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Doucet VM, Weirathmueller JJ, McLeod GJ, Murray KA. Postoperative Prophylactic Antibiotic Use in Breast Reduction Mammoplasty: A Single Centre Retrospective Cohort Study. Plast Surg (Oakv) 2024; 32:220-225. [PMID: 38681256 PMCID: PMC11046272 DOI: 10.1177/22925503221107220] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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] [Indexed: 05/01/2024] Open
Abstract
Introduction: Breast reduction mammoplasty (BRM) is a common procedure performed by plastic surgeons treating patients with hypermastia. It is customary to give preoperative prophylactic intravenous antibiotics for BRM, followed by several days of postoperative prophylactic oral antibiotics, despite the lack of evidence of their effectiveness in preventing surgical site infections (SSIs). The purpose of this study is to determine if the addition of prophylactic postoperative antibiotics is more effective in preventing SSIs in comparison to a single dose of preoperative prophylactic antibiotics in BRM. Methods: A retrospective analysis of 124 elective BRM cases by a single senior plastic surgeon was completed. Two study groups were formed based on the location of surgery and each group was assigned a different antibiotic regimen. The first antibiotic regimen consisted of a single preoperative intravenous dose of antibiotics (group 1), while the second regimen consisted of a preoperative intravenous dose followed by a 5-day course of oral antibiotics (group 2). Results: Overall SSI rate was 5.6%. Infection rate in group 1 was 8.1% in comparison to 3.2% for group 2 (P value .44). Overall, the incidence of complications was 29.0%; 38.7% in group 1 and 19.4% in group 2 (P value .03). Complications consisted of 35 cases of delayed wound healing, 7 SSIs and 2 hematomas requiring evacuation. Conclusion: Study results demonstrated that the use of postoperative prophylactic antibiotics for BRM had no significant effect on the rate of SSIs.
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Affiliation(s)
- Véronique M. Doucet
- Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Section of Plastic Surgery, Department of Surgery, University of Manitoba
| | - Jakob J. Weirathmueller
- Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Graham J. McLeod
- Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Section of Plastic Surgery, Department of Surgery, University of Manitoba
| | - Kenneth A. Murray
- Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Section of Plastic Surgery, Department of Surgery, University of Manitoba
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2
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Upadhyay N, Wolska J. Imaging the dense breast. J Surg Oncol 2024. [PMID: 38685673 DOI: 10.1002/jso.27661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 04/08/2024] [Accepted: 04/09/2024] [Indexed: 05/02/2024]
Abstract
The sensitivity of mammography reduces as breast density increases, which impacts breast screening and locoregional staging in breast cancer. Supplementary imaging with other modalities can offer improved cancer detection, but this often comes at the cost of more false positives. Magnetic resonance imaging and contrast-enhanced mammography, which assess tumour enhancement following contrast administration, are more sensitive than digital breast tomosynthesis and ultrasound, which predominantly rely on the assessment of tumour morphology.
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Affiliation(s)
- Neil Upadhyay
- Faculty of Medicine, Imperial College London, London, UK
- Imaging Department, Imperial College Healthcare NHS Trust, London, UK
| | - Joanna Wolska
- Imaging Department, Imperial College Healthcare NHS Trust, London, UK
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3
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Shaffer K, Harris L, Ng S, Tjoe JA. Nipple-Sparing Mastectomy and Adequate Margins for Patients With Ductal Carcinoma In Situ. Am Surg 2024:31348241246179. [PMID: 38605446 DOI: 10.1177/00031348241246179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
BACKGROUND For patients with ductal carcinoma in situ (DCIS) undergoing breast conservation surgery (BCS), guidelines advise a margin width of at least 2 mm, with studies demonstrating decreased recurrence risk compared to narrower margins. However, limited data exist establishing if this margin is appropriate in mastectomies, and specifically for nipple-sparing mastectomy (NSM). Consequently, we evaluated the margins of DCIS patients undergoing NSM and resulting oncologic outcomes. METHODS A single-institution retrospective review was performed in patients with DCIS or DCIS with microinvasion (DCIS + MI) undergoing NSM from April 2010 to December 2021. Patient and tumor characteristics, margin status, treatment, and outcomes information were collected. The association between margins and local-regional (LRR) and distant recurrence (DR) were examined. RESULTS 161 patients were included, comprising 284 NSM (164 therapeutic, 120 prophylactic). 153 patients had DCIS and 8 had DCIS + MI. Most patients had hormone sensitive, 123 (76.4%), and nuclear grade 2, 72 (44.7%), disease. In total, 35 (21.7%) patients had positive or <2 mm margins. Of these, 21 (60%) involved the anterior margin. At a median follow-up of 45 months (range 0-151), 2.5% (n = 4) had a LRR and .6% (n = 1) had a DR. Of patients with a recurrence, only 2 had positive or <2 mm margins, 1 had received endocrine therapy, and none received adjuvant radiation. DISCUSSION No specific margin status was found to correlate with recurrence for patients with DCIS or DCIS + MI undergoing NSM, with an altogether low recurrence risk. Overall, this suggests that recommended DCIS margins in BCS doesn't necessarily apply in NSM, where margins of <2 mm may be acceptable.
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Affiliation(s)
- Kristina Shaffer
- Department of Surgery, University of North Carolina School of Medicine, Chapel Hill, NC, USA
- Department of Surgical Oncology, Novant Health Cancer Institute, Charlotte, NC, USA
| | - Lilian Harris
- Department of Medical Oncology, Novant Health Cancer Institute, Charlotte, NC, USA
| | - Stephanie Ng
- Program in Women's Oncology, Gynecologic Oncology, and Breast Surgery, Women and Infants Hospital, Providence, RI, USA
| | - Judy A Tjoe
- Division of Surgical Oncology, Green Bay Oncology, Green Bay, WI, USA
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Yip KH, Yip YC, Tsui WK, Chan CSA, Mo YH, Smith GD. Navigating changes: A qualitative study exploring the health-related quality of life of breast cancer survivors during the coronavirus disease 2019 pandemic. J Adv Nurs 2024; 80:1531-1544. [PMID: 37902114 DOI: 10.1111/jan.15909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 09/04/2023] [Accepted: 10/10/2023] [Indexed: 10/31/2023]
Abstract
AIMS To explore the impact of the coronavirus disease 2019 pandemic on the health-related quality of life (HRQoL) of breast cancer survivors. DESIGN We utilized a qualitative descriptive approach to facilitate interviews among 25 participants, all of whom are survivors of breast cancer and have received treatment in Hong Kong within the preceding 3 years. METHODS Content analysis was performed to understand how patients' HRQoL views and experiences changed during coronavirus disease 2019 pandemic. RESULTS The results included six themes delineating the impact of the coronavirus disease 2019 pandemic: (i) survivor sensitivities in pandemic times, (ii) coping and conditioning in pandemic times, (iii) transforming work and home dynamics in pandemic times, (iv) cognitive resilience and adaptation to the COVID-19 protective measures, (v) social resilience in pandemic times and (vi) healthcare adaptation and coping in pandemic times. CONCLUSION This study provides insights into the experiences and challenges of breast cancer survivors during the coronavirus disease 2019 pandemic. Some survivors had new physical and psychological symptoms, including fear and anxiety, isolation, pain, lymphoedema and burnout, which potentially have long-term impact upon HRQoL. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE This study highlights the unique challenges faced by breast cancer survivors during the coronavirus disease 2019 pandemic, including accessing healthcare services and the impact of social isolation. Healthcare providers should consider the holistic needs of breast cancer survivors in the provision of health care and develop supportive interventions, including telehealth services and online support groups, to address these challenges and improve their HRQoL. IMPACT Surgery aimed at treating breast cancer or reducing its risk generally influences the appearance of breast areas and donor sites. The continuing effects of these changes on body image and HRQoL are well-reported, although studies have ineffectively examined the initial experiences of women regarding their postoperative appearance, particularly during the pandemic. REPORTING METHOD The checklist of consolidated criteria for reporting qualitative research (COREQ) was utilized. PATIENT OR PUBLIC CONTRIBUTION A small selection on breast cancer survivors contributed to the design of this study, in particular the content of the semi-structured interviews.
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Affiliation(s)
- Ka-Huen Yip
- School of Health Sciences, Caritas Institute of Higher Education, Hong Kong, China
| | - Yuk-Chiu Yip
- Hong Kong Institute of Paramedicine, Hong Kong, China
| | - Wai-King Tsui
- School of Health Sciences, Caritas Institute of Higher Education, Hong Kong, China
| | | | - Yuen-Han Mo
- Department of Social Work, Hong Kong Shue Yan University, Hong Kong, China
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Seth I, Lim B, Joseph K, Gracias D, Xie Y, Ross RJ, Rozen WM. Use of artificial intelligence in breast surgery: a narrative review. Gland Surg 2024; 13:395-411. [PMID: 38601286 PMCID: PMC11002485 DOI: 10.21037/gs-23-414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 10/09/2023] [Accepted: 02/21/2024] [Indexed: 04/12/2024]
Abstract
Background and Objective We have witnessed tremendous advances in artificial intelligence (AI) technologies. Breast surgery, a subspecialty of general surgery, has notably benefited from AI technologies. This review aims to evaluate how AI has been integrated into breast surgery practices, to assess its effectiveness in improving surgical outcomes and operational efficiency, and to identify potential areas for future research and application. Methods Two authors independently conducted a comprehensive search of PubMed, Google Scholar, EMBASE, and Cochrane CENTRAL databases from January 1, 1950, to September 4, 2023, employing keywords pertinent to AI in conjunction with breast surgery or cancer. The search focused on English language publications, where relevance was determined through meticulous screening of titles, abstracts, and full-texts, followed by an additional review of references within these articles. The review covered a range of studies illustrating the applications of AI in breast surgery encompassing lesion diagnosis to postoperative follow-up. Publications focusing specifically on breast reconstruction were excluded. Key Content and Findings AI models have preoperative, intraoperative, and postoperative applications in the field of breast surgery. Using breast imaging scans and patient data, AI models have been designed to predict the risk of breast cancer and determine the need for breast cancer surgery. In addition, using breast imaging scans and histopathological slides, models were used for detecting, classifying, segmenting, grading, and staging breast tumors. Preoperative applications included patient education and the display of expected aesthetic outcomes. Models were also designed to provide intraoperative assistance for precise tumor resection and margin status assessment. As well, AI was used to predict postoperative complications, survival, and cancer recurrence. Conclusions Extra research is required to move AI models from the experimental stage to actual implementation in healthcare. With the rapid evolution of AI, further applications are expected in the coming years including direct performance of breast surgery. Breast surgeons should be updated with the advances in AI applications in breast surgery to provide the best care for their patients.
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Affiliation(s)
- Ishith Seth
- Department of Plastic Surgery, Peninsula Health, Melbourne, Victoria, Australia
- Central Clinical School at Monash University, The Alfred Centre, Melbourne, Victoria, Australia
| | - Bryan Lim
- Department of Plastic Surgery, Peninsula Health, Melbourne, Victoria, Australia
- Central Clinical School at Monash University, The Alfred Centre, Melbourne, Victoria, Australia
| | - Konrad Joseph
- Department of Surgery, Port Macquarie Base Hospital, New South Wales, Australia
| | - Dylan Gracias
- Department of Surgery, Townsville Hospital, Queensland, Australia
| | - Yi Xie
- Department of Plastic Surgery, Peninsula Health, Melbourne, Victoria, Australia
| | - Richard J. Ross
- Department of Plastic Surgery, Peninsula Health, Melbourne, Victoria, Australia
- Central Clinical School at Monash University, The Alfred Centre, Melbourne, Victoria, Australia
| | - Warren M. Rozen
- Department of Plastic Surgery, Peninsula Health, Melbourne, Victoria, Australia
- Central Clinical School at Monash University, The Alfred Centre, Melbourne, Victoria, Australia
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Seth A, Slama EM. Delayed Diagnosis of Inflammatory Breast Cancer Presenting as Acute Mastitis in a Patient One Month Postpartum. Am Surg 2024:31348241241736. [PMID: 38523415 DOI: 10.1177/00031348241241736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Abstract
Inflammatory breast cancer (IBC) is a rare yet aggressive form of invasive ductal carcinoma, with a poor prognosis and decreased 5-year survival rates. Characteristic findings for IBC include rapid onset of breast edema, peau d'orange appearance, and involvement of the breast skin. Additionally, diagnosis is confirmed with a skin punch biopsy. With such nonspecific features, IBC can be mistaken for benign etiologies, causing delays in diagnosis and treatment. This patient is a 44-year-old woman presenting with left breast swelling while concurrently breastfeeding. Following antibiotic treatment but no symptom resolution, the patient was referred out for further follow-up. Despite multiple imaging studies, suggesting benign findings, clinical suspicion prompted continued evaluation and finally diagnosis of triple-negative inflammatory breast cancer with distant metastases. Further awareness of the presentation of IBC and its mimicking of other disease processes such as mastitis is paramount to earlier detection and improved outcomes in future patients.
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Affiliation(s)
- Ananya Seth
- Edward Via College of Osteopathic Medicine, Blacksburg, VA, USA
| | - Eliza M Slama
- Department of Surgery, Sentara Northern Virginia Medical Center, Woodbridge, VA, USA
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Cui RBJ, Hawes S, Azimi F, Chan B, Graham S, Mak C, Seah JL, Warrier S. Avoiding unnecessary sentinel lymph node biopsy with the use of superparamagnetic iron oxide mapping agents (Magtrace®) in breast surgery. ANZ J Surg 2024. [PMID: 38456358 DOI: 10.1111/ans.18936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 01/26/2024] [Revised: 02/24/2024] [Accepted: 02/27/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND Superparamagnetic iron oxide (SPIO) (Magtrace®) is a non-radioactive liquid tracer that can stay in the sentinel lymph nodes for 30 days. Injection of SPIO at time of primary breast surgery where upfront sentinel lymph node biopsy (SLNB) is not immediately indicated allows for a return to theatre if pathology then identifies invasive disease. SLNB is associated with paraesthesia, pain, seroma formation and lymphoedema risk. Hence, our study aims to assess the use of SPIO to avoid upfront SLNB in breast surgery for ductal carcinoma in situ (DCIS) and prophylaxis. METHODS Retrospective single-centre study of consecutive patients who underwent injection of SPIO tracer at time of primary breast surgery to avoid upfront SLNB at Chris O'Brien Lifehouse, Sydney, NSW, Australia over a 10-month period. RESULTS SPIO was injected 38 times, with 34 at time of mastectomy and four cases at time of wide local excision. The indication for surgery was DCIS in 18 cases, risk reduction in 17 cases and other indications in three patients. Six cases (15.8%) required delayed SLNB (D-SLNB) due to the finding of invasive disease on post-operative histopathology. All patients who underwent D-SLNB had nodes successfully localized with SPIO. CONCLUSION In our cohort, 84.2% of cases were able to avoid upfront SLNB, and hence avoid the associated complications of SLNB. SPIO injection was successful in localizing the SLN in all cases at time of surgery for D-SLNB. This technique was safe with few associated complications.
