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Maiz C, Silva F, Domínguez F, Galindo H, Camus M, León A, Oddó D, Villarroel A, Razmilic D, Navarro ME, Medina L, Merino T, Vines E, Peña J, Maldonado D, Pinto MP, Acevedo F, Sánchez C. Mammography correlates to better survival rates in breast cancer patients: a 20-year experience in a University health institution. Ecancermedicalscience 2020; 14:1005. [PMID: 32104207 PMCID: PMC7039691 DOI: 10.3332/ecancer.2020.1005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Indexed: 12/18/2022] Open
Abstract
Breast cancer (BC) is the most common malignancy in women. We retrieved medical records from >2,000 Chilean BC patients over the 1997–2018 period. The objective was to assess changes in clinical presentation or prognosis of our patients throughout these 20 years of practice. Although most variables did not display significant variations, we observed a progressive increase in stage IV BC over this period. Our data showed that tumour stage III/IV or HER2-enriched subtype tumours were associated with poorer prognosis. In contrast, we found that patients diagnosed by mammography had better overall survival. We speculate that better screenings and more sensitive imaging could explain the unexpected rise in stage IV cases. Our results support mammography screenings as an effective measure to reduce BC-related mortality.
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Affiliation(s)
- Cristóbal Maiz
- Departament of Oncological and Maxillofacial Surgery, School of Medicine, Pontificia Universidad Católica de Chile, 8330032 Santiago, Chile
| | - Fernando Silva
- Departament of Hematology and Oncology, School of Medicine, Pontificia Universidad Católica de Chile, 8330032 Santiago, Chile
| | - Francisco Domínguez
- Departament of Oncological and Maxillofacial Surgery, School of Medicine, Pontificia Universidad Católica de Chile, 8330032 Santiago, Chile
| | - Héctor Galindo
- Departament of Hematology and Oncology, School of Medicine, Pontificia Universidad Católica de Chile, 8330032 Santiago, Chile
| | - Mauricio Camus
- Departament of Oncological and Maxillofacial Surgery, School of Medicine, Pontificia Universidad Católica de Chile, 8330032 Santiago, Chile
| | - Augusto León
- Departament of Oncological and Maxillofacial Surgery, School of Medicine, Pontificia Universidad Católica de Chile, 8330032 Santiago, Chile
| | - David Oddó
- Departament of Anatomic Pathology, School of Medicine, Pontificia Universidad Católica de Chile, 8330032 Santiago, Chile
| | - Alejandra Villarroel
- Departament of Anatomic Pathology, School of Medicine, Pontificia Universidad Católica de Chile, 8330032 Santiago, Chile
| | - Dravna Razmilic
- Departament of Radiology, School of Medicine, Pontificia Universidad Católica de Chile, 8330032 Santiago, Chile
| | - María Elena Navarro
- Departament of Radiology, School of Medicine, Pontificia Universidad Católica de Chile, 8330032 Santiago, Chile
| | - Lidia Medina
- Cancer Center 'Nuestra Señora de la Esperanza', Pontificia Universidad Católica de Chile, 8330032 Santiago, Chile
| | - Tomás Merino
- Departament of Hematology and Oncology, School of Medicine, Pontificia Universidad Católica de Chile, 8330032 Santiago, Chile
| | - Eugenio Vines
- Departament of Hematology and Oncology, School of Medicine, Pontificia Universidad Católica de Chile, 8330032 Santiago, Chile
| | - José Peña
- Departament of Hematology and Oncology, School of Medicine, Pontificia Universidad Católica de Chile, 8330032 Santiago, Chile
| | - Daniela Maldonado
- Departament of Oncological and Maxillofacial Surgery, School of Medicine, Pontificia Universidad Católica de Chile, 8330032 Santiago, Chile
| | - Mauricio P Pinto
- Departament of Hematology and Oncology, School of Medicine, Pontificia Universidad Católica de Chile, 8330032 Santiago, Chile
| | - Francisco Acevedo
- Departament of Hematology and Oncology, School of Medicine, Pontificia Universidad Católica de Chile, 8330032 Santiago, Chile
| | - César Sánchez
- Departament of Hematology and Oncology, School of Medicine, Pontificia Universidad Católica de Chile, 8330032 Santiago, Chile
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Abstract
Metastatic breast cancer (MBC) management is based on systemic treatment (ST), while the local therapy role remains controversial. We present the case of a 36-year-old woman with a diagnosis of hormone receptor-positive and human epidermal growth factor receptor type 2-positive breast cancer and isolated sternal metastasis, who received neoadjuvant ST with complete remission and later primary tumour surgery. Oligometastatic patients are a subgroup of MBC that can benefit from aggressive local therapies, even with curative intent.
