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Flores EM, Gouveia FV, Matsumoto M, Bonacif THFS, Kuroki MA, Antunes GF, Campos ACP, Kimachi PP, Campos DO, Simões CM, Sampaio MMC, Andrade FEM, Valverde J, Barros ACSD, Pagano RL, Martinez RCR. One year follow-up on a randomized study investigating serratus anterior muscle and pectoral nerves type I block to reduced neuropathic pain descriptors after mastectomy. Sci Rep 2023; 13:4591. [PMID: 36944694 PMCID: PMC10030852 DOI: 10.1038/s41598-023-31589-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 03/14/2023] [Indexed: 03/23/2023] Open
Abstract
Breast cancer is the second most common diagnosed type of cancer in women. Chronic neuropathic pain after mastectomy occurs frequently and is a serious health problem. In our previous single-center, prospective, randomized controlled clinical study, we demonstrated that the combination of serratus anterior plane block (SAM) and pectoral nerve block type I (PECS I) with general anesthesia reduced acute postoperative pain. The present report describes a prospective follow-up study of this published study to investigate the development of chronic neuropathic pain 12 months after mastectomy by comparing the use of general anesthesia alone and general anesthesia with SAM + PECS I. Additionally, the use of analgesic medication, quality of life, depressive symptoms, and possible correlations between plasma levels of interleukin (IL)-1 beta, IL-6, and IL-10 collected before and 24 h after surgery as predictors of pain and depression were evaluated. The results showed that the use of SAM + PECS I with general anesthesia reduced numbness, hypoesthesia to touch, the incidence of patients with chronic pain in other body regions and depressive symptoms, however, did not significantly reduce the incidence of chronic neuropathic pain after mastectomy. Additionally, there was no difference in the consumption of analgesic medication and quality of life. Furthermore, no correlation was observed between IL-1 beta, IL-6, and IL-10 levels and pain and depression. The combination of general anesthesia with SAM + PECS I reduced the occurrence of specific neuropathic pain descriptors and depressive symptoms. These results could promote the use of SAM + PECS I blocks for the prevention of specific neuropathic pain symptoms after mastectomy.Registration of clinical trial: The Research Ethics Board of the Hospital Sirio-Libanes/Brazil approved the study (CAAE 48721715.0.0000.5461). This study is registered at Registro Brasileiro de Ensaios Clinicos (ReBEC), and ClinicalTrials.gov, Identifier: NCT02647385.
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Affiliation(s)
- Eva M Flores
- Division of Neuroscience, Hospital Sirio-Libanes, São Paulo, Brazil
- Anesthesiology Medical Center, Hospital Sirio-Libanes, São Paulo, Brazil
| | - Flavia V Gouveia
- Division of Neuroscience, Hospital Sirio-Libanes, São Paulo, Brazil
- Neuroscience and Mental Health, The Hospital for Sick Children, Toronto, ON, Canada
| | - Marcio Matsumoto
- Division of Neuroscience, Hospital Sirio-Libanes, São Paulo, Brazil
- Anesthesiology Medical Center, Hospital Sirio-Libanes, São Paulo, Brazil
| | | | - Mayra A Kuroki
- Division of Neuroscience, Hospital Sirio-Libanes, São Paulo, Brazil
| | | | | | - Pedro P Kimachi
- Division of Neuroscience, Hospital Sirio-Libanes, São Paulo, Brazil
- Anesthesiology Medical Center, Hospital Sirio-Libanes, São Paulo, Brazil
| | - Diego O Campos
- Division of Neuroscience, Hospital Sirio-Libanes, São Paulo, Brazil
| | - Claudia M Simões
- Division of Neuroscience, Hospital Sirio-Libanes, São Paulo, Brazil
- Anesthesiology Medical Center, Hospital Sirio-Libanes, São Paulo, Brazil
| | | | | | - João Valverde
- Division of Neuroscience, Hospital Sirio-Libanes, São Paulo, Brazil
- Anesthesiology Medical Center, Hospital Sirio-Libanes, São Paulo, Brazil
| | | | - Rosana L Pagano
- Division of Neuroscience, Hospital Sirio-Libanes, São Paulo, Brazil
| | - Raquel C R Martinez
- Division of Neuroscience, Hospital Sirio-Libanes, São Paulo, Brazil.
- LIM/23, Institute of Psychiatry, University of Sao Paulo School of Medicine, Sao Paulo, Brazil.
