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Tian Y, Han L, Ma X, Guo R, GeSang Z, Zhai Y, Hu H. Comparison of the effect of ultrasounic-harmonic scalpel and electrocautery in the treatment of axillary lymph nodes during radical surgery for breast cancer. World J Surg Oncol 2024; 22:91. [PMID: 38600546 PMCID: PMC11007932 DOI: 10.1186/s12957-024-03381-x] [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: 01/08/2024] [Accepted: 04/06/2024] [Indexed: 04/12/2024] Open
Abstract
OBJECTIVE To compare the efficacy of ultrasounic-harmonic scalpel and electrocautery in the treatment of axillary lymph nodes during radical surgery for breast cancer. METHODS A prospective study was conducted in the Department of Breast Surgery, Zhongda Hospital Affiliated to Southeast University. A total of 128 patients with pathologically confirmed breast cancer who were treated by the same surgeon from July 2023 to November 2023 were included in the analysis. All breast operations were performed using electrocautery, and surgical instruments for axillary lymph nodes were divided into ultrasounic-harmonic scalpel group and electrocautery group using a random number table. According to the extent of lymph node surgery, it was divided into four groups: sentinel lymph node biopsy, lymph node at station I, lymph node at station I and II, and lymph node dissection at station I, II and III. Under the premise of controlling variables such as BMI, age and neoadjuvant chemotherapy, the effects of ultrasounic-harmonic scalpel and electrocautery in axillary surgery were compared. RESULTS Compared with the electrosurgical group, there were no significant differences in lymph node operation time, intraoperative blood loss, postoperative axillary drainage volume, axillary drainage tube indwelling time, postoperative pain score on the day after surgery, and the incidence of postoperative complications (p>0.05). CONCLUSION There is no significant difference between ultrasounic-harmonic scalpel and electrocautery in axillary lymph node treatment for breast cancer patients, which can provide a basis for the selection of surgical energy instruments.
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Affiliation(s)
- Yujia Tian
- School of Medicine, Southeast University, Nanjing, 210009, China
- Department of General Surgery, Zhongda Hospital Affiliated to Southeast University, Nanjing, 210009, China
- Breast Disease Diagnosis and Treatment Center, Zhongda Hospital Affiliated to Southeast University, Nanjing, 210009, China
| | - Lifei Han
- Department of General Surgery, Zhongda Hospital Affiliated to Southeast University, Nanjing, 210009, China
- Breast Disease Diagnosis and Treatment Center, Zhongda Hospital Affiliated to Southeast University, Nanjing, 210009, China
| | - Xiao Ma
- Department of General Surgery, Zhongda Hospital Affiliated to Southeast University, Nanjing, 210009, China
- Breast Disease Diagnosis and Treatment Center, Zhongda Hospital Affiliated to Southeast University, Nanjing, 210009, China
| | - Rui Guo
- School of Medicine, Southeast University, Nanjing, 210009, China
- Department of General Surgery, Zhongda Hospital Affiliated to Southeast University, Nanjing, 210009, China
- Breast Disease Diagnosis and Treatment Center, Zhongda Hospital Affiliated to Southeast University, Nanjing, 210009, China
| | - Zhuoga GeSang
- School of Medicine, Southeast University, Nanjing, 210009, China
- Department of General Surgery, Zhongda Hospital Affiliated to Southeast University, Nanjing, 210009, China
- Breast Disease Diagnosis and Treatment Center, Zhongda Hospital Affiliated to Southeast University, Nanjing, 210009, China
| | - Yabo Zhai
- School of Medicine, Southeast University, Nanjing, 210009, China
- Department of General Surgery, Zhongda Hospital Affiliated to Southeast University, Nanjing, 210009, China
- Breast Disease Diagnosis and Treatment Center, Zhongda Hospital Affiliated to Southeast University, Nanjing, 210009, China
| | - Haolin Hu
- School of Medicine, Southeast University, Nanjing, 210009, China.
- Department of General Surgery, Zhongda Hospital Affiliated to Southeast University, Nanjing, 210009, China.
- Breast Disease Diagnosis and Treatment Center, Zhongda Hospital Affiliated to Southeast University, Nanjing, 210009, China.