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Affiliation(s)
- Catalina Vargas
- Department of Surgical Oncology, Pontificia Universidad Católica de Chile, Santiago 8331150, Chile
| | - Cristóbal Maiz
- Department of Surgical Oncology, Pontificia Universidad Católica de Chile, Santiago 8331150, Chile
| | - María Elena Navarro
- Department of Radiology, Pontificia Universidad Católica de Chile, Santiago 8331150, Chile
| | - David Oddó
- Department of Anatomical Pathology, Pontificia Universidad Católica de Chile, Santiago 8331150, Chile
| | - César Sánchez
- Department of Hematology-Oncology, Pontificia Universidad Católica de Chile, Santiago 8331150, Chile
| | - Marisa Bustos
- Departament of Oncological Radiotherapy, Pontificia Universidad Católica de Chile, Santiago 8331150, Chile
| | - Mauricio Camus
- Department of Surgical Oncology, Pontificia Universidad Católica de Chile, Santiago 8331150, Chile
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Carrillo M, Maturana G, Maiz C, Romero D, Domínguez F, Oddó D, Villarroel A, Razmilic D, Navarro ME, León A, Sánchez C, Camus M. Breast lesions with atypia in percutaneous biopsies, managed with surgery in the last 10 years. Ecancermedicalscience 2019; 13:923. [PMID: 31281420 PMCID: PMC6546256 DOI: 10.3332/ecancer.2019.923] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Indexed: 12/05/2022] Open
Abstract
Introduction The optimal management of breast lesions with atypia (BLA), detected in percutaneous biopsies after screening mammograms, is a controversial issue. The aim of this paper is to compare histological diagnosis by percutaneous biopsy with the results of the surgical biopsy of these lesions and to analyse the changes to clinical approach this would imply. Method A retrospective study was carried out on patients operated on between June 2007 and June 2017 with a diagnosis of BLA. One hundred and forty-seven patients were identified with a pre-operative diagnosis of flat epithelial atypia (FEA), atypical ductal hyperplasia (ADH), atypical lobular hyperplasia, lobular carcinoma in situ and other atypia. Results The average age at diagnosis of BLAs was 52 ± 9.4 years. Radiologically, the lesions presented as microcalcifications in 79%, nodules in 15.6% and other lesions 5.4%. 73.5% of these were biopsied by means of digital stereotaxis. All of the patients analysed underwent a partial mastectomy. Changes in a biologically high-risk lesion were observed in 26.5% of the surgical specimens, of which 75.5% corresponded with ADH and FEA. In the percutaneous biopsies consistent with ADH (40.1%), ductal carcinoma was discovered in 6.8% (5.1% in situ and 1.7% invasive), which implied specific, multi-disciplinary management. Of the FEAs, 84.8% required a second treatment (surgery and/or hormone therapy ± radiotherapy, depending on whether it concerned FEA 59.6%, ADH 21.2% or ductal carcinoma in situ 3.8%). Conclusion These data show the clinical relevance in the diagnosis of ADH and FEA in percutaneous biopsies. For the diagnosis of FEA in particular, the associated risk of biologically high-risk lesions and ductal carcinoma is made evident.