- Instituto de Ensino e Pesquisa, Hospital Sirio-Libanes, Rua Professor Daher Cutait, 69, São Paulo, SP, 01308-060, Brazil.
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Matsumoto M, Flores EM, Kimachi PP, Gouveia FV, Kuroki MA, Barros ACSD, Sampaio MMC, Andrade FEM, Valverde J, Abrantes EF, Simões CM, Pagano RL, Martinez RCR. Benefits in radical mastectomy protocol: a randomized trial evaluating the use of regional anesthesia. Sci Rep 2018; 8:7815. [PMID: 29777144 PMCID: PMC5959858 DOI: 10.1038/s41598-018-26273-z] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 05/08/2018] [Indexed: 12/24/2022] Open
Abstract
Surgery is the first-line treatment for early, localized, or operable breast cancer. Regional anesthesia during mastectomy may offer the prevention of postoperative pain. One potential protocol is the combination of serratus anterior plane block (SAM block) with pectoral nerve block I (PECS I), but the results and potential benefits are limited. Our study compared general anesthesia with or without SAM block + PECS I during radical mastectomy with axillary node dissection and breast reconstruction using evaluations of pain, opioid consumption, side effects and serum levels of interleukin (IL)-1beta, IL-6 and IL-10. This is a prospective, randomized controlled trial. Fifty patients were randomized to general anesthesia only or general anesthesia associated with SAM block + PECS I (25 per group). The association of SAM block + PECS I with general anesthesia reduced intraoperative fentanyl consumption, morphine use and visual analog pain scale scores in the post-anesthetic care unit (PACU) and at 24 h after surgery. In addition, the anesthetic protocol decreased side effects and sedation 24 h after surgery compared to patients who underwent general anesthesia only. IL-6 levels increased after the surgery compared to baseline levels in both groups, and no differences in IL-10 and IL-1 beta levels were observed. Our protocol improved the outcomes of mastectomy, which highlight the importance of improving mastectomy protocols and focusing on the benefits of regional anesthesia.
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Affiliation(s)
- Marcio Matsumoto
- Hospital Sirio-Libanes, Rua Professor Daher Cutait, 69, 01308-060, Sao Paulo, Brazil.,Sao Paulo Servicos Medicos de Anestesia, Rua Adma Jafet, Jafet, 91 - Bela Vista, São Paulo - SP, 01308-050, Sao Paulo, Brazil
| | - Eva M Flores
- Hospital Sirio-Libanes, Rua Professor Daher Cutait, 69, 01308-060, Sao Paulo, Brazil.,Sao Paulo Servicos Medicos de Anestesia, Rua Adma Jafet, Jafet, 91 - Bela Vista, São Paulo - SP, 01308-050, Sao Paulo, Brazil
| | - Pedro P Kimachi
- Hospital Sirio-Libanes, Rua Professor Daher Cutait, 69, 01308-060, Sao Paulo, Brazil.,Sao Paulo Servicos Medicos de Anestesia, Rua Adma Jafet, Jafet, 91 - Bela Vista, São Paulo - SP, 01308-050, Sao Paulo, Brazil
| | - Flavia V Gouveia
- Hospital Sirio-Libanes, Rua Professor Daher Cutait, 69, 01308-060, Sao Paulo, Brazil
| | - Mayra A Kuroki
- Hospital Sirio-Libanes, Rua Professor Daher Cutait, 69, 01308-060, Sao Paulo, Brazil
| | - Alfredo C S D Barros
- Hospital Sirio-Libanes, Rua Professor Daher Cutait, 69, 01308-060, Sao Paulo, Brazil
| | - Marcelo M C Sampaio
- Hospital Sirio-Libanes, Rua Professor Daher Cutait, 69, 01308-060, Sao Paulo, Brazil
| | - Felipe E M Andrade
- Hospital Sirio-Libanes, Rua Professor Daher Cutait, 69, 01308-060, Sao Paulo, Brazil
| | - João Valverde
- Hospital Sirio-Libanes, Rua Professor Daher Cutait, 69, 01308-060, Sao Paulo, Brazil.,Sao Paulo Servicos Medicos de Anestesia, Rua Adma Jafet, Jafet, 91 - Bela Vista, São Paulo - SP, 01308-050, Sao Paulo, Brazil
| | - Eduardo F Abrantes
- Hospital Sirio-Libanes, Rua Professor Daher Cutait, 69, 01308-060, Sao Paulo, Brazil
| | - Claudia M Simões
- Hospital Sirio-Libanes, Rua Professor Daher Cutait, 69, 01308-060, Sao Paulo, Brazil.,Sao Paulo Servicos Medicos de Anestesia, Rua Adma Jafet, Jafet, 91 - Bela Vista, São Paulo - SP, 01308-050, Sao Paulo, Brazil
| | - Rosana L Pagano
- Hospital Sirio-Libanes, Rua Professor Daher Cutait, 69, 01308-060, Sao Paulo, Brazil
| | - Raquel C R Martinez
- Hospital Sirio-Libanes, Rua Professor Daher Cutait, 69, 01308-060, Sao Paulo, Brazil.