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Drapalik LM, Shenk R, Rock L, Simpson A, Amin AL, Miller ME. Should breast surgery be considered for patients with de novo metastatic inflammatory breast cancer? Am J Surg 2024:S0002-9610(24)00068-0. [PMID: 38458830 DOI: 10.1016/j.amjsurg.2024.02.007] [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: 09/24/2023] [Revised: 01/29/2024] [Accepted: 02/05/2024] [Indexed: 03/10/2024]
Abstract
INTRODUCTION We aimed to identify factors predicting surgery for de novo stage IV inflammatory breast cancer (IBC) and determine the association of surgery with overall survival (OS). METHODS Female patients with unilateral AJCC clinical stage IV IBC treated 2010-2018 in the NCDB were identified. Logistic regression and multivariable proportional Cox hazards regressions determined factors associated with treatment and OS. RESULTS Of 1049 patients, 29.1% underwent breast surgery (BS) and 70.9% had no surgery (NS). Increasing age and more recent treatment year were significantly associated with NS. 2-Year OS was superior in BS patients (71% vs 38% NS). Single-site and bone-only metastasis had no association with treatment type or OS. CONCLUSION Contrary to guidelines, 1/3 of de novo stage IV IBC patients underwent BS, and had an independent OS benefit irrespective of extent or site of metastasis. Further research is needed to determine which patients with stage IV IBC should undergo BS.
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Affiliation(s)
- Lauren M Drapalik
- Department of Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA; University Hospitals Research in Surgical Outcomes and Effectiveness (UH-RISES), Cleveland, OH, USA
| | - Robert Shenk
- Department of Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA; University Hospitals Research in Surgical Outcomes and Effectiveness (UH-RISES), Cleveland, OH, USA
| | - Lisa Rock
- Department of Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Ashley Simpson
- Department of Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Amanda L Amin
- Department of Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA; University Hospitals Research in Surgical Outcomes and Effectiveness (UH-RISES), Cleveland, OH, USA
| | - Megan E Miller
- Department of Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA; University Hospitals Research in Surgical Outcomes and Effectiveness (UH-RISES), Cleveland, OH, USA.
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Yu L, Shen XJ, Liu H, Zhou YT, Zhang Q, Zhang ZD, Shen SM. Effect of ultrasound-guided continuous erector spinae plane block on postoperative pain and inflammatory response in patients undergoing modified radical mastectomy for breast cancer: study protocol for a randomised controlled trial. Trials 2024; 25:51. [PMID: 38225606 PMCID: PMC10788999 DOI: 10.1186/s13063-023-07777-0] [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: 04/21/2023] [Accepted: 11/06/2023] [Indexed: 01/17/2024] Open
Abstract
BACKGROUND A single injection of local anaesthetic (LA) in the erector spinae plane block (ESPB) can reduce pain after modified radical mastectomy (MRM) surgery, but the duration of analgesia is affected by the duration of the LA. The aim of this study is to investigate the effect of continuous ESPB on acute and chronic pain and inflammatory response after MRM surgery. METHODS In this prospective, randomised, controlled trial, we will recruit 160 patients, aged 18-80 years, scheduled for elective MRM surgery under general anaesthesia. They will be randomly assigned to two groups: a continuous ESPB group (group E) and a sham block group (group C). Both groups of patients will have a nerve block (group C pretended to puncture) and an indwelling catheter fixed prior to surgery. Electronic pumps containing LA are shielded. The primary outcome is the total consumption of analgesic agents. The secondary outcomes include the levels of inflammation-related cytokines; the occurrence of chronic pain (post-mastectomy pain syndrome, PMPS); static and dynamic pain scores at 2, 6, 12, 24 and 48 h postoperatively; and post-operative and post-puncture adverse reactions. DISCUSSION Analgesia after MRM surgery is important and chronic pain can develop when acute pain is prolonged, but the analgesic effect of a nerve block with a single injection of LA is limited by the duration of drug action. The aim of this trial is to investigate whether continuous ESPB can reduce acute pain after MRM surgery and reduce the incidence of chronic pain (PMPS), with fewer postoperative analgesic drug-related complications and less inflammatory response. Continuous ESPB and up to 12 months of follow-up are two innovations of this trial. TRIAL REGISTRATION Chinese Clinical Trial Registry ( https://www.chictr.org.cn/ ) ChiCTR2200061935. Registered on 11 July 2022. This trial is a prospective registry with the following registry names: Effect of ultrasound-guided continuous erector spinae plane block on postoperative pain and inflammatory response in patients undergoing modified radical mastectomy for breast cancer.
