Surgical Management of Locoregional Recurrence in Breast Cancer

Anesthesia-related postoperative oncological surgical outcomes: a comparison of total intravenous anesthesia and volatile anesthesia. A meta-analysis

Introduction

In patients undergoing cancer surgery, it is ambiguous whether propofol-based total intravenous anesthesia (TIVA) elicits a significantly higher overall survival rate than volatile anesthetics (VA). Consequently, evaluating the impact of TIVA and VA on long-term oncological outcomes is crucial.

Aim

This study compared TIVA versus VA for cancer surgery patients and investigated the potential correlation between anesthetics and their long-term surgical outcomes.

Material and methods

A comprehensive search of Medline, EMBASE, Scopus, and Cochrane Library identified English-language peer-reviewed journal papers. The statistical measurements of hazard ratio (HR) and 95% CI were calculated. We assessed heterogeneity using Cochrane Q and I2 statistics and the appropriate p-value. The analysis used RevMan 5.3.

Results

The meta-analysis included 10 studies with 14036 cancer patients, 6264 of whom received TIVA and 7777 VA. In this study, we examined the long-term oncological outcomes of cancer surgery patients with TIVA and VA. Our data show that the TIVA group had a considerably higher overall survival rate (HR = 0.49, 95% CI: 0.30-0.80) and recurrence-free survival rate (HR = 0.56, 95% CI: 0.32-0.97). Each outcome was statistically significant (p < 0.05).

Conclusions

The present study concludes that TIVA is a more effective anesthetic agent than VA in obtaining better long-term oncological outcomes in cancer patients after surgery as it provides a higher overall survival rate, a higher recurrence-free survival rate and fewer post-operative pathological findings in patients who have undergone surgery for cancer as compared to VA.

Locoregional recurrence in triple negative breast cancer: past, present, and future

INTRODUCTION

Triple negative breast cancer (TNBC) is a rare but aggressive biological subtype of breast cancer associated with higher locoregional and distant recurrence rates and lower overall survival despite advancements in diagnostic and treatment strategies.

AREAS COVERED

This review explores the evolving landscape of locoregional recurrence (LRR) in TNBC with improved surgical and radiation therapy delivery techniques including salvage breast conserving surgery (SBCS), re-irradiation, and thermo-radiation. We review current retrospective and prospective, albeit limited, clinical data highlighting the optimal management of locoregionally recurrent TNBC. We also discuss tumor genomic profiling and transcriptome analysis and review potential investigational directions.

EXPERT OPINION

Significant progress has been made in the prevention of LRR but rates remain suboptimal, particularly in the TNBC population, and outcomes following LRR are poor. Further prospective studies are needed to identify the most effective and safest systemic therapy regimens and to whom it should be offered. There has been growing interest in the role of molecular markers, genomic signatures, and tumor microenvironment in predicting outcomes and guiding LRR treatment. Transcriptome analyses and biomarker-driven investigations are currently being studied and represent a promising era of development in the management of LRR.

[The Significance of Oncoplastic Breast Reconstruction After Tumorectomy in Surgical Breast Cancer Therapy]

Breast-conserving therapy (BCT), meaning tumorectomy in combination with systemic therapy and locoregional radiation therapy has become the preferred method to treat early-stage breast cancer. With excellent long-term recurrence-free and overall survival rates, breast surgeons today must deliver du- rable and aesthetically appealing results that guarantee a good quality of life to meet the high patient expectations. Oncoplas- tic breast surgery (OPBS) is an innovative approach to improve the overall results of BCT. Often carried out by a team of a plastic surgeon and an oncologic breast surgeon, OPBS can actively prevent breast deformities without compromising oncological safety. In the following, an overview of the principles and techniques of oncoplastic breast surgery will be given due to its ever-increasing significance and its advantages and dis- advantages will be discussed in the context of reconstructive breast surgery.