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Abdallah A, Hamdy O, Zuhdy M, Elbalka SS, Abdelkhalek M, Zaid AM, Atef A, Elmadawy MG, Refky B, Wahab KA, Bayoumi D, Ali KM, Metwally IH, Shetiwy M. The epidemiological and clinicopathological characteristics of multifocal/multicentric breast cancer in the Egyptian Delta and its impact on management strategies. Breast Dis 2023; 42:101-114. [PMID: 37066900 DOI: 10.3233/bd-220066] [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: 04/18/2023]
Abstract
BACKGROUND Multifocal (MFBC)/multicentric (MCBC) breast cancer is being more recognized due to the improved imaging modalities and the greater orientation with this form of breast cancer, however, optimal surgical treatment, still poses a challenge. The standard surgical treatment is mastectomy, however, breast-conserving surgeries (BCS) may be appropriate in certain situations. METHODS A total of 464 cases of MF/MCBC out of 4798 cases of breast cancer were retrospectively analyzed from the database of the Oncology Center, Mansoura University (OCMU), between January 2008 and December 2019. RESULTS Radiologic involvement of multiple quadrants was reported in 27.9% by ultrasonography, 19% by mammography, and 59.1% by magnetic resonance imaging. BCS was performed in 32 cases (6.9%) while 432 cases underwent a mastectomy. Postoperative pathology revealed infiltration of other quadrants grossly in 23.5%, and under the microscope in 63.6% of the examined cases. Mean disease-free and overall survival were 95.5 and 164.6 months, respectively. When compared with MFBC, MCBC showed higher pathologic tumor size (p < 0.001), higher stages (p < 0.001), higher recurrence rates (p = 0.006), and lower DFS (P = 0.009) but with similar OS (P = 0.8). CONCLUSION Mastectomy is still the primary treatment option for MCBC with higher recurrence rates compared with MFBC. However, BCS for properly selected MFBC is considered oncologically safe, following the same rules of breast conservation for unifocal disease.
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Affiliation(s)
- Ahmed Abdallah
- Department of Surgical Oncology, Oncology Center, Mansoura University (OCMU), Mansoura, Egypt
| | - Omar Hamdy
- Department of Surgical Oncology, Oncology Center, Mansoura University (OCMU), Mansoura, Egypt
| | - Mohammad Zuhdy
- Department of Surgical Oncology, Oncology Center, Mansoura University (OCMU), Mansoura, Egypt
| | - Saleh S Elbalka
- Department of Surgical Oncology, Oncology Center, Mansoura University (OCMU), Mansoura, Egypt
| | - Mohamed Abdelkhalek
- Department of Surgical Oncology, Oncology Center, Mansoura University (OCMU), Mansoura, Egypt
| | - Amir M Zaid
- Department of Surgical Oncology, Oncology Center, Mansoura University (OCMU), Mansoura, Egypt
| | - Ahmed Atef
- Department of Surgical Oncology, Oncology Center, Mansoura University (OCMU), Mansoura, Egypt
| | - Mohamed G Elmadawy
- Department of Surgical Oncology, Oncology Center, Mansoura University (OCMU), Mansoura, Egypt
| | - Basel Refky
- Department of Surgical Oncology, Oncology Center, Mansoura University (OCMU), Mansoura, Egypt
| | - Khaled Abdel Wahab
- Department of Surgical Oncology, Oncology Center, Mansoura University (OCMU), Mansoura, Egypt
| | - Dalia Bayoumi
- Department of Radio-Diagnosis, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Khadiga M Ali
- Department of Pathology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Islam H Metwally
- Department of Surgical Oncology, Oncology Center, Mansoura University (OCMU), Mansoura, Egypt
| | - Mosab Shetiwy
- Department of Surgical Oncology, Oncology Center, Mansoura University (OCMU), Mansoura, Egypt
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Fathi A, Elmoatasembellah M, Senbel A, Shahatto F, Eldamshety O, Shetiwy M, Abdel Wahab K, Abouzid A, Setit A. Safety and Efficacy of Using Staplers and Vessel Sealing Devices for Laparoscopic Splenectomy: A Randomized Controlled Trial. Surg Innov 2020; 28:303-308. [PMID: 32845223 DOI: 10.1177/1553350620953023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 12/21/2022]
Abstract
Background. Laparoscopic splenectomy (LS) is considered the operation of choice on elective basis for managing patients with certain hematological disorders. Hemostatic control of the splenic pedicle is one of the crucial steps in LS. This study compares the safety and efficacy of using endoscopic staplers and vessel sealing devices to control the splenic pedicle in patients with nonsevere splenomegaly. Methods. Fifty-one consecutive patients with different blood disorders including idiopathic thrombocytopenic purpura (ITP), hypersplenism, and lymphoma were randomized for elective LS. Traditional steps of LS, via lateral approach, were followed, and pedicle control was done with either endovascular gastrointestinal anastomosis stapler (n = 26) or vessel sealing device (Ligasure) (n = 25). Results. No difference was noted with different splenic spans when using either methods of pedicle control (P = .145). The volume of blood loss was higher in the Ligasure group compared to the staplers group (182 mL vs 131 mL, respectively), but was not statistically significant (P = .249). Conversion to open was notably higher in the Ligasure group (P = .034), but the intraoperative complications were comparable in both groups (P = .357). Conclusion. The use of vessel sealing devices for splenic pedicle control has comparable surgical outcomes compared with the use of endoscopic staplers for LS, but with higher rate of conversion to open surgery.