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Affiliation(s)
- Mitzy Carrillo
- Department of Surgical Oncology, Pontificia Universidad Católica de Chile, Santiago, 8330024, Chile
| | - Gregorio Maturana
- School of Medicine, Pontificia Universidad Católica de Chile, Santiago, 8330024, Chile
| | - Cristóbal Maiz
- Department of Surgical Oncology, Pontificia Universidad Católica de Chile, Santiago, 8330024, Chile
| | - Diego Romero
- Oncological and Head and Neck Surgery, Hospital Sótero del Río, Santiago, 8207257, Chile
| | - Francisco Domínguez
- Department of Surgical Oncology, Pontificia Universidad Católica de Chile, Santiago, 8330024, Chile
| | - David Oddó
- Department of Anatomical Pathology, Pontificia Universidad Católica de Chile, Santiago, 8330024, Chile
| | - Alejandra Villarroel
- Department of Anatomical Pathology, Pontificia Universidad Católica de Chile, Santiago, 8330024, Chile
| | - Dravna Razmilic
- Department of Breast Radiology, Pontificia Universidad Católica de Chile, Santiago, 8330024, Chile
| | - María Elena Navarro
- Department of Breast Radiology, Pontificia Universidad Católica de Chile, Santiago, 8330024, Chile
| | - Augusto León
- Department of Surgical Oncology, Pontificia Universidad Católica de Chile, Santiago, 8330024, Chile
| | - César Sánchez
- Department of Hematology-Oncology, Pontificia Universidad Católica de Chile, Santiago, 8330024, Chile
| | - Mauricio Camus
- Department of Surgical Oncology, Pontificia Universidad Católica de Chile, Santiago, 8330024, Chile
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Quezada N, Maiz C, Daroch D, Funke R, Sharp A, Boza C, Pimentel F. Effect of Early Use of Covered Self-Expandable Endoscopic Stent on the Treatment of Postoperative Stapler Line Leaks. Obes Surg 2016; 25:1816-21. [PMID: 25840555 DOI: 10.1007/s11695-015-1622-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [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: 12/17/2022]
Abstract
BACKGROUND Postoperative leaks are a dreaded complication after bariatric surgery (BS). Its treatment is based on nutritional support and sepsis control by antibiotics, collections drainage and/or prosthesis, and/or surgery. OBJECTIVES The aim of this study is to report our experience with coated self-expandable endoscopic stents (SEES) for leaks treatment. SETTING This study was performed in a University Hospital, (censored). METHODS We performed a retrospective analysis of our BS database from January 2007 to December 2013. All patients with leak after BS treated with SEES were included. RESULTS We identified 29 patients; 17 (59%) were women, with median age of 37 (19-65) years, and preoperative body mass index of 40 (28.7-56-6) kg/m(2). Nineteen (65.5%) patients had a sleeve gastrectomy and 10 (34.5%) a Roux-en-Y gastric bypass. All patients had a leak in the stapler line. Median time from surgery to leak diagnosis was 7 (1-51) days, and SEES were installed 8 (0-104) days after diagnosis. Twenty-one (72%) patients also had abdominal exploration. Median length of SEES use was 60 (1-299) days. Patients who had SEES as primary treatment (with or without simultaneous reoperation) had a shorter leak closure time (50 [6-112] vs 109 [60-352] days; p = 0.008). Twenty-eight (96.5%) patients successfully achieved leak closure with SEES. There were 16 migrations in 10 (34%) patients, 1 (3%) stent fracture, 1 opening of the blind end of alimentary limb (3%), and 5 patients (17%) required a second stent due to leak persistence. CONCLUSIONS SEES is a feasible, safe, and effective management of post BS leaks, although patients may also require prosthesis revision and abdominal exploration. Primary SEES placement is associated with a shorter leak resolution time.