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Affiliation(s)
- Rebecca Bei Jia Cui
- Department of Breast Surgery, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
| | - Susan Hawes
- Department of Breast Surgery, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
| | - Farhad Azimi
- Department of Breast Surgery, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
| | - Belinda Chan
- Department of Breast Surgery, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
| | - Susannah Graham
- Department of Breast Surgery, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
| | - Cindy Mak
- Department of Breast Surgery, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
| | - Jue Li Seah
- Department of Breast Surgery, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
| | - Sanjay Warrier
- Department of Breast Surgery, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
- Department of Surgery, The University of Sydney, Camperdown, New South Wales, Australia
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8
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Di Lena É, Barone N, Hopkins B, Do U, Kaneva P, Fiore JF, Meterissian S. Opioid prescribing practices in breast oncologic surgery-A retrospective cohort study. World J Surg 2024; 48:642-649. [PMID: 38312060 DOI: 10.1002/wjs.12079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 01/01/2024] [Indexed: 02/06/2024]
Abstract
BACKGROUND In breast oncologic surgery, 75% of patients receive a postoperative opioid prescription at discharge, and 10%-20% will develop persistent opioid use. To inform future institutional guidelines, the objective of this study was to determine baseline opioid prescribing patterns in a single high-volume, referral-based breast center. We hypothesized that opioid prescribing practices varied between procedures and operating surgeons. METHODS A retrospective analysis of all women undergoing breast cancer surgery between January and December 2019. Opioid prescriptions at discharge were converted to morphine milligram equivalents (MME). The primary outcome of interest was MME prescribed at discharge. Multiple linear regression was used to identify factors independently associated with MME prescribed. RESULTS 392 patients met inclusion criteria; 68.3% underwent partial mastectomy. Median age was 61 (interquartile range [IQR] 51-70). Median MME prescribed at discharge was 112.5 (IQR 75-150); 83.9% of patients were prescribed co-analgesia. The prescriber was a trainee in 37.7% of cases. 15 patients (3.8%) required opioid renewal. On multivariate analysis, axillary procedure was associated with increased MME (ß = 17, 95% CI 5.5-28 and ß = 32, 95% CI 17-47, for sentinel node and axillary dissection, respectively). However, the factor with the greatest impact on MME was operating surgeon (ß = 72, 95% CI 58-87). Residents prescribed less MME compared to attending surgeons (ß = 11, 95% CI -22; -0.06). CONCLUSION In a tertiary care center, the operating surgeon had the greatest influence on opioid prescribing practices, and trainees tended to prescribe less MME. These findings support the need for a standardized approach to optimize prescribing and reduce opioid-related harms after oncologic breast surgery.
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Affiliation(s)
- Élise Di Lena
- Division of General Surgery, Department of Surgery, McGill University, Montreal, Quebec, Canada
- Division of Experimental Surgery, Department of Surgery, McGill University, Montreal, Quebec, Canada
| | - Natasha Barone
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
| | - Brent Hopkins
- Division of General Surgery, Department of Surgery, McGill University, Montreal, Quebec, Canada
| | - Uyen Do
- Centre de recherche de l'Université de Montréal, Montreal, Quebec, Canada
| | - Pepa Kaneva
- The Steinberg-Bernstein Center for Minimally Invasive Surgery, McGill University, Montreal, Quebec, Canada
| | - Julio F Fiore
- Division of General Surgery, Department of Surgery, McGill University, Montreal, Quebec, Canada
- Division of Experimental Surgery, Department of Surgery, McGill University, Montreal, Quebec, Canada
- The Steinberg-Bernstein Center for Minimally Invasive Surgery, McGill University, Montreal, Quebec, Canada
| | - Sarkis Meterissian
- Division of General Surgery, Department of Surgery, McGill University, Montreal, Quebec, Canada
- Breast Center, McGill University Health Center, Montreal, Quebec, Canada
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9
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Jimenez Muñoz Ledo G, Ortiz H, Padilla AM. Anatomic Areas of Lipoframing in Breast Surgery. Cureus 2024; 16:e57216. [PMID: 38681369 PMCID: PMC11056279 DOI: 10.7759/cureus.57216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2024] [Indexed: 05/01/2024] Open
Abstract
Breast lipoframing is a concept in breast surgery that encompasses the often-overlooked aspects of the mammary glands, such as the surrounding structures and adipose tissue within the thorax. By acknowledging the interplay between these components and recognizing the need for their simultaneous treatment, breast lipoframing aims to optimize surgical aesthetic outcomes. This article proposes a comprehensive definition of the surrounding mammary fat tissue by delineating the specific areas of the breast involved in the lipoframing technique. It presents a retrospective analysis of 554 female patients, revealing only one case of seroma and three cases of hematoma. Furthermore, we explore the application of liposuction as a means to effectively treat these areas and achieve superior results.
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Affiliation(s)
| | - Hector Ortiz
- Plastic and Reconstructive Surgery, Phi Aesthetics, Leon, MEX
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10
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Narayanan A, Cavadino A, Fisher JP, Khashram M. The effect of music on the operating surgeon: a pilot randomized crossover trial (the MOSART study). ANZ J Surg 2024; 94:299-308. [PMID: 38263368 DOI: 10.1111/ans.18877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 01/10/2024] [Accepted: 01/11/2024] [Indexed: 01/25/2024]
Abstract
OBJECTIVE The experience of stress is common among surgeons while working in the operating theatre (OT). Understanding and finding ways to mitigate this stress is important for optimizing surgical quality and maintaining clinician wellbeing. In this pilot study, we tested the feasibility and reported the outcomes of measuring the effect of background music on intra-operative surgeon stress in the clinical environment. METHODS The effect of Music on the Operating Surgeon: A pilot Randomized crossover Trial (the MOSART study) was conducted over a 9-month period in a single-centre. Vascular and general surgeons acting as primary operators (POs) performing elective, general anaesthetic operations were included. The intervention was surgeon-selected music, and the control was the absence of music. Outcome measures were feasibility (recruitment rate, practicability, and completeness of data), heart rate variability (HRV) indices, the Six-Item State-Trait Anxiety Inventory (STAI-6), and the Surgical Task-load Index (SURG-TLX). RESULTS Five POs performed 74 eligible randomized cases. The protocol was well tolerated, and no cases were abandoned. Data was incomplete in 8% of cases. The overall mean (SD) operative SURG-TLX score was 48 (±22). Mean HR increased and RMSSD decreased significantly from baseline, suggesting reduced parasympathetic activity while operating. The presence of intra-operative music was not found to affect the psychological or physiological outcomes. CONCLUSIONS A music interventional study of this nature is feasible in the operating theatre environment, though no difference was found between in the music and non-music conditions. Follow-up research in a simulated environment with intensive physiological monitoring could be considered.
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Affiliation(s)
- Anantha Narayanan
- Department of Surgery, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
- Department of Vascular Surgery and Endovascular Surgery, Waikato Hospital, Hamilton, New Zealand
- Department of Physiology, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
- Department of Surgery, Wellington Hospital, Wellington, New Zealand
| | - Alana Cavadino
- Department of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
| | - James P Fisher
- Department of Physiology, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Manar Khashram
- Department of Surgery, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
- Department of Vascular Surgery and Endovascular Surgery, Waikato Hospital, Hamilton, New Zealand
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Schwieger L, Postlewait LM, Subhedar PD, Geng F, Liu Y, Gillespie T, Arciero CA. Patterns of completion axillary dissection for patients with cT1-2N0 breast cancer undergoing total mastectomy with positive sentinel lymph nodes. J Surg Oncol 2024; 129:468-480. [PMID: 37955191 DOI: 10.1002/jso.27503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 10/21/2023] [Accepted: 10/21/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND AND OBJECTIVES The ACOSOGZ0011 trial found that overall survival (OS) for patients with 1-2 positive nodes undergoing sentinel lymph node biopsy-alone (SLNB) was noninferior to completion axillary lymph node dissection (ALND), but excluded patients undergoing mastectomy. Our study examined patterns of ALND and its relationship with OS for SLNB-positive patients undergoing mastectomy. METHODS The National Cancer Database was queried (2010-2017) for patients with cT1-2N0 breast cancer undergoing mastectomy with positive sentinel lymph nodes. Clinical data were compared. RESULTS Of 20 001 patients, 11 574 (57.9%) underwent SLNB + ALND, and 8427 (42.1%) had SLNB-alone. The SLNB + ALND group had more positive nodes (mean 2.6 vs. 1.3, p < 0.001) and more frequently received nodal radiation (33.4% vs. 28.9%, p < 0.001). Patients diagnosed in later years were less likely to undergo ALND (2010: reference; 2017: odds ratio: 0.29, 95% confidence interval [CI]: 0.25-0.33, p < 0.001). ALND (hazard ratio [HR]: 0.97, 95% CI: 0.89-1.06, p = 0.49) and nodal radiation (HR: 0.92, 95% CI: 0.83-1.02, p = 1.06) were not independently associated with OS. Propensity-score matched 5-year OS was similar (SLNB + ALND: 90.9% vs. SLNB-alone: 90.3%, p = 0.65). CONCLUSION For patients undergoing mastectomy for cT1-2N0 breast cancer with positive SLNB, SLNB-alone was common and increased over time. Axillary radiation was not routinely delivered in the SLNB-alone group. Completion ALND and nodal radiation were not associated with improved survival.
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Affiliation(s)
- Lara Schwieger
- Division of Surgical Oncology, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Lauren M Postlewait
- Division of Surgical Oncology, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
- Glenn Family Breast Center, Emory University, Atlanta, Georgia, USA
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Preeti D Subhedar
- Division of Surgical Oncology, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
- Glenn Family Breast Center, Emory University, Atlanta, Georgia, USA
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Feifei Geng
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Yuan Liu
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Theresa Gillespie
- Division of Surgical Oncology, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Cletus A Arciero
- Division of Surgical Oncology, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
- Glenn Family Breast Center, Emory University, Atlanta, Georgia, USA
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
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12
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Alalawi Y, Alamrani SAS, Alruwaili OM, Alzahrani IF, Al Madshush AM. The Relationship Between Breast Density and Breast Cancer Surgical Outcomes: A Systematic Review. Cureus 2024; 16:e57265. [PMID: 38686256 PMCID: PMC11057672 DOI: 10.7759/cureus.57265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2024] [Indexed: 05/02/2024] Open
Abstract
This study aims to investigate the relationship between mammographic breast density and the surgical outcomes of breast cancer. PubMed, SCOPUS, Web of Science, Science Direct, and the Wiley Library were systematically searched for relevant literature. Rayyan QRCI was employed throughout this comprehensive process. Our results included ten studies with a total of 5017 women diagnosed with breast cancer. The follow-up duration ranged from 1 year to 15.1 years. Eight out of the twelve included studies reported that low mammographic breast density was significantly associated with no local recurrence, metachronous contralateral breast cancer, and fewer challenges in the preoperative and intraoperative phases. On the other hand, four studies reported that mammographic breast density is not linked to disease recurrence, survival, re-excision, or an incomplete clinical and pathological response. There is a significant association between low mammographic breast density and reduced challenges in the preoperative and intraoperative phases, as well as no local recurrence and fewer mastectomy cases. However, the link between mammographic breast density and disease recurrence, survival, re-excision, and incomplete clinical and pathological response is less clear, with some studies reporting no significant association. The findings suggest that mammographic breast density may play a role in certain aspects of breast cancer outcomes, but further research is needed to fully understand its impact.
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Affiliation(s)
- Yousef Alalawi
- Department of Surgery, King Salman Armed Forces Hospital in the North-Western Region, Tabuk, SAU
| | | | - Omar M Alruwaili
- Department of Surgery, King Salman Armed Forces Hospital in the North-Western Region, Tabuk, SAU
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13
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Alsaadi D, Low L, Ting J, Craughwell M, McDonnell J, Lowery A, Sweeney K. Pre-emptive paracetamol reduces intra-operative opioid use in patients undergoing day-case oncologic breast surgery. EXCLI J 2024; 23:356-363. [PMID: 38655093 PMCID: PMC11036063 DOI: 10.17179/excli2023-6804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 02/26/2024] [Indexed: 04/26/2024]
Abstract
Minimization of intra-operative opioid use is an area of ongoing research interest with several potential benefits to the patient. Pre-emptive analgesia, defined as the administration of an analgesic before surgery to prevent establishment of central sensitization of pain, is one avenue that has been explored to achieve this. A retrospective observational study was undertaken to examine the effect of pre-emptive paracetamol on intra-operative opioid requirements. The medical and operative data of 156 patients who underwent day-case wide local excision and sentinel lymph node biopsy with and without regional block surgery at our center between October 2019 and May 2022 was carried out. Data were collected on demographics, total intra-operative and immediate post-operative opioid consumption. 57 patients did not receive pre-emptive paracetamol while 90 did. Baseline characteristics were similar. Our results showed a statistically significant reduction in morphine (p <0.029) and remifentanil (p <0.007) consumption in patients who received a regional block and pre-emptive paracetamol. Those who did not receive a regional block and were given pre-emptive paracetamol had a decrease in OxyNorm (p <0.022) requirements. A combination of general anesthesia (GA), regional block and pre-emptive paracetamol reduced intra-operative consumption of Fentanyl, OxyNorm, diclofenac, dexketoprofen, and clonidine (P <0.001) when compared to just GA alone. Use of pre-emptive paracetamol in reduction of intra-operative opioid requirements showed promising results but larger studies may strengthen the evidence for this association. A multimodal analgesic approach that utilizes pre-emptive paracetamol can be a viable method to decrease intra-operative of analgesic requirements.
