpectomy and implant-based reconstruction. Adoption of hypofractionated RT and omission of RT showed increasing trends.
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Affiliation(s)
- Ji Hyeon Joo
- Department of Radiation Oncology, Pusan National University School of Medicine, Yangsan, Republic of Korea
- Department of Radiation Oncology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Wontaek Kim
- Department of Radiation Oncology, Pusan National University School of Medicine, Yangsan, Republic of Korea
- Department of Radiation Oncology, Pusan National University Hospital, Busan, Republic of Korea
| | - Jiho Nam
- Department of Radiation Oncology, Pusan National University Hospital, Busan, Republic of Korea
| | - Donghyun Kim
- Department of Radiation Oncology, Pusan National University School of Medicine, Yangsan, Republic of Korea
- Department of Radiation Oncology, Pusan National University Hospital, Busan, Republic of Korea
| | - Hyun Yul Kim
- Department of Surgery, Pusan National University School of Medicine, Yangsan, Republic of Korea
- Department of Surgery, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Youn Joo Jung
- Department of Surgery, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Ki Seok Choo
- Department of Radiology, Pusan National University School of Medicine, Yangsan, Republic of Korea
- Department of Radiology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Kyung Jin Nam
- Department of Radiology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Su Bong Nam
- Department of Plastic and Reconstructive Surgery, Pusan National University School of Medicine, Yangsan, Republic of Korea
- Department of Plastic and Reconstructive Surgery, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Jae-Joon Kim
- Department of Oncology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Yongkan Ki
- Department of Radiation Oncology, Pusan National University School of Medicine, Yangsan, Republic of Korea
- Department of Radiation Oncology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
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Arnaout A, Zhang J, Frank S, Momtazi M, Cordeiro E, Roberts A, Ghumman A, Fergusson D, Stober C, Pond G, Jeong A, Vandermeer L, Hutton B, Clemons M. A Randomized Controlled Trial Comparing Alloderm-RTU with DermACELL in Immediate Subpectoral Implant-Based Breast Reconstruction. ACTA ACUST UNITED AC 2020; 28:184-195. [PMID: 33704185 PMCID: PMC7816190 DOI: 10.3390/curroncol28010020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 12/01/2020] [Accepted: 12/16/2020] [Indexed: 12/15/2022]
Abstract
Background: The effectiveness of different acellular dermal matrices (ADM) used for implant-based reconstruction immediately following mastectomy is an important clinical question. A prospective randomized clinical trial was performed to evaluate the superiority of DermACELL over Alloderm-RTU in reducing drain duration. Methods: Patients undergoing mastectomy with subpectoral immediate and permanent implant-based breast reconstruction were randomized to Alloderm-RTU or DermACELL. The primary outcome was seroma formation, measured by the duration of postoperative drain placement. Secondary outcomes included: post drain removal seroma aspiration, infection, redbreast syndrome, wound dehiscence, loss of the implant, and unplanned return to the operating room. Results: 62 patients were randomized for 81 mastectomies (41 Alloderm-RTU, 40 DermACELL). Baseline characteristics were similar. There was no statistically significant difference in mean drain duration (p = 0.16), with a trend towards longer duration in the Alloderm-RTU group (1.6 days; 95%CI, 0.7 to 3.9). The overall rate of minor and major complications were statistically similar between the two groups; although patients with Alloderm-RTU had 3 times as many infections requiring antibiotics (7.9% vs. 2.5%) with a risk difference of 5.4 (95%CI −4.5 to 15.2), and twice as many unplanned returns to the operating room (15.8% vs. 7.5%) with a risk difference of 8.3 (95% CI −5.9 to 22.5) as DermACELL. Conclusion: This is the first prospective randomized clinical trial comparing the two most commonly used human-derived ADMs. There was no statistically significant difference in drain duration, minor, or major complications between DermACELL over Alloderm-RTU in immediate subpectoral permanent implant-based breast reconstruction post-mastectomy.
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Affiliation(s)
- Angel Arnaout
- Department of Surgery, The Ottawa Hospital and University of Ottawa, Ottawa, ON K1Y 4E9, Canada; (A.A.); (J.Z.); (S.F.); (M.M.); (E.C.); (A.R.); (A.G.)
| | - Jing Zhang
- Department of Surgery, The Ottawa Hospital and University of Ottawa, Ottawa, ON K1Y 4E9, Canada; (A.A.); (J.Z.); (S.F.); (M.M.); (E.C.); (A.R.); (A.G.)
| | - Simon Frank
- Department of Surgery, The Ottawa Hospital and University of Ottawa, Ottawa, ON K1Y 4E9, Canada; (A.A.); (J.Z.); (S.F.); (M.M.); (E.C.); (A.R.); (A.G.)
| | - Moein Momtazi
- Department of Surgery, The Ottawa Hospital and University of Ottawa, Ottawa, ON K1Y 4E9, Canada; (A.A.); (J.Z.); (S.F.); (M.M.); (E.C.); (A.R.); (A.G.)
| | - Erin Cordeiro
- Department of Surgery, The Ottawa Hospital and University of Ottawa, Ottawa, ON K1Y 4E9, Canada; (A.A.); (J.Z.); (S.F.); (M.M.); (E.C.); (A.R.); (A.G.)