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Barros ACSD, Pinotti M, Teixeira LC, Ricci MD, Pinotti JA. Outcome Analysis of Patients with Early Infiltrating Breast Carcinoma Treated by Surgery with Intraoperative Evaluation of Surgical Margins. Tumori 2018; 90:592-5. [PMID: 15762362 DOI: 10.1177/030089160409000610] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aim The purpose of this study was to determine the effect of intraoperative evaluation of surgical margins (IESM) on the local recurrence rate, the occurrence of distant metastases and survival in invasive breast carcinoma (T1-2). Methods Two groups of patients were compared: a control group of 149 patients treated by classical quadrantectomy without IESM, and an IESM study group of 102 patients submitted to surgical treatment guided by this procedure. In the IESM group 64 quandrantectomies, 33 enlarged quadrantectomies and five mastectomies were performed. Results In the control group 17 local recurrences (11.4%), 49 distant metastases (39.2%) and 43 deaths (31.5%) occurred; in the IESM group there were no local recurrences, nine distant metastases occurred (8.8%) and three patients died (2%). Adjuvant treatment was the same in both groups. The survival curves were estimated by the Kaplan-Meier method and compared with the log-rank test. The curves were censored at 99 months of follow-up for adequate comparison because the follow-up period was different in the two groups. Significant differences in local recurrence-free survival and distant metastasis-free survival curves (P = 0.001) in favor of the study group were observed. The overall survival curve of the IESM group was also superior, but statistical analysis revealed only a strong tendency without significance (P = 0.06). Conclusion Treatment of early infiltrating breast carcinoma guided by IESM results in a better prognosis.
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Affiliation(s)
- Alfredo C S D Barros
- Gynecologic Clinic of the University of São Paulo Medical School, São Paulo, Brazil.
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Favarão KU, Mantese JC, Barros ACSD. Shoulder mobility after axillary sentinel node biopsy for early infiltrating breast cancer treatment. EUR J GYNAECOL ONCOL 2010; 31:23-26. [PMID: 20349776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
It is known that complete axillary lymph node dissection for breast cancer treatment causes more frequent sensitive and motor alterations in the homolateral shoulder and upper limb than sentinel lymph node (SLN) biopsy. However, it is not clear how often patients treated by SLN biopsy suffer from shoulder mobility (SM) restriction, as well as its severity and duration. This study was done aiming to evaluate SM in 38 patients with early infiltrating breast cancer treated by SLN biopsy in whom shoulder movements were assessed before surgery and repeated at one, two and three months later. Shoulder-arm mobility was evaluated by goniometry considering flexion, abduction, aduction, extension, internal rotation and external rotation. An abnormal result for each movement was defined by restriction greater than ten degrees compared to preoperative findings. Significant abnormal results for flexion and abduction were found in all of the patients at the first month evaluation. At the third month assessment no women showed any kind of SM impairment. The average restriction evolution for each of the parameters is presented. It is concluded that there is frequently a slight and transient SM limitation in patients undergoing SLN biopsy. Early postoperative physiotherapeutical assistance should thus be advisable to relieve and shorten disability symptomatology.
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Affiliation(s)
- K U Favarão
- Mastology Department, Hospital Sírio-Libanes, São Paulo, Brazil.