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Affiliation(s)
- Daniah Alsaadi
- Breast and Endocrinology Surgical Department, University Hospital Galway, Galway, Ireland
| | - Lyndon Low
- Breast and Endocrinology Surgical Department, University Hospital Galway, Galway, Ireland
| | - James Ting
- Breast and Endocrinology Surgical Department, University Hospital Galway, Galway, Ireland
| | - Michael Craughwell
- Breast and Endocrinology Surgical Department, University Hospital Galway, Galway, Ireland
| | - John McDonnell
- Breast and Endocrinology Surgical Department, University Hospital Galway, Galway, Ireland
| | - Aoife Lowery
- Breast and Endocrinology Surgical Department, University Hospital Galway, Galway, Ireland
| | - Karl Sweeney
- Breast and Endocrinology Surgical Department, University Hospital Galway, Galway, Ireland
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14
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Miodownik D, Bierman D, Thornton C, Moo T, Feigin K, Damato A, Le T, Williamson M, Prasad K, Chu B, Dauer L, Saphier N, Zanzonico P, Morrow M, Bellamy M. Radioactive seed localization is a safe and effective tool for breast cancer surgery: an evaluation of over 25,000 cases. J Radiol Prot 2024; 44:011511. [PMID: 38295404 DOI: 10.1088/1361-6498/ad246a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 01/31/2024] [Indexed: 02/02/2024]
Abstract
Radioactive seed localization (RSL) provides a precise and efficient method for removing non-palpable breast lesions. It has proven to be a valuable addition to breast surgery, improving perioperative logistics and patient satisfaction. This retrospective review examines the lessons learned from a high-volume cancer center's RSL program after 10 years of practice and over 25 000 cases. We provide an updated model for assessing the patient's radiation dose from RSL seed implantation and demonstrate the safety of RSL to staff members. Additionally, we emphasize the importance of various aspects of presurgical evaluation, surgical techniques, post-surgical management, and regulatory compliance for a successful RSL program. Notably, the program has reduced radiation exposure for patients and medical staff.
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Affiliation(s)
- D Miodownik
- Memorial Sloan Kettering Cancer Center, New York, NY, United States of America
| | - D Bierman
- Memorial Sloan Kettering Cancer Center, New York, NY, United States of America
| | - C Thornton
- Memorial Sloan Kettering Cancer Center, New York, NY, United States of America
| | - T Moo
- Memorial Sloan Kettering Cancer Center, New York, NY, United States of America
| | - K Feigin
- Memorial Sloan Kettering Cancer Center, New York, NY, United States of America
| | - A Damato
- Memorial Sloan Kettering Cancer Center, New York, NY, United States of America
| | - T Le
- Memorial Sloan Kettering Cancer Center, New York, NY, United States of America
| | - M Williamson
- Memorial Sloan Kettering Cancer Center, New York, NY, United States of America
| | - K Prasad
- Memorial Sloan Kettering Cancer Center, New York, NY, United States of America
| | - B Chu
- Memorial Sloan Kettering Cancer Center, New York, NY, United States of America
| | - L Dauer
- Memorial Sloan Kettering Cancer Center, New York, NY, United States of America
| | - N Saphier
- Memorial Sloan Kettering Cancer Center, New York, NY, United States of America
| | - P Zanzonico
- Memorial Sloan Kettering Cancer Center, New York, NY, United States of America
| | - M Morrow
- Memorial Sloan Kettering Cancer Center, New York, NY, United States of America
| | - M Bellamy
- Memorial Sloan Kettering Cancer Center, New York, NY, United States of America
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15
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Fagbemi OO, Ojo C, Khan MA, Marla S, Narayanan S, Jafferbhoy S, Soumian S. Efficiency Assessment of Breast Clinics for Patients Under 35: A Comparative Analysis of Targeted Models in a University Hospital. Cureus 2024; 16:e54428. [PMID: 38510890 PMCID: PMC10951552 DOI: 10.7759/cureus.54428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2024] [Indexed: 03/22/2024] Open
Abstract
Despite the higher incidence of breast cancer in older age groups, it remains pertinent not to overlook breast cancer occurrence in those aged 35 years and below. Recent transitions toward targeted under-35 clinics in England aim to enhance efficiency and meet referral standards. Three models were planned, and we assessed the efficiency of each model. This study, conducted for five months within a single National Health Service (NHS) trust, analyzed data from the following clinics: the General One-Stop Clinic, the Under 35 One-Stop Clinic with ultrasound services (USS), and the Under 35 Clinic without USS services. Of the 300 patients recruited (100 consecutive patients from each clinic), 94.3% were female. The average age at presentation was 27.53 years. The most frequently encountered age group was between 26 and 30 years, and the majority of patients had palpable lumps (78, 51.6%). Out of 300 patients who attended the clinics, 151 had USS, and of these, 15 biopsies were performed. Fibroadenomas (32, 21.2%) and cysts (22, 14.6%) were the most common radiological findings. We found that more breast imaging was being undertaken for under-35 patients who attended the general one-stop clinics compared to the specific under-35 clinics. Targeted breast clinics for individuals 35 years and below offer an effective approach in terms of resource allocation and meeting cancer targets.
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Affiliation(s)
- Ona O Fagbemi
- Department of General Surgery, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, GBR
| | - Charles Ojo
- Department of Emergency Medicine, United Lincolnshire Hospitals NHS Trust, Boston, GBR
| | - Maryam A Khan
- Department of Breast Surgery, East Cheshire NHS Trust, Macclesfield, GBR
| | - Sekhar Marla
- Department of Breast Surgery, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, GBR
| | - Sankaran Narayanan
- Department of Breast Surgery, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, GBR
| | - Sadaf Jafferbhoy
- Department of Breast Surgery, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, GBR
| | - Soni Soumian
- Department of Breast Surgery, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, GBR
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16
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Tukenmez M, Mollavelioglu B, Kozanoglu E, Emiroglu S, Cabioglu N, Muslumanoglu M. A Novel Surgical Technique for Gynecomastia: Air-Assisted Minimally Invasive Surgery With Single Axillary Incision. Surg Innov 2024; 31:5-10. [PMID: 37995296 PMCID: PMC10773160 DOI: 10.1177/15533506231217621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2023]
Abstract
BACKGROUND Gynecomastia is a benign condition that develops due to the proliferation of breast tissue in men. Surgical excision is the most effective treatment method. Minimally invasive techniques can be used to avoid visible scarring. We evaluated the efficacy and safety of air-assisted subcutaneous mastectomy in the treatment of gynecomastia. PATIENT AND METHODS 10 patients with gynecomastia underwent air-assisted subcutaneous mastectomy and liposuction through a single axillary incision, between June 2022 and February 2023. Demographic and clinical data of the patients, duration of surgery, and complications were recorded. The satisfaction levels of the patients regarding physical appearance, mental status, and social environment were measured. The body Q questionnaire was performed preoperatively and in the postoperative third month. RESULTS The median age was 26 (range, 18-54). Surgical excision was measured as a median of 69 gr (range, 41-177), and liposuction volume was measured as a median of 210 ccs (range, 63-400). The median operation time was 50 minutes (range, 21-60) for excision and 21 minutes (range, 20-75) for liposuction. Body, chest, and nipples related appearance satisfaction levels were measured preoperatively as a median of 44 (range, 36.5-52), 31 (range, 27.5-39), and 51.5 (range, 21-69.8) points vs postoperatively as 92 (range, 92-100), 93 (range, 93-94.8) and 90 (range, 90-100) points, respectively. The patients had a median follow-up of 6 months (range, 3-11). No complications were observed during the follow-up period. CONCLUSION Air-assisted subcutaneous mastectomy and liposuction is a feasible technique that may provide good cosmetic outcomes by avoiding anterior chest wall scarring.
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Affiliation(s)
- Mustafa Tukenmez
- Departments of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Baran Mollavelioglu
- Departments of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Erol Kozanoglu
- Plastic and Reconstructive Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Selman Emiroglu
- Departments of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Neslihan Cabioglu
- Departments of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Mahmut Muslumanoglu
- Departments of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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17
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Tang P, Ng SL. Delayed complications from polyacrylamide gel breast fillers: a case report. J Surg Case Rep 2024; 2024:rjae095. [PMID: 38404447 PMCID: PMC10884734 DOI: 10.1093/jscr/rjae095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 02/04/2024] [Indexed: 02/27/2024] Open
Abstract
In the late nineties, polyacrylamide gel (PAAG) gained popularity in China as a soft tissue filler for breast augmentation and contouring, but was banned 10 years later due to the increasing incidence of complications. We report a case of PAAG complication that occurred 20 years after the initial injection, where the patient had significant unilateral breast swelling and an intracapsular lesion. Surgical removal of the breast filler and immediate breast reconstruction was successfully performed, and histology confirmed a benign breast lesion. These findings highlight the importance of clinical awareness of PAAG breast filler complications.
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Affiliation(s)
- Patrick Tang
- Department of Surgery, Austin Health, 145 Studley Road, Heidelberg, 3084, Victoria, Australia
| | - Suat L Ng
- Department of Surgery, Austin Health, 145 Studley Road, Heidelberg, 3084, Victoria, Australia
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18
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Knoedler S, Kauke-Navarro M, Knoedler L, Friedrich S, Matar DY, Diatta F, Mookerjee VG, Ayyala H, Wu M, Kim BS, Machens HG, Pomahac B, Orgill DP, Broer PN, Panayi AC. Racial disparities in surgical outcomes after mastectomy in 223 000 female breast cancer patients: a retrospective cohort study. Int J Surg 2024; 110:684-699. [PMID: 38052017 PMCID: PMC10871660 DOI: 10.1097/js9.0000000000000909] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 11/02/2023] [Indexed: 12/07/2023]
Abstract
BACKGROUND Breast cancer mortality and treatment differ across racial groups. It remains unclear whether such disparities are also reflected in perioperative outcomes of breast cancer patients undergoing mastectomy. STUDY DESIGN The authors reviewed the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database (2008-2021) to identify female patients who underwent mastectomy for oncological purposes. The outcomes were stratified by five racial groups (white, Black/African American, Asian, American Indian/Alaska Native, and Native Hawaiian/Pacific Islander) and included 30-day mortality, reoperation, readmission, surgical and medical complications, and non-home discharge. RESULTS The study population included 222 947 patients, 68% ( n =151 522) of whom were white, 11% ( n =23 987) Black/African American, 5% ( n =11 217) Asian, 0.5% ( n =1198) American Indian/Alaska Native, and 0.5% ( n =1018) Native Hawaiian/Pacific Islander. While 136 690 (61%) patients underwent partial mastectomy, 54 490 (24%) and 31 767 (14%) women received simple and radical mastectomy, respectively. Overall, adverse events occurred in 17 222 (7.7%) patients, the largest portion of which were surgical complications ( n =7246; 3.3%). Multivariable analysis revealed that being of Asian race was protective against perioperative complications [odds ratio (OR)=0.71; P <0.001], whereas American Indian/Alaska Native women were most vulnerable to the complication occurrence (OR=1.41; P <0.001). Black/African American patients had a significantly lower risk of medical (OR=0.59; P <0.001) and surgical complications (OR=0.60; P <0.001) after partial and radical mastectomy, respectively, their likelihood of readmission (OR=1.14; P =0.045) following partial mastectomy was significantly increased. CONCLUSION The authors identified American Indian/Alaska Native women as particularly vulnerable to complications following mastectomy. Asian patients experienced the lowest rate of complications in the perioperative period. The authors' analyses revealed comparable confounder-adjusted outcomes following partial and complete mastectomy between Black and white races. Their findings call for care equalization in the field of breast cancer surgery.
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Affiliation(s)
- Samuel Knoedler
- Department of Plastic Surgery and Hand Surgery, Klinikum Rechts der Isar, Technical University of Munich, Germany
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Martin Kauke-Navarro
- Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Leonard Knoedler
- Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
- Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Sarah Friedrich
- Department of Mathematical Statistics and Artificial Intelligence in Medicine, University of Augsburg, Augsburg, Germany
| | - Dany Y. Matar
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Fortunay Diatta
- Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Vikram G. Mookerjee
- Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Haripriya Ayyala
- Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Mengfan Wu
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Plastic Surgery, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Bong-Sung Kim
- Department of Plastic Surgery and Hand Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Hans-Guenther Machens
- Department of Plastic Surgery and Hand Surgery, Klinikum Rechts der Isar, Technical University of Munich, Germany
| | - Bohdan Pomahac
- Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Dennis P. Orgill
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - P. Niclas Broer
- Department of Plastic, Reconstructive, Hand and Burn Surgery, Bogenhausen Academic Teaching Hospital Munich, Munich, Germany
| | - Adriana C. Panayi
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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19
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Butala S, Forestier C, Nithiananthan S, Defran AJ, Kuwajerwala NK. Paget's Presentation of High-Grade Ductal Carcinoma In Situ (DCIS) in a Very Young Female With Breast Cancer 2 (BRCA2) Mutation. Cureus 2024; 16:e54678. [PMID: 38524061 PMCID: PMC10960524 DOI: 10.7759/cureus.54678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2024] [Indexed: 03/26/2024] Open
Abstract
This is a case of a previously healthy 29-year-old female with erythema and skin excoriations of the left breast nipple-areolar complex (NAC). After a repeat trial and failure of topical hydrocortisone, a diagnostic mammogram and nipple biopsy revealed Paget's disease (PD) of the nipple with ductal carcinoma in situ (DCIS). A subsequent genetic analysis found a breast cancer 2 (BRCA2) gene mutation. Treatment consisted of a left breast skin-sparing simple mastectomy with sentinel lymph node (SLN) biopsy and immediate tissue expander placement for implant reconstruction. Further management involved right breast short-interval surveillance with annual mammography and magnetic resonance imaging (MRI) with the possibility of prophylactic surgery along with oophorectomy after childbearing.
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Affiliation(s)
- Sneha Butala
- Pediatrics, Rainbow Babies & Children's Hospital, Cleveland, USA
| | - Chancée Forestier
- Medicine, American University of the Caribbean School of Medicine, Cupecoy, SXM
- Obstetrics and Gynecology, Ascension Providence Hospital, Southfield, USA
| | | | - Asilis J Defran
- General Surgery, Ascension Providence Hospital, Southfield, USA
| | - Nafisa K Kuwajerwala
- Breast Surgery, Ascension Providence Hospital, Southfield, USA
- Breast Surgery, Ascension Rochester Hills, Rochester Hills, USA
- Breast Surgery, Corewell Health, Troy, USA
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20
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Tanna N, Barnett S, Aiello C, Boehm LM, Calobrace MB. Redefining the Axillary Aesthetic: Surgical Management of Axillary Tissue Hypertrophy. Medicina (Kaunas) 2024; 60:126. [PMID: 38256387 PMCID: PMC10821127 DOI: 10.3390/medicina60010126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 12/28/2023] [Accepted: 01/09/2024] [Indexed: 01/24/2024]
Abstract
Background and Objectives: Axillary tissue hypertrophy consists of ectopic breast tissue and occurs in up to six percent of women. Women complain of pain, interference with activity, and dissatisfaction with appearance. While it is recommended that accessory breast tissue be removed via surgical excision, there is lack of consensus on the best technique for the surgical management of axillary tissue hypertrophy. In this study, the senior authors (BC and NT) review outcomes and complications as they pertain to the surgical treatment of axillary tissue hypertrophy and axillary contouring. Materials and Methods: A retrospective review of all patients (n = 35), from two separate institutions, who presented with axillary tissue hypertrophy between December 2019 and August 2021 was conducted. All patients underwent a technique that included direct crescentic dermato-lipectomy and glandular excision with axillary crease obliteration. Tissue was sent for histological analysis after removal. During a six-month follow-up period, all patient outcomes were recorded. Results: The authors treated 35 women with axillary tissue hypertrophy. All patients complained of aesthetic deformity with significant discomfort leading to the desire for surgery. Histologically, all specimens contained benign breast and adipose tissue. Hypertrophic scarring, seroma, and axillary cording were noted complications. Conclusions: Detailed is the surgical management and optimal technique that can be used to treat both adipose and fibroglandular axillary tissue hypertrophy while simultaneously providing a favorable axillary aesthetic.
