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Lagendijk M, Vos EL, Koning AHJ, Hunink MGM, Pignol JP, Corten EML, de Monye C, van Deurzen CHM, van Dam JH, Vrijland WW, Contant CME, Verhoef C, van Lankeren W, Koppert LB. TUmor-volume to breast-volume RAtio for improving COSmetic results in breast cancer patients (TURACOS); a randomized controlled trial. BMC Cancer 2017; 17:336. [PMID: 28514945 PMCID: PMC5436425 DOI: 10.1186/s12885-017-3280-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Accepted: 04/12/2017] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Cosmetic result following breast conserving surgery (BCS) for cancer influences quality of life and psychosocial functioning in breast cancer patients. A preoperative prediction of expected cosmetic result following BCS is not (yet) standard clinical practice and therefore the choice for either mastectomy or BCS is still subjective. Recently, we showed that tumour volume to breast volume ratio as well as tumour location in the breast are independent predictors of superior cosmetic result following BCS. Implementation of a prediction model including both factors, has not been studied in a prospective manner. This study aims to improve cosmetic outcome by implementation of a prediction model in the treatment decision making for breast cancer patients opting for BCS. METHODS/DESIGN Multicentre, single-blinded, randomized controlled trial comparing standard preoperative work-up to a preoperative work-up with addition of the prediction model. Tumour volume to breast volume ratio and tumour location in the breast will be used to predict cosmetic outcome in invasive breast cancer patients opting for BCS. Three dimensional (3D)-ultrasonography will be used to measure the tumour volume to breast volume ratio needed for the prediction model. Sample size was estimated based on a 14% improvement in incidence of superior cosmetic result one year after BCS (71% in the control group versus 85% in the intervention group). Primarily cosmetic outcome will be evaluated by a 6-member independent panel. Secondary endpoints include; (1) patient reported outcome measured by BREAST-Q, EORTC-QLQ-C30/BR23 and EQ-5D-5 L (2) cosmetic outcome as assessed through the BCCT.core software, (3) radiation-induced reaction (4) surgical treatment performed, (5) pathological result and (6) cost-effectiveness. Follow-up data will be collected for 3 years after surgery or finishing radiotherapy. DISCUSSION This randomized controlled trial examines the value of a preoperative prediction model for the treatment-decision making. It aims for a superior cosmetic result in breast cancer patients opting for BCS. We expect improvement of patients' quality of life and psychosocial functioning in a cost-effective way. TRIAL REGISTRATION Prospectively registered, February 17th 2015, at 'Nederlands Trialregister - NTR4997 '.
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Affiliation(s)
- M. Lagendijk
- Department of Oncological Surgery, Erasmus MC Cancer Institute, DHA-102, PO Box 5201, 3008 AE Rotterdam, The Netherlands
| | - E. L. Vos
- Department of Oncological Surgery, Erasmus MC Cancer Institute, DHA-102, PO Box 5201, 3008 AE Rotterdam, The Netherlands
| | - A. H. J. Koning
- Department of Bioinformatics, Erasmus MC, Rotterdam, the Netherlands
| | - M. G. M. Hunink
- Department of Epidemiology and Department of Radiology, Erasmus MC, Rotterdam, the Netherlands
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, MA USA
| | - J. P. Pignol
- Department of Radiotherapy, Erasmus MC, Rotterdam, the Netherlands
| | - E. M. L. Corten
- Department of plastic and reconstructive surgery, Erasmus MC, Rotterdam, the Netherlands
| | - C. de Monye
- Department of Radiology, Erasmus MC, Rotterdam, the Netherlands
| | | | - J. H. van Dam
- Department of surgery, Havenziekenhuis, Rotterdam, the Netherlands
| | - W. W. Vrijland
- Department of surgery, Franciscus Gasthuis, Rotterdam, the Netherlands
| | - C. M. E. Contant
- Department of surgery, Maasstad ziekenhuis, Rotterdam, the Netherlands
| | - C. Verhoef
- Department of Oncological Surgery, Erasmus MC Cancer Institute, DHA-102, PO Box 5201, 3008 AE Rotterdam, The Netherlands
| | - W. van Lankeren
- Department of Radiology, Erasmus MC, Rotterdam, the Netherlands
| | - L. B. Koppert
- Department of Oncological Surgery, Erasmus MC Cancer Institute, DHA-102, PO Box 5201, 3008 AE Rotterdam, The Netherlands
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Van't Sant HP, Slieker JC, Hop WCJ, Weidema WF, Lange JF, Vermeulen J, Contant CME. The influence of mechanical bowel preparation in elective colorectal surgery for diverticulitis. Tech Coloproctol 2012; 16:309-14. [PMID: 22706733 PMCID: PMC3398249 DOI: 10.1007/s10151-012-0852-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2011] [Accepted: 05/29/2012] [Indexed: 12/13/2022]
Abstract
Background Mechanical bowel preparation (MBP) has been shown to have no influence on the incidence of anastomotic leakage in overall colorectal surgery. The role of MBP in elective surgery in combination with an inflammatory component such as diverticulitis is yet unclear. This study evaluates the effects of MBP on anastomotic leakage and other septic complications in 190 patients who underwent elective surgery for colonic diverticulitis. Methods A subgroup analysis was performed in a prior multicenter (13 hospitals) randomized trial comparing clinical outcome of MBP versus no MBP in elective colorectal surgery. Primary endpoint was the occurrence of anastomotic leakage in patients operated on for diverticulitis, and secondary endpoints were septic complications and mortality. Results Out of a total of 1,354 patients, 190 underwent elective colorectal surgery (resection with primary anastomosis) for (recurrent or stenotic) diverticulitis. One hundred and three patients underwent MBP prior to surgery and 87 did not. Anastomotic leakage occurred in 7.8 % of patients treated with MBP and in 5.7 % of patients not treated with MBP (p = 0.79). There were no significant differences between the groups in septic complications and mortality. Conclusion Mechanical bowel preparation has no influence on the incidence of anastomotic leakage, or other septic complications, and may be safely omitted in case of elective colorectal surgery for diverticulitis.