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Affiliation(s)
- Liang Yu
- Department of Anesthesiology, Huzhou Central Hospital, The Fifth School of Clinical Medicine of Zhejiang Chinese Medical University, The Affiliated Huzhou Hospital, Zhejiang University School of Medicine, Affiliated Central Hospital, Huzhou University, No. 1558 Sanhuan North Road, Huzhou, 313000, Zhejiang, China
| | - Xiao-Juan Shen
- Department of 706A Ward Nursing, Huzhou Central Hospital, The Fifth School of Clinical Medicine of Zhejiang Chinese Medical University, The Affiliated Huzhou Hospital, Zhejiang University School of Medicine, Affiliated Central Hospital, Huzhou University, No. 1558 Sanhuan North Road, Huzhou, 313000, Zhejiang, China.
| | - He Liu
- Department of Anesthesiology, Huzhou Central Hospital, The Fifth School of Clinical Medicine of Zhejiang Chinese Medical University, The Affiliated Huzhou Hospital, Zhejiang University School of Medicine, Affiliated Central Hospital, Huzhou University, No. 1558 Sanhuan North Road, Huzhou, 313000, Zhejiang, China
| | - Yu-Ting Zhou
- Department of Breast Surgery, Huzhou Central Hospital, The Fifth School of Clinical Medicine of Zhejiang Chinese Medical University, The Affiliated Huzhou Hospital, Zhejiang University School of Medicine, Affiliated Central Hospital, Huzhou University, No. 1558 Sanhuan North Road, Huzhou, 313000, Zhejiang, China
| | - Qin Zhang
- Department of Anesthesiology, Huzhou Central Hospital, The Fifth School of Clinical Medicine of Zhejiang Chinese Medical University, The Affiliated Huzhou Hospital, Zhejiang University School of Medicine, Affiliated Central Hospital, Huzhou University, No. 1558 Sanhuan North Road, Huzhou, 313000, Zhejiang, China
| | - Zhen-Duo Zhang
- Department of Anesthesiology, Huzhou Central Hospital, The Fifth School of Clinical Medicine of Zhejiang Chinese Medical University, The Affiliated Huzhou Hospital, Zhejiang University School of Medicine, Affiliated Central Hospital, Huzhou University, No. 1558 Sanhuan North Road, Huzhou, 313000, Zhejiang, China
| | - Shu-Min Shen
- Department of Anesthesiology, Huzhou Central Hospital, The Fifth School of Clinical Medicine of Zhejiang Chinese Medical University, The Affiliated Huzhou Hospital, Zhejiang University School of Medicine, Affiliated Central Hospital, Huzhou University, No. 1558 Sanhuan North Road, Huzhou, 313000, Zhejiang, China
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Gao W, Li H, Li T, Zhang L, Zhang T, Lin W, Wen Z, Cao L, Tan H. Effects of S-ketamine on Postoperative Recovery Quality and Inflammatory Response in Patients Undergoing Modified Radical Mastectomy. Pain Ther 2023; 12:1165-1178. [PMID: 37354266 PMCID: PMC10444913 DOI: 10.1007/s40122-023-00533-x] [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: 05/07/2023] [Accepted: 06/08/2023] [Indexed: 06/26/2023] Open
Abstract
INTRODUCTION S-ketamine plays an important role in reducing postoperative pain, but its impact on the quality of recovery in breast cancer has not been clarified. We designed this trial to explore the effects of s-ketamine on the quality of postoperative recovery and inflammatory response in modified radical mastectomy. METHODS A total of 138 patients were randomly assigned to group C (group control), group K1 (group of s-ketamine dose 1) and group K2 (group of s-ketamine dose 2). Groups K1 and K2 were given 0.1 mg/kg, 0.2 mg/kg s-ketamine intravenous (IV) after induction, followed by 0.1 mg/kg/h or 0.2 mg/kg/h continuous intravenous infusion, respectively. Group C received the same volume of saline. A 40-item Quality of Recovery Questionnaire (QoR-40) was used to assess the quality of recovery at 24 h postoperatively. Changes in inflammatory markers, nociceptive thresholds, and the occurrence of adverse events were recorded at 24 h postoperatively. RESULTS The QoR-40 scores at 24 h postoperatively were higher in group K2 [182.00 (179.00-185.00)] compared to group K1 [174.00 (169.50-180.50)] and group C [169.00 (163.75-174.25)] (group K2 vs. group K1, P < 0.001; group K2 vs. group C, P < 0.001). At 24 h postoperatively, the neutrophil count, NLR (neutrophil-lymphocyte ratio), and CRP (C-creative protein) were all significantly lower in group K2 than group C(P < 0.05), no differences were observed between group K1 and C(P > 0.05), group K1 and K2(P > 0.05), respectively. There was no significant difference in the incidence of adverse effects among the three groups (P > 0.05). CONCLUSIONS A high dose of s-ketamine improved the quality of recovery at 24 h after surgery, as well as alleviated the inflammatory response without increasing the incidence of adverse effects.