- Ottawa Hospital Research Institute and University of Ottawa, Ottawa, ON K1H 8L6, Canada; (D.F.); (C.S.); (A.J.); (L.V.); (B.H.)
| | - Amanda Roberts
- Department of Surgery, The Ottawa Hospital and University of Ottawa, Ottawa, ON K1Y 4E9, Canada; (A.A.); (J.Z.); (S.F.); (M.M.); (E.C.); (A.R.); (A.G.)
| | - Ammara Ghumman
- Department of Surgery, The Ottawa Hospital and University of Ottawa, Ottawa, ON K1Y 4E9, Canada; (A.A.); (J.Z.); (S.F.); (M.M.); (E.C.); (A.R.); (A.G.)
| | - Dean Fergusson
- Ottawa Hospital Research Institute and University of Ottawa, Ottawa, ON K1H 8L6, Canada; (D.F.); (C.S.); (A.J.); (L.V.); (B.H.)
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, ON K1H 8L6, Canada
| | - Carol Stober
- Ottawa Hospital Research Institute and University of Ottawa, Ottawa, ON K1H 8L6, Canada; (D.F.); (C.S.); (A.J.); (L.V.); (B.H.)
| | - Gregory Pond
- Juravinski Cancer Center, McMaster University, Hamilton, ON L8S 4L8, Canada;
| | - Ahwon Jeong
- Ottawa Hospital Research Institute and University of Ottawa, Ottawa, ON K1H 8L6, Canada; (D.F.); (C.S.); (A.J.); (L.V.); (B.H.)
| | - Lisa Vandermeer
- Ottawa Hospital Research Institute and University of Ottawa, Ottawa, ON K1H 8L6, Canada; (D.F.); (C.S.); (A.J.); (L.V.); (B.H.)
| | - Brian Hutton
- Ottawa Hospital Research Institute and University of Ottawa, Ottawa, ON K1H 8L6, Canada; (D.F.); (C.S.); (A.J.); (L.V.); (B.H.)
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, ON K1H 8L6, Canada
| | - Mark Clemons
- Ottawa Hospital Research Institute and University of Ottawa, Ottawa, ON K1H 8L6, Canada; (D.F.); (C.S.); (A.J.); (L.V.); (B.H.)
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, ON K1H 8L6, Canada
- Department of Medicine, Division of Medical Oncology, The Ottawa Hospital and University of Ottawa, Ottawa, ON K1H 8L6, Canada
- Correspondence: ; Tel.: +1-613-737-7700 (ext. 70170)
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Prosthetic Breast Reconstruction and Red Breast Syndrome: Demystification and a Review of the Literature. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 7:e2108. [PMID: 31333922 PMCID: PMC6571326 DOI: 10.1097/gox.0000000000002108] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 11/27/2018] [Indexed: 01/08/2023]
Abstract
Supplemental Digital Content is available in the text. Red breast syndrome (RBS) represents an inflammatory condition that rarely occurs in the setting of acellular dermal matrix use after prosthetic reconstruction. It is characterized by erythema or rubor that occurs directly over the ADM, and its appearance resembles that of a cellulitis. There have been many explanations with regard to etiology, but none have addressed the physiologic alterations leading to the onset and resolution of RBS. RBS is postulated to be the result of lymphatic disruption and is self-limiting. Resolution is postulated to be the result of angiolymphatic regeneration and the re-establishment of lymphatic flow within the mastectomy skin flap and the ADM, resulting in the clearance of inflammatory mediators responsible for the localized erythema.
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de Vita R, Buccheri EM. Nipple sparing mastectomy and direct to implant breast reconstruction, validation of the safe procedure through the use of laser assisted indocyanine green fluorescent angiography. Gland Surg 2018; 7:258-266. [PMID: 29998075 DOI: 10.21037/gs.2018.04.03] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Nipple sparing mastectomy (NSM) is a psychologically effective and oncological safe procedure followed by immediate breast reconstruction. Methods Between January 2015 and September 2015 the authors conducted a retrospective review of 40 patients divided into two groups depending on breast volume and weight of mastectomy: group A, 20 patients with small breast; group B, 20 patients with medium breast for nipple sparing mastectomy and direct to implant (DTI) breast reconstruction using strict patient selection and a standardized surgical technique. The nipple areola complex/flap viability were analysed intraoperatively through the use of laser assisted indocyanine green (ICG) fluorescent angiography. Results A total of 44 procedures were followed-up for 24 months. Nineteen patients were assisted in DTI breast reconstruction by acellular dermal matrix (ADM) for inferior/lateral part of the implant coverage. Encouraging results are presented with a unique case of implant failure. Conclusions We report our retrospective experience corroborated by intraoperative laser assisted ICG fluorescent angiography to demonstrate the safety and reliability of the oncoplastic procedure proposed. We also advocate the central role of oncoplastic surgeon as "one man band" to manage breast cancer from the oncological procedure to the breast reconstruction.
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Affiliation(s)
- Roy de Vita
- Department of Plastic Surgery, Regina Elena Cancer Institute of Rome, Rome, Italy
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