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Affiliation(s)
- Nicolás Quezada
- Department of Digestive Surgery. School of Medicine, Pontificia Universidad Católica de Chile, Marcoleta 350, patio interior, División de Cirugía, Región Metropolitana, Santiago, Chile,
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Maldonado C, Daroch D, Maiz C, Bachler J, Crovari F, Boza C, Funke R, Köckerling F, Dabic D, Maric B, Perunicic V, Aho J, Samaha M, Antiel R, Dupont S, Ballman K, Sloan J, Bingener J, Macano C, Brookes A, Samee A, Davies S, Haleem A, Hayden S, Al-Aaraji S, Beardsmore D, Cox T, Huntington C, Blair L, Prasad T, Augenstein V, Heniford BT, Bauder A, Fischer J, Kovach S. Topic: Abdominal Wall Hernia - Epigastric hernia: choice of approach, repair, results, follow up. Hernia 2015; 19 Suppl 1:S208-11. [PMID: 26518802 DOI: 10.1007/bf03355351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- C Maldonado
- Pontificia Universidad Católica de Chile, Santiago, Chile
| | - D Daroch
- Pontificia Universidad Católica de Chile, Santiago, Chile
| | - C Maiz
- Pontificia Universidad Católica de Chile, Santiago, Chile
| | - J Bachler
- Pontificia Universidad Católica de Chile, Santiago, Chile
| | - F Crovari
- Pontificia Universidad Católica de Chile, Santiago, Chile
| | - C Boza
- Pontificia Universidad Católica de Chile, Santiago, Chile
| | - R Funke
- Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | - D Dabic
- Department of surgery, General Hospital Cacak, Cacak, Serbia
| | | | | | - J Aho
- Mayo Clinic, Rochester, USA
| | | | | | | | | | | | | | - C Macano
- University Hospital of North Staffordshire, Stoke-on-Trent, UK
| | | | | | | | | | | | | | | | - T Cox
- Department of GI and Minimally Invasive Surgery, Carolinas Medical Center, Charlotte, USA
| | - C Huntington
- Department of GI and Minimally Invasive Surgery, Carolinas Medical Center, Charlotte, USA
| | - L Blair
- Department of GI and Minimally Invasive Surgery, Carolinas Medical Center, Charlotte, USA
| | - T Prasad
- Department of GI and Minimally Invasive Surgery, Carolinas Medical Center, Charlotte, USA
| | - V Augenstein
- Department of GI and Minimally Invasive Surgery, Carolinas Medical Center, Charlotte, USA
| | - B T Heniford
- Department of GI and Minimally Invasive Surgery, Carolinas Medical Center, Charlotte, USA
| | - A Bauder
- Hospital of the University of Pennsylvania, Philadelphia, USA
| | - J Fischer
- Hospital of the University of Pennsylvania, Philadelphia, USA
| | - S Kovach
- Hospital of the University of Pennsylvania, Philadelphia, USA
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León F, Maiz C, Daroch D, Quezada N, Gabrielli M, Muñoz C, Boza C. Laparoscopic hand-sewn revisional gastrojejunal plication for weight loss failure after Roux-en-Y gastric bypass. Obes Surg 2015; 25:744-9. [PMID: 25618780 DOI: 10.1007/s11695-014-1463-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Revisional surgery has become a widely accepted alternative for weight loss failure/regain after bariatric surgery. However, it is associated to higher morbi-mortality and lesser weight loss than primary bariatric procedure. Our aims are to present a novel technique for weight loss treatment after failed laparoscopic Roux-en-Y gastric bypass (LRYGB) and to report its short-term results. METHODS This is a retrospective analysis of patients submitted to a revisional hand-sewn double-layer gastrojejunal plication (GJP) for treatment of weight loss failure/regain after LRYGB. Analysis of demographics, body mass index (BMI), and percentage of excess weight loss (%EWL) at the 6th month complications, and financial costs involved was included. RESULTS Four patients were submitted to revisional GJP. Three patients were female and the mean age at revision was 30 ± 9 years (21-44). The median time interval between LRYGB and GJP was 51 months (24-120). The median BMI at the moment of GJP and the 3rd and 6th month was 35.6 kg/m2 (32.0-37.8), 32.2 kg/m2 (29.7-34.1), and 30.7 kg/m2 (28.1-32.1), respectively. The median %EWL at the 3rd and 6th month was 35.4% (13.6-38.9) and 46.2 % (45.1-55.5), respectively, reaching a cumulative (combined surgeries) %EWL of 62.9% (16.5-67.9) and 71.7% (65.1-77.6), respectively. There were no complications or mortality. Financial costs were significantly lower compared to revisional gastrojejunal stapled reduction (US $1400 cheaper). CONCLUSION Revisional GJP is a feasible, safe, and cost-effective novel procedure for treatment of weight loss failure/regain after LRYGB. Mid- and long-term results are necessary in order to establish its real effectiveness.