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Affiliation(s)
- Wuyou Gao
- Department of Thoracic Surgery, State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, China
| | - Huiting Li
- Department of Anesthesiology, State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, China
| | - Ting Li
- Department of Anesthesiology, State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, China
| | - Lili Zhang
- Department of Anaesthesiology, Hubei Cancer Hospital, Hubei, 430000, China
| | - Tianhua Zhang
- Department of Anesthesiology, State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, China
| | - Wenqian Lin
- Department of Anesthesiology, State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, China
| | - Zhesheng Wen
- Department of Thoracic Surgery, State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, China.
| | - Longhui Cao
- Department of Anesthesiology, State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, China.
| | - Hongying Tan
- Department of Anesthesiology, State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, China.
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Xu Y, Cao J, Gong K, Li S, Liu Y, Xiong F, Pan Y, Chen M, Gong J, Luo N, Yuan S. Oncoplastic breast-conserving surgery improves cosmetic outcomes without increasing recurrence risk compared to modified radical mastectomy in early breast cancer patients: development and validation of a recurrence risk prediction model. Am J Cancer Res 2023; 13:4259-4268. [PMID: 37818068 PMCID: PMC10560934] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 08/17/2023] [Indexed: 10/12/2023] Open
Abstract
In the quest for effective treatment of early-stage breast cancer, this study aimed to compare the clinical efficacy of modified radical mastectomy (MRM) and oncoplastic breast-conserving surgery (OBCS). Breast cancer remains a major health concern globally, where early detection and effective treatment strategies are crucial for improving the outcomes of patients. MRM and OBCS are two primary treatment modalities for breast cancer, each with its distinct benefits and challenges. Through a retrospective analysis, we found that although the patients in the OBCS group experienced a longer operation time, they had significantly less intraoperative bleeding, postoperative drainage, and hospitalization time compared to the MRM group. Furthermore, patients in the OBCS group demonstrated higher subjective satisfaction and quality of life scores, along with better objective outcomes. In terms of postoperative complications and recurrence rates, no significant difference was identified between the two groups. However, our multivariate Cox regression analysis identified lymph node metastasis and molecular type as independent prognostic factors for disease-free survival (DFS). Subsequently, we constructed a risk model based on these variables, which was proven to be effective in predicting recurrence, with an area under the risk score curve for recurrence prediction being 0.852. The group with a lower risk score demonstrated a significantly higher DFS rate. Our study suggests that compared with MRM, OBCS can significantly reduce surgical incision, improve patient satisfaction, and does not increase the risk of complications or recurrence. Our risk model, developed using Cox regression, also demonstrated high clinical value in predicting breast cancer recurrence, thereby aiding in personalized patient management and treatment planning.