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Affiliation(s)
- H P Van't Sant
- Department of Surgery, Ikazia Hospital, Montessoriweg 1, 3083 AN, Rotterdam, The Netherlands.
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Contant CME, van Wersch AME, Menke-Pluymers MBE, Wai RTJ, Eggermont AMM, van Geel AN. Satisfaction and prosthesis related complaints in women with immediate breast reconstruction following prophylactic and oncological mastectomy. PSYCHOL HEALTH MED 2004. [DOI: 10.1080/13548500310001637760] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Contant CME, Menke-Pluijmers MBE, Seynaeve C, Meijers-Heijboer EJ, Klijn JGM, Verhoog LC, Tjong Joe Wai R, Eggermont AMM, van Geel AN. Clinical experience of prophylactic mastectomy followed by immediate breast reconstruction in women at hereditary risk of breast cancer (HB(O)C) or a proven BRCA1 and BRCA2 germ-line mutation. Eur J Surg Oncol 2002; 28:627-32. [PMID: 12359199 DOI: 10.1053/ejso.2002.1279] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AIM Women with a proven BRCA1 or BRCA2 germ-line mutation or with a 50% risk of carrying the mutation, have an increased risk of breast cancer. Regular surveillance, chemoprevention or prophylactic mastectomy (PM) are options to detect breast cancer at an early stage or to reduce the risk. We describe the management of women who have opted for PM, the postoperative complications of PM, especially in combination with immediate breast reconstruction (IBR), and the oncological follow-up. METHODS The medical records of all women who underwent a PM from December 1993 to December 1999 have been reviewed with respect to management, patient characteristics, complications and oncological follow-up. RESULTS During the study period 112 women with a median age of 38.8 years opted for a PM: 76 were germline mutation carriers. After PM, 79 women without breast or ovarian cancer in their medical history, were free of disease after 2.5 years (median). Before PM, 29 women had been treated for breast cancer, 3.9 years (median) previously; 5 of these women had developed metastatic disease by the last consultation. Before PM, 2 patients had been treated for DCIS and 2 patients for ovarian cancer. Four DCIS were found; none of these women had evidence of disease 4.0 years (median) after PM. In 59 women laparoscopic prophylactic bilateral oophorectomy (PBO) was performed; 36 simultaneously with PM and 23 separately. A total of 103 women (92%) opted for IBR. After PM, the complication rate for IBR was 21%: 11% within 6 weeks and 10% at long-term follow-up (median 3.5) after PM, including the removal of 10 prostheses. CONCLUSIONS Women with an increased risk of breast cancer due to a genetic predisposition should be adequately informed about the different treatment options in the setting of a multidisciplinary approach. PM can simultaneously be combined with PBO and IBR. IBR can facilitate the decision to undergo a PM. PM followed by IBR has an acceptable complication rate.
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Affiliation(s)
- C M E Contant
- Department of Surgical Oncology, University Hospital Rotterdam/Daniel den Hoed Cancer Centre, Zuiderziekenhuis Rotterdam, The Netherlands
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Contant CME, Swaak AJG, Obdeijn AIM, van der Holt B, Tjong Joe Wai R, van Geel AN, Eggermont AMM. A prospective study on silicone breast implants and the silicone-related symptom complex. Clin Rheumatol 2002; 21:215-9. [PMID: 12111627 DOI: 10.1007/pl00011221] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This cohort study prospectively evaluated the prevalence of the silicone-related symptom complex (SRSC) in relation to antinuclear antibodies (ANA) and magnetic resonance imaging (MRI) of silicone breast implants (SBI) 1 year after implantation. A total of 57 women undergoing mastectomy followed by immediate breast reconstruction (IBR) and SBI between March 1995 and March 1997 at the University Hospital Rotterdam/Daniel den Hoed Cancer Centre, were prospectively evaluated. Just before and 1 year after IBR the sera of these women were tested for the presence of ANA and they were screened for the prevalence of SRSC-related symptoms by questionnaire. All prostheses were evaluated by MRI 1 month and 1 year after IBR. Just before operation 11% of the women had a Sjögren score of more than 2, whereas 30% had such a score 1 year after IBR ( P = 0.01). One year postoperatively women had significantly more RA/Raynaud-related complaints: 21% preoperatively versus 40% 1 year after IBR ( P = 0.03). Within the undefined complaints-related group 19% had a score of 2 or more preoperatively and 33% 1 year after IBR ( P = 0.09). There were no new cases of ANA positivity 1 year after IBR. The linguine sign was seen by MRI in three implants: one 1 month after IBR and two 1 year after IBR. There was no relation to changes in SRSC expression and these MRI findings. In conclusion, 1 year after SBI implantation women had more SRSC-related complaints, especially Sjögren's and RA/Raynaud's. Moreover there was no correlation between elevated SRSC expression and changes in the presence of ANA or changes in MRI of the SBI 1 year after IBR.
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Affiliation(s)
- C M E Contant
- University Hospital Rotterdam/Daniel den Hoed Cancer Centre, Rotterdam, the Netherlands
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