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Affiliation(s)
- Neil Tanna
- Division of Plastic and Reconstructive Surgery, Northwell Health, Great Neck, NY 11021, USA; (S.B.); (C.A.)
- Donald & Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY 11549, USA
| | - Sarah Barnett
- Division of Plastic and Reconstructive Surgery, Northwell Health, Great Neck, NY 11021, USA; (S.B.); (C.A.)
- Donald & Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY 11549, USA
| | - Christopher Aiello
- Division of Plastic and Reconstructive Surgery, Northwell Health, Great Neck, NY 11021, USA; (S.B.); (C.A.)
- Donald & Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY 11549, USA
| | - Lucas M. Boehm
- CaloAesthetic Plastic Surgery, Division of Plastic Surgery, University of Louisville, Louisville, KY 40222, USA; (L.M.B.); (M.B.C.)
| | - M. Bradley Calobrace
- CaloAesthetic Plastic Surgery, Division of Plastic Surgery, University of Louisville, Louisville, KY 40222, USA; (L.M.B.); (M.B.C.)
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21
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Villacampa G, Papakonstantinou A, Fredriksson I, Matikas A. Impact of Primary Breast Surgery on Overall Survival of Patients With De Novo Metastatic Breast Cancer: A Systematic Review and Meta-Analysis. Oncologist 2024; 29:1-7. [PMID: 37700450 PMCID: PMC10769792 DOI: 10.1093/oncolo/oyad266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 08/29/2023] [Indexed: 09/14/2023] Open
Abstract
BACKGROUND Breast surgery in cases of de novo metastatic breast cancer (MBC) is associated with improved outcomes in retrospective studies, although the results of randomized controlled trials (RCTs) are conflicting. We aimed to investigate whether surgery in this context prolongs patient survival. METHODS We performed a systematic review of the literature to identify RCTs comparing surgery of primary breast cancer to no surgery in patients with de novo MBC. Cochrane Library, Embase, Medline (OVID), and Web of Science were searched with latest update in July 2023, while conference proceedings were manually searched. Data concerning patient and tumor characteristics, as well as outcomes, were extracted. A meta-analysis with random effects models was performed considering heterogeneity between trials. RESULTS Overall, 3255 entries were identified and 5 RCTs fulfilled all inclusion criteria, which had enrolled 1381 patients. The overall estimation in the intention-to-treat population showed no benefit for patients who had surgical excision of the primary breast tumor (HR = 0.93; 95% CI, 0.76-1.14). No subgroups in terms of receptor status or patterns of metastasis seemed to benefit from surgery, except for younger/premenopausal patients (HR = 0.74, 95% CI, 0.58-0.94). Breast surgery was associated with improved local progression-free survival (HR = 0.37, 95% CI, 0.19-0.74). CONCLUSION Surgery of the primary tumor in patients with de novo MBC does not prolong survival, except possibly in younger/premenopausal patients. Breast surgery should be offered within the context of well-designed clinical trials examining the issue.
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Affiliation(s)
- Guillermo Villacampa
- SOLTI Breast Cancer Research Group, Spain
- The Institute of Cancer Research, London, UK
- Oncology Data Science, Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Andri Papakonstantinou
- Oncology/Pathology Department, Karolinska Institute, Stockholm, Sweden
- Breast Center, Karolinska University Hospital and Karolinska Comprehensive Cancer Center, Stockholm, Sweden
| | - Irma Fredriksson
- Breast Center, Karolinska University Hospital and Karolinska Comprehensive Cancer Center, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
| | - Alexios Matikas
- Oncology/Pathology Department, Karolinska Institute, Stockholm, Sweden
- Breast Center, Karolinska University Hospital and Karolinska Comprehensive Cancer Center, Stockholm, Sweden
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22
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Cui RBJ, Hawes S, Potter AJ, Merrick K, Warrier S, Azimi F. Dermatofibrosarcoma protuberans of the breast in pregnancy. J Surg Case Rep 2024; 2024:rjad738. [PMID: 38239379 PMCID: PMC10795911 DOI: 10.1093/jscr/rjad738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 11/12/2023] [Accepted: 12/26/2023] [Indexed: 01/22/2024] Open
Abstract
Dermatofibrosarcoma Protuberans (DFSP) is a rare, locally aggressive fibroblastic mesenchymal neoplasm, typically derived from the dermis, with the intramammary subtype being seen infrequently. We present a case of a 40-year-old woman whom was diagnosed with an intramammary DFSP during pregnancy, whom underwent successful surgical management during her second trimester. Our case demonstrates the importance of increased clinical awareness in the diagnosis and treatment of breast DFSP with careful multidisciplinary consideration.
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Affiliation(s)
- Rebecca B J Cui
- Department of Breast Surgery, Chris O’Brien Lifehouse, Sydney, NSW, Australia
| | - Susan Hawes
- Department of Breast Surgery, Chris O’Brien Lifehouse, Sydney, NSW, Australia
| | - Alison J Potter
- Department of Tissue Oncology and Diagnostic Pathology, Royal Prince Alfred Hospital & NSW Health Pathology, Camperdown, NSW, Australia
- Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
- Faculty of Medicine and Health, University of NSW, Kensington, NSW, Australia
| | - Kathleen Merrick
- Department of Pathology, Douglass Hanly Moir Pathology, Macquarie Park, NSW, Australia
| | - Sanjay Warrier
- Department of Breast Surgery, Chris O’Brien Lifehouse, Sydney, NSW, Australia
| | - Farhad Azimi
- Department of Breast Surgery, Chris O’Brien Lifehouse, Sydney, NSW, Australia
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Gürkan Y, Kalyoncu İ, Şimşek D, Manici M. Multiple Thoracic Wall Blocks for Awake Breast Surgery: A Case Report. Turk J Anaesthesiol Reanim 2023; 51:510-512. [PMID: 38149380 PMCID: PMC10758671 DOI: 10.4274/tjar.2023.231472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 11/10/2023] [Accepted: 11/22/2023] [Indexed: 12/28/2023] Open
Abstract
Awake breast surgeries under nerve blocks have been a challenge for anaesthesiologists, and different block combinations have been used for surgery under sedation. Thoracic paravertebral block (TPVB) was thought to be sufficient alone for surgical anaesthesia of the breast. We performed a combination of TPVB, pectoralis nerve I block, and serratus anterior plane block for awake breast surgery in an elderly patient with serious comorbidities. Surgical anaesthesia was achieved, excluding skin incision. Any regional anaesthesia technique alone is not sufficient; rather, multiple thoracic wall blocks are needed for surgical anaesthesia of the breast.
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Affiliation(s)
- Yavuz Gürkan
- Koç University Faculty of Medicine, Koç University Hospital, Department of Anaesthesiology and Reanimation, İstanbul, Turkey
| | - İlayda Kalyoncu
- Koç University Faculty of Medicine, Koç University Hospital, Department of Anaesthesiology and Reanimation, İstanbul, Turkey
| | - Doğa Şimşek
- Koç University Faculty of Medicine, Koç University Hospital, Department of Anaesthesiology and Reanimation, İstanbul, Turkey
| | - Mete Manici
- Koç University Faculty of Medicine, Koç University Hospital, Department of Anaesthesiology and Reanimation, İstanbul, Turkey
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Merchant SJ, Shellenberger JP, Sawhney M, La J, Brogly SB. Physician Characteristics Associated With Opioid Prescribing After Same-Day Breast Surgery in Ontario, Canada: A Population-Based Cohort Study. Ann Surg Open 2023; 4:e365. [PMID: 38144500 PMCID: PMC10735111 DOI: 10.1097/as9.0000000000000365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 09/27/2023] [Accepted: 10/28/2023] [Indexed: 12/26/2023] Open
Abstract
Background and Objectives Opioid overprescribing in patients undergoing breast surgery is a concern, as evidence suggests that minimal or no opioid is needed to manage pain. We sought to describe characteristics of opioid prescribers and determine associations between prescriber's characteristics and high opioid prescribing within 7 days of same-day breast surgery. Methods Patients ≥18 years of age who underwent same-day breast surgery in Ontario, Canada from 2012 to 2020 were identified and linked to prescriber data. The primary outcome was current high opioid prescribing defined as >75th percentile of the mean oral morphine equivalents (OME; milligrams). Prescriber characteristics including age, sex, specialty, years in practice, practice setting, and history of high (>75th percentile) opioid prescribing in the previous year were captured. Associations between prescriber characteristics and the primary outcome were estimated in modified Poisson regression models. Results The final cohort contained 56,434 patients, 3469 unique prescribers, and 58,656 prescriptions. Over half (1971/3469; 57%) of prescribers wrote ≥1 prescription that was >75th percentile of mean OME of 180 mg, of which 50% were family practice physicians. Adjusted mean OMEs prescribed varied by specialty with family practice specialties prescribing the highest mean OME (614 ± 38 mg) compared to surgical specialties (general surgery [165 ± 9 mg], plastic surgery [198 ± 10 mg], surgical oncology [154 ± 14 mg]). Whereas 73% of first and 31% of second prescriptions were provided by general surgery physicians, family practice physicians provided 2% of first and 51% of second prescriptions. Prescriber characteristics associated with a higher likelihood of high current opioid prescribing were family practice (risk ratio [RR], 1.56; 95% confidence interval [CI], 1.35-1.79 compared to general surgery), larger community practice setting (RR, 1.34; 95% CI, 1.05-1.71 compared to urban), and a previous high opioid prescribing behavior (RR, 2.28; 95% CI, 2.06-2.52). Conclusions While most studies examine surgeon opioid prescribing, our data suggest that other specialties contribute to opioid overprescribing in surgical patients and identify characteristics of physicians likely to overprescribe.
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Affiliation(s)
| | | | - Monakshi Sawhney
- Department of Anesthesiology and Perioperative Medicine, School of Nursing, Queen’s University, Kingston, Ontario, Canada
| | - Julie La
- From the Department of Surgery, Queen’s University
| | - Susan B. Brogly
- From the Department of Surgery, Queen’s University
- ICES Queen’s
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25
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Gopwani S, Bahrun E, Singh T, Popovsky D, Cramer J, Geng X. Efficacy of Electronic Reminders in Increasing the Enhanced Recovery After Surgery Protocol Use During Major Breast Surgery: Prospective Cohort Study. JMIR Perioper Med 2023; 6:e44139. [PMID: 37921854 PMCID: PMC10656665 DOI: 10.2196/44139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 11/07/2022] [Revised: 06/12/2023] [Accepted: 08/18/2023] [Indexed: 11/04/2023] Open
Abstract
BACKGROUND Enhanced recovery after surgery (ERAS) protocols are patient-centered, evidence-based guidelines for peri-, intra-, and postoperative management of surgical candidates that aim to decrease operative complications and facilitate recovery after surgery. Anesthesia providers can use these protocols to guide decision-making and standardize aspects of their anesthetic plan in the operating room. OBJECTIVE Research across multiple disciplines has demonstrated that clinical decision support systems have the potential to improve protocol adherence by reminding providers about departmental policies and protocols via notifications. There remains a gap in the literature about whether clinical decision support systems can improve patient outcomes by improving anesthesia providers' adherence to protocols. Our hypothesis is that the implementation of an electronic notification system to anesthesia providers the day prior to scheduled breast surgeries will increase the use of the already existing but underused ERAS protocols. METHODS This was a single-center prospective cohort study conducted between October 2017 and August 2018 at an urban academic medical center. After obtaining approval from the institutional review board, anesthesia providers assigned to major breast surgery cases were identified. Patient data were collected pre- and postimplementation of an electronic notification system that sent the anesthesia providers an email reminder of the ERAS breast protocol the night before scheduled surgeries. Each patient's record was then reviewed to assess the frequency of adherence to the various ERAS protocol elements. RESULTS Implementation of an electronic notification significantly improved overall protocol adherence and several preoperative markers of ERAS protocol adherence. Protocol adherence increased from 16% (n=14) to 44% (n=44; P<.001), preoperative administration of oral gabapentin (600 mg) increased from 13% (n=11) to 43% (n=43; P<.001), and oral celebrex (400 mg) use increased from 16% (n=14) to 35% (n=35; P=.006). There were no statistically significant differences in the use of scopolamine transdermal patch (P=.05), ketamine (P=.35), and oral acetaminophen (P=.31) between the groups. Secondary outcomes such as intraoperative and postoperative morphine equivalent administered, postanesthesia care unit length of stay, postoperative pain scores, and incidence of postoperative nausea and vomiting did not show statistical significance. CONCLUSIONS This study examines whether sending automated notifications to anesthesia providers increases the use of ERAS protocols in a single academic medical center. Our analysis exhibited statistically significant increases in overall protocol adherence but failed to show significant differences in secondary outcome measures. Despite the lack of a statistically significant difference in secondary postoperative outcomes, our analysis contributes to the limited literature on the relationship between using push notifications and clinical decision support in guiding perioperative decision-making. A variety of techniques can be implemented, including technological solutions such as automated notifications to providers, to improve awareness and adherence to ERAS protocols.