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Affiliation(s)
- Yong Xu
- Department of Breast and Nail Surgery, The First People's Hospital of Changde City Changde 415000, Hunan, China
| | - Jiyao Cao
- Department of Breast and Nail Surgery, The First People's Hospital of Changde City Changde 415000, Hunan, China
| | - Ke Gong
- Department of Breast and Nail Surgery, The First People's Hospital of Changde City Changde 415000, Hunan, China
| | - Shengyun Li
- Department of Breast and Nail Surgery, The First People's Hospital of Changde City Changde 415000, Hunan, China
| | - Youzhong Liu
- Department of Breast and Nail Surgery, The First People's Hospital of Changde City Changde 415000, Hunan, China
| | - Fang Xiong
- Department of Breast and Nail Surgery, The First People's Hospital of Changde City Changde 415000, Hunan, China
| | - Yuejun Pan
- Department of Breast and Nail Surgery, The First People's Hospital of Changde City Changde 415000, Hunan, China
| | - Mingtao Chen
- Department of Breast and Nail Surgery, The First People's Hospital of Changde City Changde 415000, Hunan, China
| | - Jia Gong
- Department of Breast and Nail Surgery, The First People's Hospital of Changde City Changde 415000, Hunan, China
| | - Na Luo
- Department of Breast and Nail Surgery, The First People's Hospital of Changde City Changde 415000, Hunan, China
| | - Songlin Yuan
- Department of Breast and Nail Surgery, The First People's Hospital of Changde City Changde 415000, Hunan, China
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S. B, Yadav SK, Sharma D, Agarwal P, Jha S, Shekhar S, Sharma DB, Mishra A. Patient Perspectives After Surgery-Related Complications Among Breast Cancer Patients from a LMIC. Indian J Surg Oncol 2023; 14:595-600. [PMID: 37900625 PMCID: PMC10611678 DOI: 10.1007/s13193-023-01721-z] [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: 01/19/2023] [Accepted: 02/13/2023] [Indexed: 02/23/2023] Open
Abstract
Long-term quality of life in breast cancer patients has been studied and published regularly. However, the lived experiences of patients who develop complications after surgery are not well understood. Determining this experience of patients is challenging in most low- and middle-income countries where the majority of patients belong to poor strata of society and are uneducated. We aimed to explore the thoughts, feelings, and experiences of patients with surgery-related complications after breast cancer surgery. Purposive sampling was used to identify patients who developed any postoperative complication, and semi-structured interviews were conducted. Common patterns of patient experiences were identified and analyzed using descriptive thematic analysis. Twenty-eight patients out of 210 developing complications postoperatively were identified. The median age was 48 years (range 32-65 years). The majority (n = 26) were housewives, educated below the primary level (n = 11) and below the poverty line (n = 13). Complications included seroma (n = 17), flap necrosis and infection (n = 5), and hematoma (n = 1). Seven domains emerged from the interviews-knowledge of complications, psychological impact, burden, disruptiveness, social impact, relationship with the surgical team, and suggestions to improve the experience. The themes identified in the present study provide insights into the lived experiences and can inform the future development of patient-reported outcome measures and quality improvement programs, including more effective pre-operative counseling and consent. Supplementary Information The online version contains supplementary material available at 10.1007/s13193-023-01721-z.
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Affiliation(s)
- Bharath S.
- Department of Surgery, NSCB Medical College, Jabalpur, India
| | | | | | - Pawan Agarwal
- Department of Surgery, NSCB Medical College, Jabalpur, India
| | - Shikha Jha
- Department of Psychiatry, AIIMS, Patna, India
| | - Saket Shekhar
- Department of Preventive, Social Medicine and Biostatistics, Rama Medical College, Kanpur, India
| | | | - Arpan Mishra
- Department of Surgery, NSCB Medical College, Jabalpur, India
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Shi HY, Li CH, Chen YC, Chiu CC, Lee HH, Hou MF. Quality of life and cost-effectiveness of different breast cancer surgery procedures: a Markov decision tree-based approach in the framework of Predictive, Preventive, and Personalized Medicine. EPMA J 2023; 14:457-475. [PMID: 37605647 PMCID: PMC10439868 DOI: 10.1007/s13167-023-00326-4] [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: 03/09/2023] [Accepted: 05/14/2023] [Indexed: 08/23/2023]
Abstract
Purpose Breast cancer is a complex disease with heterogeneous outcomes that may benefit from the implementation of Predictive, Preventive, and Personalized Medicine (PPPM/3PM) strategies. In this study, we aimed to explore the potential of PPPM approaches by investigating the 10-year trends in quality of life (QOL) and the cost-effectiveness of different types of surgeries for patients with breast cancer. Methods This prospective cohort study recruited 144 patients undergoing breast conserving surgery (BCS), 199 undergoing modified radical mastectomy (MRM), and 44 undergoing total mastectomy with transverse rectus abdominis myocutaneous flap (TRAMF) from three medical centers in Taiwan between June 2007 and June 2010. Results All patients exhibited a significant decrease in most QOL dimension scores from before surgery to 6 months postoperatively (p < 0.05); however, from postoperative year 1 to 2, improvement in most QOL dimension scores was significantly better in the TRAMF group than in the BCS and MRM groups (p < 0.05). At 2, 5, and 10 years after surgery, the patients' QOL remained stable. In the Markov decision tree model, the TRAMF group had higher total direct medical costs than the MRM and BCS groups (US$ 32,426, US$ 29,487, and US$ 28,561, respectively) and higher average QALYs gained (7.771, 6.773, and 7.385, respectively), with an incremental cost-utility ratio (ICUR) of US$ 2,944.39 and US$ 10,013.86 per QALY gained. Conclusions TRAMF appeared cost effective compared with BCS and MRM, and it has been proved with considerable QOL improvements in the framework of PPPM. Future studies should continue to explore the potential of PPPM approaches in breast cancer care. By incorporating predictive models, personalized treatment plans, and preventive strategies into routine clinical practice, we can further optimize patient outcomes and reduce healthcare costs associated with breast cancer treatment. Supplementary Information The online version contains supplementary material available at 10.1007/s13167-023-00326-4.