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Affiliation(s)
- Felipe León
- Bariatric Surgery Unit, Digestive Surgery Department, School of Medicine, Pontificia Universidad Católica de Chile, Marcoleta 350, patio interior, División de Cirugía, Región Metropolitana, Santiago, Chile,
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Maiz C, Alvarado J, Quezada N, Salinas J, Funke R, Boza C. Bariatric surgery in 1119 patients with preoperative body mass index<35 (kg/m(2)): results at 1 year. Surg Obes Relat Dis 2015; 11:1127-32. [PMID: 26645489 DOI: 10.1016/j.soard.2015.03.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2014] [Revised: 03/11/2015] [Accepted: 03/23/2015] [Indexed: 01/08/2023]
Abstract
BACKGROUND The use of body mass index (BMI) as the only criterion to indicate bariatric surgery is currently under discussion. There is growing evidence that supports bariatric surgery in carefully selected patients with lower BMI. OBJECTIVES To report our experience in bariatric surgery in>1000 patients with BMI<35 kg/m(2) and their results at 1 year. SETTING University hospital (censored). METHODS A retrospective analysis was performed in patients who underwent laparoscopic Roux-en-Y gastric bypass (LRYGB) or sleeve gastrectomy (SG) with preoperative BMI<35 kg/m(2) from January 2008 to December 2011. Demographic and anthropometric data, preoperative co-morbidities, and perioperative variables were retrieved. Weight loss and co-morbidities progression were analyzed 1 year after surgery and compared among procedures. A P value<.05 was considered significant. RESULTS We identified 1119 patients: mean age 38.8±11.4, 951 (85%) women, preoperative weight 87.5±9.3 kg and BMI 33.1 (31.9-34.1) kg/m(2). Preoperatively, 11.7% had type 2 diabetes mellitus, 25.9% arterial hypertension, 55.6% insulin resistance, and 53.2% dyslipidemia. In total, 283 patients (25.2%) underwent LRYGB and 836 (74.8%) SG. One year after surgery (follow-up: 66.67%) patients reached 24.5 (22.8-26.4) BMI and the percentage of excess of weight loss (%EWL) was 107.9±36.6%. Diabetes, hypertension, insulin resistance, and dyslipidemia remission/improvement rates were 54/39%, 58/29%, 72/17%, and 54/30%, respectively. CONCLUSIONS Bariatric surgery in selected class I obesity patients can safely be performed. We have observed good results in terms of weight loss and co-morbidity improvement/remission. Long-term follow-up is required.
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Affiliation(s)
- Cristóbal Maiz
- Department of Digestive Surgery, Bariatric Surgery Unit, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Juan Alvarado
- Department of Digestive Surgery, Bariatric Surgery Unit, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Nicolás Quezada
- Department of Digestive Surgery, Bariatric Surgery Unit, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - José Salinas
- Department of Digestive Surgery, Bariatric Surgery Unit, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Ricardo Funke
- Department of Digestive Surgery, Bariatric Surgery Unit, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Camilo Boza
- Department of Digestive Surgery, Bariatric Surgery Unit, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.
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