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Affiliation(s)
- Sumeet Gopwani
- Department of Anesthesiology, MedStar Georgetown University Hospital, Washington, DC, United States
| | - Ehab Bahrun
- Georgetown University School of Medicine, Washington, DC, United States
| | - Tanvee Singh
- Georgetown University School of Medicine, Washington, DC, United States
| | - Daniel Popovsky
- Georgetown University School of Medicine, Washington, DC, United States
| | - Joseph Cramer
- Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Xue Geng
- Department of Biostatistics, Bioinformatics & Biomathematics, Georgetown University, Washington, DC, United States
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Erol VB, Goktas Aydin S, Bilici A, Cakir A, Acikgoz O, Olmez OF, Basim P. Relationship between the change in tumour-infiltrating lymphocyte level and residual tumour after neoadjuvant chemotherapy in patients with locally advanced breast cancer. J Chemother 2023; 35:662-670. [PMID: 37599454 DOI: 10.1080/1120009x.2023.2247207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 07/01/2023] [Accepted: 07/20/2023] [Indexed: 08/22/2023]
Abstract
To evaluate the tumour-infiltrating lymphocyte (TIL) rates in breast tissue before and after neoadjuvant chemotherapy (NAC) and their impact on survival, eighty-four patients with locally advanced breast cancer (LABC) were assessed. Pre- and post-NAC TIL levels were determined using biopsy and surgical specimens, respectively. The median TIL rate was significantly different before (17.5%) and after (5%) NAC. Pre- and postoperative Ki-67 index, molecular subtype, pre- and post-NAC TIL concentration, and preoperative residual-cancer-burden TIL were significantly associated with pathological complete response (pCR). Specifically, higher pre-NAC TIL levels were associated with higher pCR rates. Postoperative Ki-67 index and pCR, and postoperative Ki-67 index were significant predictors of disease-free (DFS) and overall survival, respectively. The independent prognostic factors for DFS were postoperative Ki-67 score (hazard ratio [HR]: 6.16; p = 0.012), post-NAC TIL score (HR: 0.42; P = 0.041), and pCR (HR: 0.10; P = 0.038). Our study confirms that higher pre-NAC and lower postoperative TIL levels may be surrogate factors for longer DFS, and postoperative TIL rate may predict post-NAC pCR in patients with LABC.
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Affiliation(s)
- Vedat Bugra Erol
- Department of Medical Oncology, Medical Faculty, Istanbul Medipol University, Istanbul, Turkey
| | - Sabin Goktas Aydin
- Department of Medical Oncology, Medical Faculty, Istanbul Medipol University, Istanbul, Turkey
| | - Ahmet Bilici
- Department of Medical Oncology, Medical Faculty, Istanbul Medipol University, Istanbul, Turkey
| | - Asli Cakir
- Department of Pathology, Medical Faculty, Istanbul Medipol University, Istanbul, Turkey
| | - Ozgur Acikgoz
- Department of Medical Oncology, Medical Faculty, Istanbul Medipol University, Istanbul, Turkey
| | - Omer Fatih Olmez
- Department of Medical Oncology, Medical Faculty, Istanbul Medipol University, Istanbul, Turkey
| | - Pelin Basim
- Department of Surgery, Medical Faculty, Istanbul Medipol University, Istanbul, Turkey
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27
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Armstrong K, Maxwell J. Oncoplastic surgery for breast cancer: Global perspectives and trends. J Surg Oncol 2023; 128:967-971. [PMID: 37818917 DOI: 10.1002/jso.27408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 07/16/2023] [Indexed: 10/13/2023]
Abstract
Oncoplastic surgery (OPS) is a form of breast conservation that combines definitive oncologic resection with optimal aesthetic outcomes. Various definitions exist, with most focusing on volume displacement techniques to close the lumpectomy defect and redistribute the remaining breast volume over the preserved breast. Although its oncologic safety has been well demonstrated, uptake into practice varies globally. This article details the definition, safety, training opportunities, and practice patterns of OPS on a global scale.
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Affiliation(s)
- Kate Armstrong
- Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Jessica Maxwell
- Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska, USA
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28
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Rao A, Manley L, Smith S. Use of artificial intelligence to identify patients to be assessed in a breast clinic on 2-week wait: a retrospective cohort study. Ann Med Surg (Lond) 2023; 85:5459-5463. [PMID: 37915669 PMCID: PMC10617910 DOI: 10.1097/ms9.0000000000001293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 09/03/2023] [Indexed: 11/03/2023] Open
Abstract
Background The number of urgent referrals from primary care to specialist one stop breast clinics continues to rise beyond the capacity of the 2-week wait service. This study aims to use artificial intelligence (AI) to identify patients with new breast symptoms requiring a biopsy to identify those who should be prioritised for urgent breast clinic assessment. Methods Data were collected retrospectively for patients attending one stop triple assessment breast clinic at Broomfield hospital between 1 June and 1 October 2021. PHP machine learning software was used to run AI on the data to identify patients who had a core biopsy in clinic. Results A total of 794 cases were referred to one stop breast clinic for new breast symptoms-37 male (4.6%) and 757 female (95.3%). The average age of the patients included was 43.2 years. Five hundred thirty-six patients (67.5%) presented with a breast lump, 180 (22.7%) with breast pain, 61 (7.7%) with changes to shape or skin and 13 (1.6%) with a lump identified by their general practitioner. The patients who had a biopsy were of increased age [52.8 (SD 17.9) vs. 44.1 (SD 16.8), P<0.001], and had previous mammogram [n=21, (31.8%) vs. n=148 (20.3%), P 0.03], previous benign breast disease [n=9 (13.6%) vs. n=23 (3.1%), P<0.001], and increased use of HRT [n=13 (19.7%) vs. n=53 (6.4%), P<0.001]. The sensitivity and specificity of AI with neural network algorithms were 84% and 90%, respectively. Conclusion AI was very effective at predicting the presenting symptoms that are likely to result in biopsy and can therefore be used to identify patients who need to be seen urgently in breast clinic.
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Affiliation(s)
- Ahsan Rao
- Department of Public Health, Imperial College London, London
| | - Lara Manley
- Breast Unit, Broomfield Hospital, Chelmsford, Essex, UK
| | - Simon Smith
- Breast Unit, Broomfield Hospital, Chelmsford, Essex, UK
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29
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Ishiba T, Nishibuchi I, Hara F, Shikama N, Shien T, Iwata H. Metastasis-directed therapy for oligometastases in breast cancer. Jpn J Clin Oncol 2023; 53:893-898. [PMID: 37424379 DOI: 10.1093/jjco/hyad077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 06/22/2023] [Indexed: 07/11/2023] Open
Abstract
The concept of oligometastases was first proposed to describe a disease state between localized cancer and extensive metastasis. After the emergence of variations in the definition of oligometastasis, in April 2020 the European Society for Radiotherapy and Oncology and the European Organization for Research and Treatment of Cancer defined oligometastases as the presence of one to five metastatic lesions that can be safely treated. However, the pathogenesis of oligometastases remains unknown, and it is uncertain which patients will benefit from metastasis-directed therapy. Breast cancer with oligometastases is generally managed with systemic therapy. Retrospective studies have suggested that the addition of metastasis-directed therapy, such as surgery, radiofrequency ablation and stereotactic body radiation therapy, may increase overall survival in breast cancer patients with oligometastases, but as yet there have been no prospective studies. Phase II trials of stereotactic body radiation therapy or fractionated irradiation for oligometastases of breast cancer have demonstrated impressive rates of local control and overall survival. Although the efficacy of stereotactic body radiation therapy in the SABR-COMET was largely anticipated, it is noteworthy that only 18% of the patient population had breast cancer. For this reason, various trials were planned or are being conducted globally to investigate the efficacy of metastasis-directed therapy for oligometastases of breast cancer. Metastasis-directed therapy for oligometastases has been shown to be effective, and stereotactic body radiation therapy and other therapies are commonly used internationally and are considered to be safe. However, the efficacy of metastasis-directed therapy for oligometastases has not yet been proven. The results of future clinical trials are thus eagerly awaited.
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Affiliation(s)
- Toshiyuki Ishiba
- Department of Breast Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - Ikuno Nishibuchi
- Department of Radiation Oncology, Hiroshima University Graduate School of Biomedical & Health Sciences, Hiroshima, Japan
| | - Fumikata Hara
- Breast Oncology Center, The Cancer Institute Hospital of JFCR, Tokyo, Japan
| | - Naoto Shikama
- Department of Radiation Oncology, Juntendo University, Tokyo, Japan
| | - Tadahiko Shien
- Department of Breast and Endocrine Surgery, Okayama University Hospital, Okayama, Japan
| | - Hiroji Iwata
- Department of Breast Oncology, Aichi Cancer Center, Nagoya, Japan
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30
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Rhoul C, Kharkhach A, Aabdi H, Atmani A, Mhand M, Seghrouchni N, Amal B, Bouhout T, Serji B, El Harroudi T. Radiation-induced angiosarcoma of the breast: a case report. Ann Med Surg (Lond) 2023; 85:5047-5050. [PMID: 37811031 PMCID: PMC10553051 DOI: 10.1097/ms9.0000000000001141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 09/25/2022] [Accepted: 07/31/2023] [Indexed: 10/10/2023] Open
Abstract
Introduction Breast angiosarcoma is a rare, aggressive tumour affecting adult women. It can occur in two forms, primary form and secondary forms or radiation-induced breast angiosarcoma affecting patients with history of breast or chest radiotherapy. Case presentation The authors report a new case of breast angiosarcoma in 52-year-old women, with history of invasive ductal carcinoma, and reporting a discoloration of her breast skin. The patient did undergo a mastectomy of right breast and adjuvant chemotherapy. Conclusion/discussion Surgery with total excision associated or not to adjuvant chemotherapy remains the treatment of choice in breast angiosarcoma.
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Affiliation(s)
- Chafik Rhoul
- Faculty of Medicine and Pharmacy, Mohammed Ist university
- Department of Oncological Surgery, Regional oncology Center
| | - Ayoub Kharkhach
- Faculty of Medicine and Pharmacy, Mohammed Ist university
- Department of Oncological Surgery, Regional oncology Center
| | - Houssam Aabdi
- Faculty of Medicine and Pharmacy, Mohammed Ist university
- Department of Oncological Surgery, Regional oncology Center
| | - Abderrahman Atmani
- Faculty of Medicine and Pharmacy, Mohammed Ist university
- Department of Oncological Surgery, Regional oncology Center
| | - Mohammed Mhand
- Faculty of Medicine and Pharmacy, Mohammed Ist university
- Department of Oncological Surgery, Regional oncology Center
| | - Noura Seghrouchni
- Faculty of Medicine and Pharmacy, Mohammed Ist university
- Department of Pathology, Mohammed VI University Hospital Oujda Morocco
| | - Bennani Amal
- Faculty of Medicine and Pharmacy, Mohammed Ist university
- Department of Pathology, Mohammed VI University Hospital Oujda Morocco
| | - Tarik Bouhout
- Faculty of Medicine and Pharmacy, Mohammed Ist university
- Department of Oncological Surgery, Regional oncology Center
| | - Badr Serji
- Faculty of Medicine and Pharmacy, Mohammed Ist university
- Department of Oncological Surgery, Regional oncology Center
| | - Tijani El Harroudi
- Faculty of Medicine and Pharmacy, Mohammed Ist university
- Department of Oncological Surgery, Regional oncology Center
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31
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Rosen J, Manley LR, Patel A, Gandamihardja T, Rao A. Prediction of negative axillary node clearance by sentinel node-positive to total node ratio: a retrospective cohort study. Ann Med Surg (Lond) 2023; 85:4689-4693. [PMID: 37811068 PMCID: PMC10553108 DOI: 10.1097/ms9.0000000000000932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 05/20/2023] [Indexed: 10/10/2023] Open
Abstract
Introduction Increasing evidence suggests that de-escalation of axillary surgery is safe, without significantly impacting patient outcome. Obtaining positive lymph nodes at a sentinel lymph node biopsy (SNB) can guide decisions toward the requirement of axillary nodal clearance (ANC). However, methods to predict how many further nodes will be positive are not available. This study investigates the feasibility of predicting the likelihood of a negative ANC based on the ratio between positive nodes and the total number of lymph nodes excised at SNB. Methods Retrospective data from January 2017 to March 2022 was collected from electronic medical records. Patients with oestrogen receptor (ER) positive and HER2 negative receptor disease were included in the study. ER-negative and HER2-positive disease was excluded, alongside patients who had chemotherapy before ANC. Results Of 102 patients, 58.8% (n=60) had no macrometastasis at ANC. On average, 2.76 lymph nodes were removed at SNB. A higher SNB ratio of positive to total nodes [OR 11.09 (CI 95% 2.33-52.72), P=0.002] had a significant association with positive nodes during ANC. SNB ratio less than or equal to 0.33 (1/3) had a specificity of 79.2% in identifying cases that later had a negative completion ANC, with a 95.8% specificity of no further upgrade of nodal staging. Conclusion A low SNB ratio of less than 0.33 (1/3) has a high specificity in excluding the upgradation of nodal staging on completion of ANC, with a false-negative rate of less than 5%. This may be used to identify patients with a low risk of axillary metastasis, who can avoid ANC.
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Affiliation(s)
- Jemima Rosen
- Broomfield Hospital, Mid and South Essex NHS Foundation Trust, Broomfield, Chelmsford, UK
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32
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Conti D, Valoriani J, Ballo P, Pazzi M, Gianesello L, Mengoni V, Criscenti V, Gemmi E, Stera C, Zoppi F, Galli L, Pavoni V. The clinical impact of pectoral nerve block in an 'enhanced recovery after surgery' program in breast surgery. Pain Manag 2023; 13:585-592. [PMID: 37937422 DOI: 10.2217/pmt-2023-0063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2023] Open
Abstract
Background: Pectoral nerve block (PECS) is increasingly performed in breast surgery. Aim: The study evaluated the clinical impact of these blocks in the postoperative course. Patients & methods: In this case-control study, patients undergoing breast surgery with 'enhanced recovery after surgery' pathways were divided into group 1 (57 patients) in whom PECS was performed before general anesthesia, and group 2 (57 patients) in whom only general anesthesia was effected. Results: Postoperative opioid consumption (p < 0.002), pain at 32 h after surgery (p < 0.005) and the length of stay (p < 0.003) were significantly lower in group 1. Conclusion: Reducing opioid consumption and pain after surgery, PECS could favor a faster recovery with a reduction in length of stay, ensuring a higher turnover of patients undergoing breast surgery.