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Affiliation(s)
- Hon-Yi Shi
- Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung, 80708 Taiwan
- Department of Business Management, National Sun Yat-Sen University, Kaohsiung, 80420 Taiwan
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, 80708 Taiwan
- Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, 40402 Taiwan
| | - Chiu-Hui Li
- Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung, 80708 Taiwan
- Superintendent Office Secretary Admission Service Center, Health Management and Occupational Safety and Health Center, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung, 81267 Taiwan
| | - Yen-Chen Chen
- Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung, 80708 Taiwan
| | - Chong-Chi Chiu
- Department of General Surgery, E-Da Cancer Hospital, I-Shou University, Kaohsiung, 82445 Taiwan
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung, 82445 Taiwan
- Department of Medical Education and Research, E-Da Cancer Hospital, I-Shou University, Kaohsiung, 82445 Taiwan
| | - Hao-Hsien Lee
- Department of Surgery, Chi Mei Medical Center, Liouying, Tainan 73658 Taiwan
| | - Ming-Feng Hou
- Division of Breast Oncology and Surgery, Department of Surgery, Kaohsiung Medical University Chung-Ho Memorial Hospital, No. 100, Shih-Chuan 1St Road, Kaohsiung, 80708 Taiwan
- Department of Biomedical Science and Environmental Biology, College of Life Science, Kaohsiung Medical University, Kaohsiung, 80708 Taiwan
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Bryan AF, Castillo-Angeles M, Minami C, Laws A, Dominici L, Broyles J, Friedlander DF, Ortega G, Jarman MP, Weiss A. Value of Ambulatory Modified Radical Mastectomy. Ann Surg Oncol 2023; 30:4637-4643. [PMID: 37166742 PMCID: PMC10173905 DOI: 10.1245/s10434-023-13588-z] [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] [Received: 01/17/2023] [Accepted: 03/13/2023] [Indexed: 05/12/2023]
Abstract
BACKGROUND Modified radical mastectomy (MRM) still is largely performed in inpatient settings. This study sought to determine the value (expenditures and complications) of ambulatory MRM. METHODS Health Care Utilization Project (HCUP) state databases from 2016 were queried for patients who underwent MRM. The study examined rates of 30-day readmission for surgical-site infection (SSI) or hematoma, charges by index care setting, and predictors of 30-day readmission. RESULTS Overall, 8090 patients underwent MRM: 5113 (63 %) inpatient and 2977 (37 %) ambulatory patients. Compared with the patients who underwent inpatient MRM, those who underwent ambulatory MRM were older (61 vs. 59 years), more often white (66 % vs. 57 %), in the lowest income quartile (28 % vs. 21 %), insured by Medicare (43 % vs. 33 %) and residents in a small metro area (6 % vs. 4 %) (all p < 0.01). Of the 5113 patients treated as inpatients, 126 (2.5 %) were readmitted, whereas 50 (1.7 %) of the ambulatory patients were readmitted (p = 0.02). The adjusted charge for inpatient MRM without readmission was $113,878 (range, $107,355-120,402) compared with $94,463 (range, $86,021-102,907) for ambulatory MRM, and the charge for inpatient MRM requiring readmission was $159,355 (range, $147,142-171,568) compared with $139,940 (range, $125,808-154,073) for ambulatory MRM (all p < 0.01). This difference remained significant after adjustment for hospital length of stay. Adjusted logistic regression showed that the ambulatory setting was protective for readmission (odds ratio, 0.49; 95 % confidence interval, 0.35-0.70; p < 0.01). CONCLUSIONS The analyses suggest that ambulatory MRM is both safe and less expensive. The findings advocate that MRM, a last holdout of inpatient care within breast surgical oncology, can be transitioned to the ambulatory setting for appropriate patients.