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Barros ACSD, Barros MAC, Andrade FE, Mori LJ, Costa PA, Sheng PY, Pelizon CHT. Combined Radioguided Nonpalpable Lesion Localization and Sentinel Lymph Node Biopsy for Early Breast Carcinoma. Ann Surg Oncol 2007; 14:1472-7. [PMID: 17225979 DOI: 10.1245/s10434-006-9268-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2006] [Revised: 07/10/2006] [Accepted: 08/03/2006] [Indexed: 11/18/2022]
Abstract
BACKGROUND The aim of this study was to test a new strategy for radioguided management of malignant or suspicious nonpalpable breast lesions, with a combination of radioguided occult lesion localization (ROLL), sentinel lymph node (SLN) mapping, and, if necessary, immediate local surgery and SLN biopsy with a single injection of (99m)Tc-labeled dextran for the whole procedure. METHODS A total of 115 nonpalpable lesions were studied: 101 with high suspicion of malignancy from which frozen sections had been produced, and 14 carcinomas diagnosed by mammotomy. On the day before surgery, 0.2 mL of solution of dextran labeled with 15 MBq of (99m)Tc was injected into the center of the lesions under imaging guidance. All patients underwent lymphoscintigraphy and open-surgery biopsy guided by gamma probe, followed by radiographic verification of the specimen. If malignancy was detected, in cases of infiltrating or ductal carcinoma-in-situ with comedonecrosis or high nuclear grade, breast-conserving surgery and SLN biopsy were performed during the same operation. RESULTS The combination of ROLL and SLN biopsy was feasible and practical. The rate of simultaneous SLN mapping by lymphoscintigraphy was 97.4% (112 of 115), and the confirmation rate for breast lesion removal by specimen radiography was 100%. It was known that 57 cases were malignant at the time of surgery. After segmental breast resection, SLN immediately underwent biopsy in 50 cases (34 infiltrating carcinomas and 16 ductal carcinoma-in-situ) with probe monitoring. Three were cytologically positive for metastasis and required full axillary dissection. CONCLUSIONS ROLL and SLN biopsy are emerging procedures that can be used simultaneously. They permit exact breast lesion excision, immediate local breast surgery, and intraoperative SLN biopsy in a single procedure. The combination of radioguided nonpalpable lesion localization and SLN biopsy is a suitable alternative to working up subclinical imaging-detected breast carcinomas.
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Affiliation(s)
- Alfredo C S D Barros
- Mastology Department, Hospital Sírio Libanês, Rua Adma Jafet, 91, Bela Vista, 01308-000, São Paulo, SP, Brazil.
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Sacchini V, Pinotti JA, Barros ACSD, Luini A, Pluchinotta A, Pinotti M, Boratto MG, Ricci MD, Ruiz CA, Nisida AC, Veronesi P, Petit J, Arnone P, Bassi F, Disa JJ, Garcia-Etienne CA, Borgen PI. Nipple-sparing mastectomy for breast cancer and risk reduction: oncologic or technical problem? J Am Coll Surg 2006; 203:704-14. [PMID: 17084333 DOI: 10.1016/j.jamcollsurg.2006.07.015] [Citation(s) in RCA: 205] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2006] [Revised: 06/18/2006] [Accepted: 07/05/2006] [Indexed: 10/24/2022]
Abstract
BACKGROUND We evaluated the risks and benefits of nipple-sparing mastectomy in a multiinstitutional experience in the settings of risk-reducing surgery and breast cancer treatment. STUDY DESIGN We analyzed data on 123 patients who had undergone nipple-sparing mastectomy with breast reconstruction for prophylaxis (n=55), treatment of breast cancer (n=41), or both (n=27) at four large centers. RESULTS Median patient age was 45 years (range 22 to 70 years). There were 192 procedures (69 bilateral, 54 unilateral). Forty-four patients had invasive cancer; 20 had ductal carcinoma in situ (DCIS); 4 had phyllodes tumor. In all of these patients, the nipple tissue was cancer free on pathologic review. Median followup was 24.6 months (range 2.0 to 570.4 months). Local recurrence developed in two patients: one had DCIS in the upper-outer quadrant, with 71.8 months of followup; the other's cancer was invasive, in the upper-outer quadrant, with 6 months of followup. Distant metastasis developed in a third patient, who died 50 months after the procedure. Breast cancer developed in two patients after prophylactic mastectomy: one in the upper-outer quadrant at 61.8 months; one in the axillary tail at 24.4 months. No patients had recurrences in the nipple-areolar complex. Necrosis of the nipple was reported in 22 of 192 patients (11%) and it was judged minimal (less than one-third total skin of nipple) in 13 of 22 patients (59%). Overall cosmesis was judged by the patient and surgeon as good to excellent in the majority of patients. Level of satisfaction with cosmetic results was similar between prophylactic and treatment patients. CONCLUSIONS The risk of local relapse was very low in our series of nipple-sparing mastectomies performed for DCIS or invasive cancer. Nipple-sparing mastectomy in the risk-reducing and breast cancer-treatment settings may be feasible in selected patients and should be the subject of additional prospective clinical trials.
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Affiliation(s)
- Virgilio Sacchini
- Breast Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA
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