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Affiliation(s)
- Duccio Conti
- Emergency Department & Critical Care Area, Anesthesia & Intensive Care Unit, Santa Maria Annunziata Hospital, Bagno a Ripoli, Florence, 50012, Italy
| | - Juri Valoriani
- Emergency Department & Critical Care Area, Anesthesia & Intensive Care Unit, Santa Maria Annunziata Hospital, Bagno a Ripoli, Florence, 50012, Italy
| | - Piercarlo Ballo
- Cardiology Unit, Santa Maria Annunziata Hospital, Bagno a Ripoli, Florence, 50012, Italy
| | - Maddalena Pazzi
- Emergency Department & Critical Care Area, Anesthesia & Intensive Care Unit, Santa Maria Annunziata Hospital, Bagno a Ripoli, Florence, 50012, Italy
| | - Lara Gianesello
- Department of Anesthesia & Intensive Care, Orthopedic Anesthesia, University-Hospital Careggi, Florence, 50012, Italy
| | - Veronica Mengoni
- Breast Unit, S. Maria Annunziata Hospital, Florence, 50012, Italy
| | | | - Eleonora Gemmi
- Emergency Department & Critical Care Area, Anesthesia & Intensive Care Unit, Santa Maria Annunziata Hospital, Bagno a Ripoli, Florence, 50012, Italy
| | - Caterina Stera
- Emergency Department & Critical Care Area, Anesthesia & Intensive Care Unit, Santa Maria Annunziata Hospital, Bagno a Ripoli, Florence, 50012, Italy
| | - Federica Zoppi
- Emergency Department & Critical Care Area, Anesthesia & Intensive Care Unit, Santa Maria Annunziata Hospital, Bagno a Ripoli, Florence, 50012, Italy
| | - Lorenzo Galli
- Breast Unit, S. Maria Annunziata Hospital, Florence, 50012, Italy
| | - Vittorio Pavoni
- Emergency Department & Critical Care Area, Anesthesia & Intensive Care Unit, Santa Maria Annunziata Hospital, Bagno a Ripoli, Florence, 50012, Italy
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Cylwik J, Celińska-Spodar M, Buda N. Evaluation of the Efficacy of Pectoral Nerve-2 Block (PECS 2) in Breast Cancer Surgery. J Pers Med 2023; 13:1430. [PMID: 37888041 PMCID: PMC10608528 DOI: 10.3390/jpm13101430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 08/13/2023] [Revised: 09/11/2023] [Accepted: 09/22/2023] [Indexed: 10/28/2023] Open
Abstract
This study aimed to evaluate the efficacy of the pectoral nerves interfacial plane block (PECS II) in breast cancer surgery focusing on postoperative pain management and patient satisfaction. A prospective study was conducted, including 200 patients scheduled for breast cancer surgery. The participants were randomly assigned to the PECS II block and control groups. The PECS II block group received a preoperative interfascial plane block, while the control group received standard analgesia. Postoperative pain scores at 4 h intervals for the first 3 postoperative days, as well as opioid consumption and patient-reported satisfaction, were measured and compared between both groups. The PECS II block group demonstrated significantly lower postoperative pain scores at all measured time points (p < 0.001). Additionally, the PECS II block group showed reduced opioid consumption (p < 0.001), reported higher levels of patient satisfaction compared to the control group, and had a notably shorter stay in the postoperative care unit (p < 0.001). Integrating the PECS block with general anesthesia in breast cancer surgeries enhances pain management, reduces opioid use, and shorten postanesthesia care unit stay. The evident benefits suggest PECS as a potential standard in breast surgeries. Future research should further investigate its long-term impacts and broader applications.
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Affiliation(s)
- Jolanta Cylwik
- Anesthesiology and Intensive Care Unit, Mazovia Regional Hospital, 08-110 Siedlce, Poland;
| | - Małgorzata Celińska-Spodar
- Anesthesiology and Intensive Care Unit, Mazovia Regional Hospital, 08-110 Siedlce, Poland;
- Anesthesiology and Intensive Care Unit, The National Institute of Cardiology, 04-628 Warsaw, Poland
| | - Natalia Buda
- Simulation Laboratory of Endoscopic and Minimally Invasive Techniques, Medical University of Gdansk, 80-211 Gdansk, Poland
- Lung Transplant Department of Cardio Surgery Clinic, University Clinical Center in Gdansk, 80-211 Gdansk, Poland
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Tan SY, Tan PH, Tan VKM, Leong LCH. Extensively infarcted breast cancer. BMJ Case Rep 2023; 16:e253823. [PMID: 37678940 PMCID: PMC10496683 DOI: 10.1136/bcr-2022-253823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2023] Open
Abstract
This is a case of a tumour that appeared largely unviable after near complete infarction. The lesion presented as a regular shaped mass with cystic appearance lacking definitive malignant radiological signs. Together with the initial non-diagnostic histological result, this could have easily led to a missed diagnosis of cancer.
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Affiliation(s)
- Si Ying Tan
- Department of Breast Surgery, National Cancer Centre Singapore, Singapore
- Department of Breast Surgery, Singapore General Hospital, Singapore
- SingHealth Duke-NUS Breast Centre, Singapore
| | | | - Veronique Kiak Mien Tan
- Department of Breast Surgery, National Cancer Centre Singapore, Singapore
- Department of Breast Surgery, Singapore General Hospital, Singapore
- SingHealth Duke-NUS Breast Centre, Singapore
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Huniler HC, Deniz MN, Günişen İ, Yakut Özdemir Ö, Tetik A, Ulukaya S. Effects of Perioperative Hypothermia on Extubation, Recovery Time, and Postoperative Shivering in Breast Surgery. Ther Hypothermia Temp Manag 2023. [PMID: 37639685 DOI: 10.1089/ther.2023.0037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023] Open
Abstract
Women undergoing breast surgery seem to be under the risk for hypothermia (central body temperature <36°) due to the uncertainty caused by the preoperative preparation time and the variety of operations, leading to neglect of warming precautions. The study examines the perioperative hypothermia (PH) in breast surgery and the relationships between the depth of decrease in body temperature and individual or clinical variables. This prospective, cross-sectional, observational study includes 120 female patients 18-65 years of age who were given general anesthesia for breast surgery. The incidence of hypothermia was 68.1%. The given patients were discriminated as body temperature <36°, hypothermia was significantly related with lower weight, body mass index, American Society of Anesthesiology (ASA) score, baseline body temperatures, higher extubation, and recovery times. When patients' temperature decreases by >1 or 1.5°, lower age and longer durations of operation and anesthesia were also significant variables. The incidence of shivering is quite high at temperatures below 36°C or at 1 and 1.5°C reductions from baseline (72.7%, 84%, 94.1%, respectively). Body temperature changes of the patients had no effect on nausea-vomiting and pain scores. It turned out that the incidence of PH and shivering is high in women who underwent breast surgery. We think that the depth of decrease in body temperature should be taken into account when evaluating the predictors or clinical consequences of hypothermia, except for the 36°C limit for body temperature.
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Affiliation(s)
- Hatice Cansu Huniler
- Department of Anesthesiology and Reanimation, Ege University School of Medicine, Izmir, Turkey
| | - Mustafa Nuri Deniz
- Department of Anesthesiology and Reanimation, Ege University School of Medicine, Izmir, Turkey
| | - İlkben Günişen
- Department of Anesthesiology and Reanimation, Ege University School of Medicine, Izmir, Turkey
| | - Özlem Yakut Özdemir
- Department of Anesthesiology and Reanimation, Ege University School of Medicine, Izmir, Turkey
| | - Aslı Tetik
- Department of Anesthesiology and Reanimation, Ege University School of Medicine, Izmir, Turkey
| | - Sezgin Ulukaya
- Department of Anesthesiology and Reanimation, Ege University School of Medicine, Izmir, Turkey
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36
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Seth I, Bulloch G, Joseph K, Hunter-Smith DJ, Rozen WM. Use of Artificial Intelligence in the Advancement of Breast Surgery and Implications for Breast Reconstruction: A Narrative Review. J Clin Med 2023; 12:5143. [PMID: 37568545 PMCID: PMC10419723 DOI: 10.3390/jcm12155143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 07/03/2023] [Revised: 07/28/2023] [Accepted: 08/04/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND Breast reconstruction is a pivotal part of the recuperation process following a mastectomy and aims to restore both the physical aesthetic and emotional well-being of breast cancer survivors. In recent years, artificial intelligence (AI) has emerged as a revolutionary technology across numerous medical disciplines. This narrative review of the current literature and evidence analysis explores the role of AI in the domain of breast reconstruction, outlining its potential to refine surgical procedures, enhance outcomes, and streamline decision making. METHODS A systematic search on Medline (via PubMed), Cochrane Library, Web of Science, Google Scholar, Clinical Trials, and Embase databases from January 1901 to June 2023 was conducted. RESULTS By meticulously evaluating a selection of recent studies and engaging with inherent challenges and prospective trajectories, this review spotlights the promising role AI plays in advancing the techniques of breast reconstruction. However, issues concerning data quality, privacy, and ethical considerations pose hurdles to the seamless integration of AI in the medical field. CONCLUSION The future research agenda comprises dataset standardization, AI algorithm refinement, and the implementation of prospective clinical trials and fosters cross-disciplinary partnerships. The fusion of AI with other emergent technologies like augmented reality and 3D printing could further propel progress in breast surgery.
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Affiliation(s)
- Ishith Seth
- Department of Plastic Surgery, Peninsula Health, Melbourne, VIC 3199, Australia
- Faculty of Medicine, The University of Melbourne, Melbourne, VIC 3053, Australia
| | - Gabriella Bulloch
- Faculty of Medicine, The University of Melbourne, Melbourne, VIC 3053, Australia
| | - Konrad Joseph
- Faculty of Medicine, The University of Wollongong, Wollongon, NSW 2500, Australia
| | | | - Warren Matthew Rozen
- Department of Plastic Surgery, Peninsula Health, Melbourne, VIC 3199, Australia
- Faculty of Medicine, The University of Melbourne, Melbourne, VIC 3053, Australia
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37
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Bhardwaj PV, Wang Y, Brunk E, Spanheimer PM, Abdou YG. Advances in the Management of Early-Stage Triple-Negative Breast Cancer. Int J Mol Sci 2023; 24:12478. [PMID: 37569851 PMCID: PMC10419523 DOI: 10.3390/ijms241512478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 07/03/2023] [Revised: 08/02/2023] [Accepted: 08/03/2023] [Indexed: 08/13/2023] Open
Abstract
Triple-negative breast cancer (TNBC) is a subtype of breast cancer with both inter- and intratumor heterogeneity, thought to result in a more aggressive course and worse outcomes. Neoadjuvant therapy (NAT) has become the preferred treatment modality of early-stage TNBC as it allows for the downstaging of tumors in the breast and axilla, monitoring early treatment response, and most importantly, provides important prognostic information that is essential to determining post-surgical therapies to improve outcomes. It focuses on combinations of systemic drugs to optimize pathologic complete response (pCR). Excellent response to NAT has allowed surgical de-escalation in ideal candidates. Further, treatment algorithms guide the systemic management of patients based on their pCR status following surgery. The expanding knowledge of molecular pathways, genomic sequencing, and the immunological profile of TNBC has led to the use of immune checkpoint inhibitors and targeted agents, including PARP inhibitors, further revolutionizing the therapeutic landscape of this clinical entity. However, subgroups most likely to benefit from these novel approaches in TNBC remain elusive and are being extensively studied. In this review, we describe current practices and promising therapeutic options on the horizon for TNBC, surgical advances, and future trends in molecular determinants of response to therapy in early-stage TNBC.
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Affiliation(s)
- Prarthna V. Bhardwaj
- Division of Hematology-Oncology, University of Massachusetts Chan Medical School—Baystate, Springfield, MA 01199, USA
| | - Yue Wang
- Department of Pharmacology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
- Curriculum in Pharmacology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Elizabeth Brunk
- Department of Pharmacology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
- Department of Chemistry, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
- Integrative Program for Biological and Genomic Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
- Lineberger Comprehensive Cancer Center, UNC Chapel Hill, NC 27599, USA
- Computational Medicine Program, UNC Chapel Hill, NC 27599, USA
| | - Philip M. Spanheimer
- Lineberger Comprehensive Cancer Center, UNC Chapel Hill, NC 27599, USA
- Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Yara G. Abdou
- Lineberger Comprehensive Cancer Center, UNC Chapel Hill, NC 27599, USA
- Division of Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
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38
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Cong J, Jo H, Zou N, Kong L, Ri H. Neoadjuvant therapy for HER2-positive acantholytic squamous cell breast carcinoma: a case report. J Int Med Res 2023; 51:3000605231187936. [PMID: 37534455 PMCID: PMC10566270 DOI: 10.1177/03000605231187936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 06/12/2023] [Indexed: 08/04/2023] Open
Abstract
HER2-positive acantholytic squamous cell carcinoma (ASCC) of the breast is exceptionally rare, and its clinicopathologic features are poorly understood. The impact of neoadjuvant therapy on HER2-positive breast ASCC is unclear. Here we report on a 58-year-old woman who was diagnosed with HER2-positive ASCC of the right breast, who underwent neoadjuvant treatment with albumin-paclitaxel, carboplatin, and trastuzumab, and surgery. Neoadjuvant therapy was effective, with no recurrence or metastasis after 1.5 years of postoperative follow-up.
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Affiliation(s)
- Jia Cong
- Department of Breast Surgery, Dalian Women and Children's Medical Group, Dalian, People’s Republic of China
| | - HyonSu Jo
- Department of Breast Surgery, The Second Hospital of Dalian Medical University, Dalian, People’s Republic of China
- Department of General Surgery, The Hospital of Pyongyang Medical University, Pyongyang, D.P.R. of Korea
| | - Na Zou
- Department of Pathology, Dalian Women and Children's Medical Group, Dalian, People’s Republic of China
| | - LingXin Kong
- Department of Radiology, Dalian Women and Children's Medical Group, Dalian, People’s Republic of China
| | - HyokJu Ri
- Department of Breast Surgery, The Second Hospital of Dalian Medical University, Dalian, People’s Republic of China
- Department of General Surgery, The Hospital of Pyongyang Medical University, Pyongyang, D.P.R. of Korea
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Kanwal MA, Khalid U, Amir M, Sajjad B, Zeeshan R, Urooj N, Farooqi N, Parvaiz MA, Iqbal Khan A, Chaudhry MZ. Benchmarking Excellence: Evaluating Advanced Breast Carcinoma Care in Pakistan's Largest Cancer Hospital Against the National Institute for Health and Care Excellence (NICE) Guidelines. Cureus 2023; 15:e44332. [PMID: 37779814 PMCID: PMC10538803 DOI: 10.7759/cureus.44332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2023] [Indexed: 10/03/2023] Open
Abstract
Introduction Breast cancer is the most common type of cancer worldwide, and even with all the screening and education, great numbers of diagnoses are made in advanced stages. Additionally, patients in remission always remain at risk of relapse and metastasis. Pakistan has the highest incidence of breast cancer among Asian countries. The purpose of this clinical audit was to compare data from the largest cancer hospital in Pakistan with international standards to provide room for quality improvement. Methods A retrospective review of patients with advanced breast carcinoma over a period of six months was done. Permission was obtained from the Quality Assurance and Patent Safety Department before the commencement of the audit. Standards Data obtained were audited against nine standards of four different categories from the National Institute for Health and Care Excellence (NICE) guidelines on advanced breast carcinoma. Results For the diagnosis and assessment category, for which a target of 100% was set, 99.66% was achieved; for disease monitoring, for which a target of 100% was set, 91.8% was achieved; for systemic disease-modifying therapy, for which the majority was the target, only 1% was achieved; for managing complications, for which a target of 100% was set, 71.8% was achieved. Conclusion Continuous research and breakthrough advancements have made health care an ever-evolving field. Clinical audits like these that compare international standards with local data are beneficial and lead to quality improvement. They highlight issues that may be overlooked otherwise, raise questions that may never be asked, and may inspire prospective research studies. Limitations of the audit were that this clinical audit was conducted outside of the NHS where NICE guidelines are not followed and local guidelines differ from NICE guidelines.