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Affiliation(s)
- Ava Ferguson Bryan
- Department of Surgery, University of Chicago, Chicago, IL, USA
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Manuel Castillo-Angeles
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Christina Minami
- Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Alison Laws
- Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Laura Dominici
- Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Justin Broyles
- Harvard Medical School, Boston, MA, USA
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Gezzer Ortega
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Molly P Jarman
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Anna Weiss
- Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA.
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
- Division of Surgical Oncology, Department of Surgery, University of Rochester, Rochester, NY, USA.
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9
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Zhang J, Jia D, Li W, Li X, Ma Q, Chen X. General anesthesia with S-ketamine improves the early recovery and cognitive function in patients undergoing modified radical mastectomy: a prospective randomized controlled trial. BMC Anesthesiol 2023; 23:214. [PMID: 37340359 DOI: 10.1186/s12871-023-02161-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 06/02/2023] [Indexed: 06/22/2023] Open
Abstract
BACKGROUND Postoperative cognitive dysfunction (POCD) is a common postoperative disorder that is frequently observed after general anesthesia, which seriously threatens the quality of patients' life. Existing studies have demonstrated that S-ketamine plays an important role in improving neuroinflammation. This trial aimed to explore the effects of S-ketamine on quality of recovery and cognitive function in patients following modified radical mastectomy (MRM). METHODS Ninety patients aged 45 to 70 years with ASA grades of I or II, who underwent MRM, were selected. Patients were randomly assigned to the S-ketamine or control group. In the S-ketamine group, patients were induced with S-ketamine instead of sufentanil and maintained with S-ketamine and remifentanil. In the control group, patients were induced with sufentanil and maintained with remifentanil. The primary outcome was the Mini-Mental State Examination (MMSE) and Quality of Recovery-15 (QoR-15) score. Secondary outcomes including visual analog scale (VAS) score, cumulative propofol and opioids consumption, post anesthesia care unit (PACU) recovery time, occurrence of remedial analgesia, postoperative nausea and vomiting (PONV), other adverse events, as well as patient satisfaction. RESULTS The global QoR-15 scores at postoperative day 1 (POD1) were significantly higher in the S-ketamine group than in the control group (124 [119.5-128.0] vs. 119 [114.0-123.5], P = 0.002), with a median difference of 5 points (95% confidence interval [CI] [-8 to -2]). Similarly, the global QoR-15 scores at postoperative day 2 (POD2) in the S-ketamine group were significantly higher than in the control group (140.0 [133.0-145.0] vs. 132.0 [126.5-141.5], P = 0.004). In addition, among the five subcomponents of the 15-item scale, S-ketamine group had a higher score in terms of physical comfort, pain, and emotional state both at POD1 and POD2. In terms of MMSE score, S-ketamine could promote the recovery of postoperative cognitive function at POD1, but not at POD2. Furthermore, the consumption of opioids, VAS score, and remedial analgesia in the S-ketamine group decreased significantly. CONCLUSIONS Collectively, our findings support that general anesthesia with S-ketamine as a potential strategy showed high safety and could not only improve the quality of recovery mainly through improving pain, physical comfort, and emotional state but also promote the recovery of cognitive function on POD1 in patients undergoing MRM. TRIAL REGISTRATION The study was registered in the Chinese Clinical Trial Registry (registration No:ChiCTR2200057226, Date of registration: 04/03/2022).