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Affiliation(s)
- Adel Fathi
- Surgical Oncology Unit, Oncology Center, Department of Surgery, 243489Mansoura University, Egypt
| | - Mansour Elmoatasembellah
- Surgical Oncology Unit, Oncology Center, Department of Surgery, 243489Mansoura University, Egypt
| | - Ahmed Senbel
- Surgical Oncology Unit, Oncology Center, Department of Surgery, 243489Mansoura University, Egypt
| | - Fayez Shahatto
- Surgical Oncology Unit, Oncology Center, Department of Surgery, 243489Mansoura University, Egypt
| | - Osama Eldamshety
- Surgical Oncology Unit, Oncology Center, Department of Surgery, 243489Mansoura University, Egypt
| | - Mosab Shetiwy
- Surgical Oncology Unit, Oncology Center, Department of Surgery, 243489Mansoura University, Egypt
| | - Khaled Abdel Wahab
- Surgical Oncology Unit, Oncology Center, Department of Surgery, 243489Mansoura University, Egypt
| | - Amr Abouzid
- Surgical Oncology Unit, Oncology Center, Department of Surgery, 243489Mansoura University, Egypt
| | - Ahmed Setit
- Surgical Oncology Unit, Oncology Center, Department of Surgery, 243489Mansoura University, Egypt
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Hussein O, Abdel Wahab K, Hamdy O, Arafa M, Hamed EE, Awny S, Roshdy S, Denewer A, Mosbah M. Parotid Quadrantectomy Is a Safe Management for Localized Pleomorphic Adenoma. Front Surg 2018; 5:3. [PMID: 29459898 PMCID: PMC5807666 DOI: 10.3389/fsurg.2018.00003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 08/07/2017] [Accepted: 01/09/2018] [Indexed: 11/30/2022] Open
Abstract
Aim Pleomorphic adenoma is the most common benign tumor of the parotid gland and is classically treated with superficial or total parotidectomy. Less radical surgeries have been proposed to minimize the risk of facial nerve injury. The oncological safety of these procedures remains controversial. We conducted this study to evaluate the safety of superficial hemi-lobectomy (quadrantectomy). Patients and methods Retrospective analysis was conducted on the paraffin sections of archived superficial parotidectomy specimens from 11 male and 6 female patients (median age 33 years). The microscopic extent of extra-capsular extension was determined on pathological revision. In addition, prospective evaluation of 12 quadrantectomy procedures (M/F = 7/5, median age = 36 years) compared to 24 radical surgeries (M = F, median age = 40 years) regarding temporary and persistent facial nerve dysfunction on routine clinical assessment and recurrence rate. Results On retrospective pathological revision, pleomorphic adenomata had a median microscopic spread of 3 mm beyond capsule in paraffin sections (SD = 3.6). On prospective analysis with a median follow-up of 33 months (range = 18–54 months), quadrantectomy had similar relative risk of temporary facial nerve dysfunction evaluated at the immediate postoperative period as well as persistent nerve dysfunction assessed at 3 months (P = 0.701 and P = 0.902, respectively). Of the whole study population, one case of recurrence after total parotidectomy was observed at mid-term follow-up (P = 1.000). Conclusion Parotid quadrantectomy is a safe management for smaller pleomorphic adenomata localized close to one of the two divisions of the facial nerve.
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Affiliation(s)
- Osama Hussein
- Surgical Oncology Department, Mansoura University Faculty of Medicine, Mansoura University Cancer Center, Mansoura, Egypt
| | - Khaled Abdel Wahab
- Surgical Oncology Department, Mansoura University Faculty of Medicine, Mansoura University Cancer Center, Mansoura, Egypt
| | - Omar Hamdy
- Surgical Oncology Department, Mansoura University Faculty of Medicine, Mansoura University Cancer Center, Mansoura, Egypt
| | - Mohammad Arafa
- Pathology Department, Mansoura University Faculty of Medicine, Mansoura, Egypt
| | - Emad-Eldeen Hamed
- Surgical Oncology Department, Mansoura University Faculty of Medicine, Mansoura University Cancer Center, Mansoura, Egypt
| | - Shady Awny
- Surgical Oncology Department, Mansoura University Faculty of Medicine, Mansoura University Cancer Center, Mansoura, Egypt
| | - Sameh Roshdy
- Surgical Oncology Department, Mansoura University Faculty of Medicine, Mansoura University Cancer Center, Mansoura, Egypt
| | - Adel Denewer
- Surgical Oncology Department, Mansoura University Faculty of Medicine, Mansoura University Cancer Center, Mansoura, Egypt
| | - Mahmoud Mosbah
- Surgical Oncology Department, Mansoura University Faculty of Medicine, Mansoura University Cancer Center, Mansoura, Egypt
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