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Affiliation(s)
- Muhammad Awais Kanwal
- Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | - Umaisa Khalid
- Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | - Momina Amir
- Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | - Barka Sajjad
- Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | - Rana Zeeshan
- Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | - Namra Urooj
- Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | - Nifasat Farooqi
- Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | - Muhammad Asad Parvaiz
- Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | - Amina Iqbal Khan
- Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
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40
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Supper P, Semmler L, Placheta-Györi E, Teufelsbauer M, Harik-Chraim E, Radtke C. [Update and Trends in Breast Reconstruction After Mastectomy]. HANDCHIR MIKROCHIR P 2023; 55:253-261. [PMID: 37487507 PMCID: PMC10415025 DOI: 10.1055/a-2082-1542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 02/15/2023] [Indexed: 07/26/2023] Open
Abstract
Due to refinements in operating techniques, autologous breast reconstruction has become part of standard care. It has become more difficult to advise patients due to the expansion of oncologic options for mastectomy, radiation therapy and the variety of reconstructive techniques. The goal of reconstruction is to achieve oncologically clear margins and a long-term aesthetically satisfactory result with a high quality of life. Immediate reconstruction preserves the skin of the breast and its natural form and prevents the psychological trauma associated with mastectomy. However, secondary reconstructions often have a higher satisfaction, since here no restitutio ad integrum is assumed. Alloplastic, i. e., implant-based, breast reconstruction and autologous breast reconstruction are complementary techniques. This article provides an overview of current options for breast reconstruction including patients' satisfaction and quality of life following breast reconstruction. Although immediate reconstruction is still the preferred choice of most patients and surgeons, delayed reconstruction does not appear to compromise clinical or patient-reported outcomes. Recent refinements in surgical techniques and autologous breast reconstruction include stacked-flaps, as well as microsurgical nerve coaptation to restore sensitivity, which lead to improved outcomes and quality of life. Nowadays Skin-sparing and nipple-sparing mastectomy, accompanied by improved implant quality, allows immediate prosthetic breast reconstruction as well as reemergence of the prepectoral implantation. The choice of breast reconstruction depends on the type of mastectomy, necessary radiation, individual risk factors, as well as the patient's habitus and wishes. Overall, recent developments in breast reconstruction led to an increase in patient satisfaction, quality of life and aesthetic outcome with oncological safety.
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Affiliation(s)
- Paul Supper
- Universitätsklinik für Plastische, Rekonstruktive und
Ästhetische Chirurgie, Medizinische Universität
Wien
| | - Lorenz Semmler
- Universitätsklinik für Plastische, Rekonstruktive und
Ästhetische Chirurgie, Medizinische Universität
Wien
| | - Eva Placheta-Györi
- Universitätsklinik für Plastische, Rekonstruktive und
Ästhetische Chirurgie, Medizinische Universität
Wien
| | - Maryana Teufelsbauer
- Universitätsklinik für Plastische, Rekonstruktive und
Ästhetische Chirurgie, Medizinische Universität
Wien
| | - Elissa Harik-Chraim
- Universitätsklinik für Plastische, Rekonstruktive und
Ästhetische Chirurgie, Medizinische Universität
Wien
| | - Christine Radtke
- Universitätsklinik für Plastische, Rekonstruktive und
Ästhetische Chirurgie, Medizinische Universität
Wien
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Marchegiani F, Siragusa L, Zadoroznyj A, Laterza V, Mangana O, Schena CA, Ammendola M, Memeo R, Bianchi PP, Spinoglio G, Gavriilidis P, de'Angelis N. New Robotic Platforms in General Surgery: What's the Current Clinical Scenario? Medicina (Kaunas) 2023; 59:1264. [PMID: 37512075 PMCID: PMC10386395 DOI: 10.3390/medicina59071264] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 07/01/2023] [Accepted: 07/04/2023] [Indexed: 07/30/2023]
Abstract
Background and Objectives: Robotic surgery has been widely adopted in general surgery worldwide but access to this technology is still limited to a few hospitals. With the recent introduction of new robotic platforms, several studies reported the feasibility of different surgical procedures. The aim of this systematic review is to highlight the current clinical practice with the new robotic platforms in general surgery. Materials and Methods: A grey literature search was performed on the Internet to identify the available robotic systems. A PRISMA compliant systematic review was conducted for all English articles up to 10 February 2023 searching the following databases: MEDLINE, EMBASE, and Cochrane Library. Clinical outcomes, training process, operating surgeon background, cost-analysis, and specific registries were evaluated. Results: A total of 103 studies were included for qualitative synthesis after the full-text screening. Of the fifteen robotic platforms identified, only seven were adopted in a clinical environment. Out of 4053 patients, 2819 were operated on with a new robotic device. Hepatopancreatobiliary surgery specialty performed the majority of procedures, and the most performed procedure was cholecystectomy. Globally, 109 emergency surgeries were reported. Concerning the training process, only 45 papers reported the background of the operating surgeon, and only 28 papers described the training process on the surgical platform. Only one cost-analysis compared a new robot to the existing reference. Two manufacturers promoted a specific registry to collect clinical outcomes. Conclusions: This systematic review highlights the feasibility of most surgical procedures in general surgery using the new robotic platforms. Adoption of these new devices in general surgery is constantly growing with the extension of regulatory approvals. Standardization of the training process and the assessment of skills' transferability is still lacking. Further studies are required to better understand the real clinical and economical benefit.
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Affiliation(s)
- Francesco Marchegiani
- Unit of Colorectal and Digestive Surgery, DIGEST Department, Beaujon University Hospital, AP-HP, University of Paris Cité, Clichy, 92110 Paris, France
| | - Leandro Siragusa
- Department of Surgical Sciences, University of Rome "Tor Vergata", Viale Oxford 81, 00133 Rome, Italy
| | - Alizée Zadoroznyj
- Unit of Colorectal and Digestive Surgery, DIGEST Department, Beaujon University Hospital, AP-HP, University of Paris Cité, Clichy, 92110 Paris, France
| | - Vito Laterza
- Unit of Colorectal and Digestive Surgery, DIGEST Department, Beaujon University Hospital, AP-HP, University of Paris Cité, Clichy, 92110 Paris, France
| | - Orsalia Mangana
- Unit of Colorectal and Digestive Surgery, DIGEST Department, Beaujon University Hospital, AP-HP, University of Paris Cité, Clichy, 92110 Paris, France
| | - Carlo Alberto Schena
- Unit of Colorectal and Digestive Surgery, DIGEST Department, Beaujon University Hospital, AP-HP, University of Paris Cité, Clichy, 92110 Paris, France
| | - Michele Ammendola
- Science of Health Department, Digestive Surgery Unit, University "Magna Graecia" Medical School, 88100 Catanzaro, Italy
| | - Riccardo Memeo
- Unit of Hepato-Pancreato-Biliary Surgery, General Regional Hospital "F. Miulli", 70021 Acquaviva delle Fonti, Italy
| | - Paolo Pietro Bianchi
- Division of General and Robotic Surgery, Department of Health Sciences, San Paolo Hospital, University of Milan, 20142 Milan, Italy
| | - Giuseppe Spinoglio
- Research Institute Against Digestive Cancer (IRCAD), 67000 Strasbourg, France
| | - Paschalis Gavriilidis
- Department of Surgery, Saint Helena General Hospital, Jamestown, Saint Helena STHL 1ZZ, South Atlantic Ocean, UK
| | - Nicola de'Angelis
- Unit of Colorectal and Digestive Surgery, DIGEST Department, Beaujon University Hospital, AP-HP, University of Paris Cité, Clichy, 92110 Paris, France
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Chu JJ, Tadros AB, Gallo L, Mehrara BJ, Morrow M, Pusic AL, Voineskos SH, Nelson JA. Interpreting the BREAST-Q for Breast-Conserving Therapy: Minimal Important Differences and Clinical Reference Values. Ann Surg Oncol 2023; 30:4075-4084. [PMID: 36840864 PMCID: PMC10996067 DOI: 10.1245/s10434-023-13222-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 01/24/2023] [Indexed: 02/26/2023]
Abstract
BACKGROUND The BREAST-Q is an important tool for evaluating patient satisfaction and quality of life in breast-conserving therapy (BCT) patients, but its clinical utility is limited by the lack of guidance on score interpretation. This study determines reference values and the minimal important difference (MID) for the BREAST-Q BCT module. METHODS A retrospective review of BCT patients at Memorial Sloan Kettering Cancer Center from January 2011 to December 2021 was performed. Descriptive statistics were used to summarize median BREAST-Q scores. Distribution-based analyses estimated MIDs based on 0.2 standard deviation of baseline BREAST-Q scores and 0.2 standardized response mean of the difference between baseline and 1-year postoperative BREAST-Q scores. MIDs for different clinical groupings based on body mass index, radiation, and reexcision also were estimated. RESULTS Overall, 8060 patients were included for determining reference values, and 5673 patients were included for estimating MIDs. Median BREAST-Q scores trended upwards and stabilized by 2 years after surgery for all domains except Physical Well-Being of the Chest, which decreased and stabilized by 2 years. A score interpretation tool, the Real-Time Engagement and Communication Tool, was created based on 25th percentile, median, and 75th percentile scores trajectories. All MID estimates ranged from 3 to 5 points; 4 points was determined to be appropriate for use in clinical practice and research. CONCLUSIONS Reference values and MIDs are crucial to BREAST-Q score interpretation, which can lead to improved clinical evaluation and decision making and improved research methodology. Future research should validate this study's findings in different patient cohorts.
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Affiliation(s)
- Jacqueline J Chu
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Audree B Tadros
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Lucas Gallo
- Division of Plastic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Babak J Mehrara
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Monica Morrow
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Andrea L Pusic
- Department of Plastic and Reconstructive Surgery, Brigham and Women's Hospital, Boston, MA, USA
- Patient Reported Outcomes, Value, and Experience (PROVE) Center, Brigham Health, Boston, MA, USA
| | - Sophocles H Voineskos
- Division of Plastic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence and Impact (HEI), McMaster University, Hamilton, ON, Canada
| | - Jonas A Nelson
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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Taha N, Rahman S, Kilshaw A. The Efficacy of Antiseptic Treatment of Surgical Drains on Bacterial Colonisation and Surgical Site Infection Post Breast Surgery: A Systematic Review and Meta-Analysis. Cureus 2023; 15:e41585. [PMID: 37559847 PMCID: PMC10407596 DOI: 10.7759/cureus.41585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2023] [Indexed: 08/11/2023] Open
Abstract
Surgical site infection (SSI) is a common complication in women with post-operative drains following breast surgery, with the risk being as high as 19%. The authors aimed to conduct the first meta-analysis to determine the efficacy of antiseptic treatment of drains to reduce the incidence of infections by comparing it to drains with no antiseptic coating. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed with an extensive search of the electronic databases retrieving 114 articles. Four articles met the inclusion criteria. The primary outcome measure was the incidence of SSIs and secondary outcome measures included the incidence of bacterial colonisation in the bulb fluid and drain tube. The incidence of SSIs was significantly lower in the antiseptic group compared to the control (CI 95% 0.09 - 0.82, p = 0.02). In addition, there was a lower incidence of colonisation from both the bulb fluid and drain tube with P values of < 0.00001 and P < 0.0001 respectively. The authors report the first meta-analysis within the literature showing the efficacy of antiseptic treatment of surgical drains on colonisation and SSIs following breast surgery. More high-quality trials are recommended to further the current evidence base.
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Affiliation(s)
- Nadia Taha
- Plastic Surgery, Leeds General Infirmary, Leeds, GBR
| | - Shafiq Rahman
- Plastic Surgery, Leeds General Infirmary, Leeds, GBR
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Shamoun S, Ahmad M. Complete Decongestive Therapy Effect on Breast Cancer Related to Lymphedema: A Systemic Review and Meta-Analysis of Randomized Controlled Trials. Asian Pac J Cancer Prev 2023; 24:2225-2238. [PMID: 37505751 PMCID: PMC10676504 DOI: 10.31557/apjcp.2023.24.7.2225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 07/08/2023] [Indexed: 07/29/2023] Open
Abstract
PURPOSE To review and analyze critically the available evidence for Complete Decongestive Therapy Effect on Breast Cancer Related to Lymphedema. DATA SOURCES Publications were retrieved from the major database search engines, included Google scholar, EBSCO host, and PubMed database. The search terms including: "Complete decongestive therapy (CDT)", "breast cancer", "Breast cancer related to lymphedema (BCRL)" "breast surgery" and "mastectomy". STUDY SELECTION The studies were initially selected based on keywords associated with inclusion criteria. Then, articles were chosen based on their titles. Then, based on the fill text and design, randomized control with a comprehensive description of the outcomes. The authors analyzed 3,181 articles, of which 15 randomized controlled trials met inclusion criteria with no publication date constraint. DATA EXTRACTION Each article's authors, nations, participants, outcomes variables, measuring instruments, intervention technique and follow-up, outcomes, and results were retrieved. After reaching consensus among authors, study quality was evaluated using the Jadad scale, and risk of bias was determined using the Cochrane Rob2 tool. DATA SYNTHESIS The levels of evidence were of excellent quality. The retrieved articles were of "high" methodological caliber. The major outcome variables were in QOL, pain, ROM and edema. The effect size of CDT on QOL was 2.347 (95% CI: -1.41, 6.11) (p=0.22). Pain was -0.068 (95% CI: -35.21) (p=0.64). ROM was 0.324 (95% CI: -0.44,0.09) (p=0.41) and edema was -2.9 (95% -1.53,1.11) (p=0.76). CONCLUSIONS The CDT is still recommended as the primary therapy for BCRL and is regarded the most practical and cost-effective treatment for BCRL. This result recommends patients to perform CDT to improve their QOL, ROM, and to lessen pain and edema volume. To improve the body of evidence supporting the effectiveness of the CDT on BCRL, additional trials with bigger sample sizes, longer follow-ups, blindness outcomes, and patient compliance evaluations are required.
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Caputo G, Scarabosio A, Di Filippo J, Contessi Negrini F, Albanese R, Mura S, Parodi PC. Optimizing Acellular Dermal Matrix Integration in Heterologous Breast Reconstructive Surgery: Surgical Tips and Post-Operative Management. Medicina (Kaunas) 2023; 59:1231. [PMID: 37512043 PMCID: PMC10383214 DOI: 10.3390/medicina59071231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 06/13/2023] [Accepted: 06/28/2023] [Indexed: 07/30/2023]
Abstract
Background and Objective: Prepectoral implant placement in breast reconstruction is currently a must-have in the portfolios of breast surgeons. The introduction of new tools and conservative mastectomies is a game changer in this field. The prepectoral plane usually goes hand-in-hand with the ADM wrapping of the implant. It is a cell-free dermal matrix comprising a structurally integrated basement membrane complex and an extracellular matrix. The literature reports that ADMs may be useful, but proper patient selection, surgical placement, and post-operative management are essential to unlock the potential of this tool, as these factors contribute to the proper integration of the matrix with surrounding tissues. Materials and Methods: A total of 245 prepectoral breast reconstructions with prostheses or expanders and ADMs were performed in our institution between 2016 and 2022. A retrospective study was carried out to record patient characteristics, risk factors, surgical procedures, reconstructive processes, and complications. Based on our experience, we developed a meticulous reconstruction protocol in order to optimize surgical practice and lower complication rates. The DTI and two-stage reconstruction were compared. Results: Seroma formation was the most frequent early complication (less than 90 days after surgery) that we observed; however, the majority were drained in outpatient settings and healed rapidly. Secondary healing of wounds, which required a few more weeks of dressing, represented the second most frequent early complication (10.61%). Rippling was the most common late complication, particularly in DTI patients. After comparing the DTI and two-stage reconstruction, no statistically significant increase in complications was found. Conclusions: The weakness of prepectoral breast reconstruction is poor matrix integration, which leads to seroma and other complications. ADM acts like a graft; it requires firm and healthy tissues to set in. In order to do so, there are three key steps to follow: (1) adequate patient selection; (2) preservative and gentle handling of intra-operative technique; and (3) meticulous post-operative management.
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Affiliation(s)
- Glenda Caputo
- Clinic of Plastic and Reconstructive Surgery, Academic Hospital of Udine, Department of Medical Area (DAME), University of Udine (Italy), 33100 Udine, Italy
| | - Anna Scarabosio
- Clinic of Plastic and Reconstructive Surgery, Academic Hospital of Udine, Department of Medical Area (DAME), University of Udine (Italy), 33100 Udine, Italy
| | - Jacopo Di Filippo
- Clinic of Plastic and Reconstructive Surgery, Academic Hospital of Udine, Department of Medical Area (DAME), University of Udine (Italy), 33100 Udine, Italy
| | - Filippo Contessi Negrini
- Clinic of Plastic and Reconstructive Surgery, Academic Hospital of Udine, Department of Medical Area (DAME), University of Udine (Italy), 33100 Udine, Italy
| | - Roberta Albanese
- Clinic of Plastic and Reconstructive Surgery, Ospedale Santa Maria della Misericordia, 33100 Udine, Italy
| | - Sebastiano Mura
- Clinic of Plastic and Reconstructive Surgery, Ospedale Santa Maria della Misericordia, 33100 Udine, Italy
| | - Pier Camillo Parodi
- Clinic of Plastic and Reconstructive Surgery, Academic Hospital of Udine, Department of Medical Area (DAME), University of Udine (Italy), 33100 Udine, Italy
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Ofri A, Von Hagt D, Ponniah K. Limberg flap in mastectomy T-junction necrosis: an underutilised technique. BMJ Case Rep 2023; 16:e253587. [PMID: 37399347 DOI: 10.1136/bcr-2022-253587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/05/2023] Open
Abstract
The Wise-pattern skin-sparing mastectomy (SSM) is well known for its efficacy in large ptotic breasts, and its safety in facilitating immediate breast reconstruction. An unfortunate sequalae for all SSM techniques is mastectomy skin flap necrosis (MSFN) with a reported range of occurrence of 5%-30%. For the Wise pattern, the common area of wound dehiscence or necrosis is the T-junction. Different techniques have been described in the management of MSFN-ranging from primary closure to local and distant flaps. Full thickness MSFN results in wound breakdown and can expose a prosthesis, subsequently closure must be obtained with potential for the prosthesis to be explanted. To date, there has been no reports in the literature of the usage of a rhomboid flap in an SSM with immediate prepectoral implant. We discuss our experience in the usage of this local cosmetic flap to avoid prosthesis loss and have reviewed the literature regarding MSFN, the application of the rhomboid (Limberg) flap in breast surgery and its applicability in MSFN to preserve underlying prosthesis.
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Affiliation(s)
- Adam Ofri
- Breast Surgery, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Davina Von Hagt
- Breast Surgery, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - Kallyani Ponniah
- Breast Surgery, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
- School of Medicine, University of Notre Dame, Fremantle, WA, Australia
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Li J, Huang J, Yang JT, Liu JC. Perioperative intravenous lidocaine for postoperative pain in patients undergoing breast surgery: a meta-analysis with trial sequential analysis of randomized controlled trials. Front Oncol 2023; 13:1101582. [PMID: 37427130 PMCID: PMC10327428 DOI: 10.3389/fonc.2023.1101582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 06/08/2023] [Indexed: 07/11/2023] Open
Abstract
Background The effectiveness of intravenous lidocaine infusion in managing acute and chronic pain following breast surgery has been a topic of debate. This meta-analysis aims to assess the impact of perioperative intravenous lidocaine on the relief of postoperative pain among patients undergoing breast surgery. Methods A systematic search of databases was conducted to identify randomized controlled trials (RCTs) that compared the effects of intravenous lidocaine infusion with placebo or routine care in patients undergoing breast surgery. The primary outcome of interest was the occurrence of chronic post-surgical pain (CPSP) at the longest follow-up. Meta-analyses, incorporating trial sequential analysis, were performed using a random-effects model to assess the overall effect. Results A total of twelve trials, involving 879 patients, were included in the analysis. Perioperative intravenous lidocaine demonstrated a significant reduction in the incidence of CPSP at the longest follow-up (risk ratio [RR] 0.62, 95% confidence interval [CI] 0.48-0.81; P = 0.0005; I2 = 6%). Trial sequential analysis (TSA) indicated that the cumulative z curve crossed the trial sequential monitoring boundary for benefit, providing sufficient and conclusive evidence. Furthermore, intravenous lidocaine was associated with decreased opioid consumption and a shorter length of hospital stay. Conclusion Perioperative intravenous lidocaine is effective in relieving acute and CPSP in patients undergoing breast surgery. Systematic review registration https://inplasy.com/, identifier INPLASY2022100033.
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Affiliation(s)
- Jia Li
- Department of Anesthesiology, The First Affiliated Hospital, Guangxi Medical University, Nanning, China
| | - Jiao Huang
- Department of Anesthesiology, The First Affiliated Hospital, Guangxi Medical University, Nanning, China
| | - Jiang-tao Yang
- Department of Orthopedics, Guangxi Traditional Chinese Medical University Affiliated First Hospital, Nanning, China
| | - Jing-chen Liu
- Department of Anesthesiology, The First Affiliated Hospital, Guangxi Medical University, Nanning, China
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Zhang X, Guo Y, Wang J, Zhang X, Cheng J, Chen H, Pi Q. Study on effectiveness analysis of multi-media combined with PBL teaching in breast surgery. Afr Health Sci 2023; 23:330-335. [PMID: 38223575 PMCID: PMC10782306 DOI: 10.4314/ahs.v23i2.36] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2024] Open
Abstract
Objective To explore the effectiveness of multi-media combined with PBL teaching in breast surgery. Methods 56 interns who came to our hospital for breast surgery from January 2019 to December 2020 were randomly divided into two groups: traditional teaching control group (n = 28) and multi-media PBL teaching observation group (n = 28). Two groups' theoretical knowledge, skill operation, teaching quality, student's evaluation and satisfaction with the teaching model were compared before ending the internship. Results The total scores of breast examination, differential diagnosis, imaging reading, diagnosis and treatment scheme and total scores of the students in the observation group were higher than those of the students in the control group, and the total scores of body position, surgical site selection, disinfection and local anesthesia, surgical operation, postoperative treatment and clinical operation skills were also higher than those of the students in the control group (P < 0.05), but there was no significant difference between the two groups in medical history collection, professional knowledge and preoperative preparation (P > 0.05). The teaching quality of the students in the observation group was also significantly higher than that in the control group (P < 0.05). In addition, the students' satisfaction with the teaching method, the teaching effect and the overall satisfaction in the observation group were significantly higher than those in the control group (P < 0.05). Conclusion Multi-media combined with PBL teaching can effectively improve students' professional knowledge theory level, operation skills, enhance students' enthusiasm and initiative, develop good clinical thinking habits, and have high teaching satisfaction. It is worthy of being popularized in the clinical teaching of breast surgery.
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Affiliation(s)
- Xusheng Zhang
- General Surgery in Northwest Minzu University, Lanzhou 730000, Gansu Province, China
| | - Yiqing Guo
- General Surgery in Northwest Minzu University, Lanzhou 730000, Gansu Province, China
| | - Ji Wang
- General Surgery in Northwest Minzu University, Lanzhou 730000, Gansu Province, China
| | - Xudong Zhang
- ShiJiaZhuang Medical College, Shijiazhuang 050599, Hebei Province, China
| | - Junsheng Cheng
- General Surgery in Northwest Minzu University, Lanzhou 730000, Gansu Province, China
| | - Haoqiang Chen
- General Surgery in Northwest Minzu University, Lanzhou 730000, Gansu Province, China
| | - Qixing Pi
- Northwest Minzu University, Lanzhou 730000, Gansu Province, China
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Zaussinger M, Duscher D, Huemer GM. Nagor Impleo Round Silicone Gel Breast Implants: Early Outcome Analysis after 340 Primary Breast Augmentations. J Clin Med 2023; 12:jcm12113708. [PMID: 37297902 DOI: 10.3390/jcm12113708] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 05/01/2023] [Revised: 05/20/2023] [Accepted: 05/25/2023] [Indexed: 06/12/2023] Open
Abstract
For decades, implant-based breast augmentation has been one of the most performed surgical procedures for cosmetic purposes around the world. Hence, novel manufactured implants should be critically investigated to prove them safe and effective. Here, the authors describe the first independently conducted clinical study on Nagor Impleo textured round breast implants. For this retrospective study, outcomes of 340 consecutive female patients undergoing primary cosmetic breast augmentation were analyzed. Demographic and surgical data as well as outcomes and complications were evaluated. Furthermore, a survey concerning effectiveness and aesthetic satisfaction after breast augmentation was examined. All 680 implants were placed in a submuscular plane with incisions at the inframammary fold. The main indications for surgery were hypoplasia and hypoplasia with asymmetry. The mean implant volume was 390 cc and the main type of projection was high profile. The most common complications were hematoma and capsular contracture (0.9 percent, respectively). The overall revision rate for complications was 2.4%. Additionally, almost all patients showed increased quality of life and aesthetic satisfaction after a breast augmentation. Hence, all patients would undergo breast augmentation again with these newly launched devices. Nagor Impleo implants demonstrate a low complication rate and high safety profile. Although high aesthetic satisfaction and quality of life results were achieved, analysis of an even larger series over a longer period of time would be beneficial to evaluate the reliability of this implant.
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Affiliation(s)
- Maximilian Zaussinger
- Medical Faculty, Johannes Kepler University Linz, Altenbergerstr. 69, 4040 Linz, Austria
- Section of Plastic, Aesthetic and Reconstructive Surgery, Kepler University Hospital Linz, Krankenhausstrasse 9, 4020 Linz, Austria
| | - Dominik Duscher
- Department of Plastic, Reconstructive, Hand and Burn Surgery, BG-Trauma Center, Eberhard Karls University Tübingen, 72076 Tübingen, Germany
| | - Georg M Huemer
- Medical Faculty, Johannes Kepler University Linz, Altenbergerstr. 69, 4040 Linz, Austria
- Section of Plastic, Aesthetic and Reconstructive Surgery, Kepler University Hospital Linz, Krankenhausstrasse 9, 4020 Linz, Austria
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Bhardwaj PV, Mason H, Kaufman SA, Visintainer P, Makari-Judson G. Outcomes of a Multidisciplinary Team in the Management of Patients with Early-Stage Breast Cancer Undergoing Neoadjuvant Chemotherapy at a Community Cancer Center. Curr Oncol 2023; 30:4861-4870. [PMID: 37232824 DOI: 10.3390/curroncol30050366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 02/09/2023] [Revised: 03/31/2023] [Accepted: 05/04/2023] [Indexed: 05/27/2023] Open
Abstract
Background: The utilization of neoadjuvant chemotherapy (NAC) remains highly variable in clinical practice. The implementation of NAC requires coordination of handoffs between a multidisciplinary team (MDT). This study aims to assess the outcomes of an MDT in the management of early-stage breast cancer patients undergoing neoadjuvant chemotherapy at a community cancer center. Methods: We conducted a retrospective case series on patients receiving NAC for early-stage operable or locally advanced breast cancer coordinated by an MDT. Outcomes of interest included the rate of downstaging of cancer in the breast and axilla, time from biopsy to NAC, time from completion of NAC to surgery, and time from surgery to radiation therapy (RT). Results: Ninety-four patients underwent NAC; 84% were White and mean age was 56.5 yrs. Of them, 87 (92.5%) had clinical stage II or III cancer, and 43 (45.8%) had positive lymph nodes. Thirty-nine patients (42.9%) were triple negative, 28 (30.8%) were human epidermal growth factor receptor (HER-2)+, and 24 (26.2%) were estrogen receptor (ER) +HER-2-. Of 91 patients, 23 (25.3%) achieved pCR; 84 patients (91.4%) had downstaging of the breast tumor, and 30 (33%) had axillary downstaging. The median time from diagnosis to NAC was 37.5 days, the time from completion of NAC to surgery was 29 days, and the time from surgery to RT was 49.5 days. Conclusions: Our MDT provided timely, coordinated, and consistent care for patients with early-stage breast cancer undergoing NAC as evidenced by time to treatment outcomes consistent with recommended national trends.
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Affiliation(s)
- Prarthna V Bhardwaj
- Division of Hematology-Oncology, University of Massachusetts Chan Medical School-Baystate, 759 Chestnut Street, Springfield, MA 01199 , USA
| | - Holly Mason
- Breast Surgery Section, University of Massachusetts Chan Medical School-Baystate, 759 Chestnut Street, Springfield, MA 01199, USA
| | - Seth A Kaufman
- Division of Radiation Oncology, University of Massachusetts Chan Medical School-Baystate, 759 Chestnut Street, Springfield, MA 01199, USA
| | - Paul Visintainer
- Institute for Healthcare Delivery and Population Science, University of Massachusetts Chan Medical-Baystate, 759 Chestnut Street, Springfield, MA 01199, USA
| | - Grace Makari-Judson
- Division of Hematology-Oncology, University of Massachusetts Chan Medical School-Baystate, 759 Chestnut Street, Springfield, MA 01199 , USA
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