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Affiliation(s)
- Junxia Zhang
- Department of Anaesthesia and Perioperative Medicine, Cancer Hospital, General Hospital of Ningxia Medical University, No. 804 Shengli South Street, Xingqing District, Yinchuan, Ningxia, 750004, People's Republic of China
| | - Danting Jia
- Department of Anaesthesia and Perioperative Medicine, Cancer Hospital, General Hospital of Ningxia Medical University, No. 804 Shengli South Street, Xingqing District, Yinchuan, Ningxia, 750004, People's Republic of China
| | - Wenbin Li
- Department of Anaesthesia and Perioperative Medicine, Cancer Hospital, General Hospital of Ningxia Medical University, No. 804 Shengli South Street, Xingqing District, Yinchuan, Ningxia, 750004, People's Republic of China
| | - Xiaohui Li
- Department of Anaesthesia and Perioperative Medicine, Cancer Hospital, General Hospital of Ningxia Medical University, No. 804 Shengli South Street, Xingqing District, Yinchuan, Ningxia, 750004, People's Republic of China
| | - Qian Ma
- Department of Anaesthesia and Perioperative Medicine, Cancer Hospital, General Hospital of Ningxia Medical University, No. 804 Shengli South Street, Xingqing District, Yinchuan, Ningxia, 750004, People's Republic of China
| | - Xuexin Chen
- Department of Anaesthesia and Perioperative Medicine, Cancer Hospital, General Hospital of Ningxia Medical University, No. 804 Shengli South Street, Xingqing District, Yinchuan, Ningxia, 750004, People's Republic of China.
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10
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Khan S, Khan M, Wasim A. Single vs. double drain in modified radical mastectomy: A randomized controlled trial. Turk J Surg 2023; 39:145-152. [PMID: 38026913 PMCID: PMC10681105 DOI: 10.47717/turkjsurg.2023.5666] [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: 02/01/2022] [Accepted: 05/22/2023] [Indexed: 12/01/2023]
Abstract
Objectives It was aimed to test the hypothesis that the use of a double drain results in less seroma formation, duration of the hospital stay, surgical site infection (SSI), postoperative pain, hematoma, flap necrosis compared to a single drain in patients undergoing modified radical mastectomy. Material and Methods This parallel-group, single-institution randomized controlled trial was conducted at the department of surgery of our institute between April 2015 and July 2018. Women undergoing modified radical mastectomy were randomly allocated to either a single drain (n= 98) or double drain (n= 98). Results Both groups were comparable for baseline variables such as age, co-morbidity, BMI, and tumor characteristics. The variables of single drain yielded no better outcomes compared to double drain with estimated blood loss (101.67 ± 25.14 vs.101.67 ± 24.40, p> 0.001), drain volume (898.81 ± 116.42 vs 803.97 ± 103.22 mL, p> 0.001), duration of surgery in minutes (103.19 ± 15.96, 103.19 ± 15.93) and seroma formation (13.4% vs 6.1%, p= 0.082). However, single drain yielded less postoperative pain (mean 2.5 ± 0.70 vs 5.22 ± 5.10, p <0.000). On multivariable Cox regression analysis, single drain was associated with a lower risk of significant postoperative pain [adjusted relative risk 0.14 (95% confidence interval (CI) 0.070-0.25)] and overall complications [adjusted relative risk 0.47, (95% CI 0.26-0.86)]. On multiple linear regression, the duration of drains in the single drain group was 0.01 days less than double drain (r2= 0.00, b= 0.388, p> 0.001). Conclusion The use of a single drain significantly reduces postoperative discomfort and pain while demonstrating similar morbidity to the patient with two drains. We thus recommend preferential use of a single drain in modified radical mastectomy (NCT02411617).
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Affiliation(s)
- Salma Khan
- Department of Surgery, Rehman Medical Institute, Peshawar, Pakistan
- Clinic of Surgery, BronxCare Hospital, New York, USA
| | - Momna Khan
- Department of Gynaecology, Bilawal Medical College, Jamshoro, Pakistan
| | - Asma Wasim
- Department of Research, Colorado Technical University, Texas, USA
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11
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Abstract
OPINION STATEMENT Inflammatory breast cancer (IBC) is a rare but aggressive subtype of breast cancer that has a propensity for locoregional recurrence and distant metastasis and is associated with a disproportionately high percentage of breast cancer deaths. IBC is not resectable at initial diagnosis and trimodality therapy is considered the standard treatment for IBC. This includes systemic therapy upfront, followed by modified radical mastectomy and comprehensive chest wall and regional node radiation. Despite this aggressive multi-modal treatment strategy, the prognosis remains worse in IBC when compared with non-inflammatory locally advanced breast cancers. For patients presenting with de novo stage IV IBC, treatment recommendations vary depending on tumor burden, cancer subtype, and presence of comorbidities. Efforts to improve outcomes in IBC are currently underway; however, progress has been affected by the low incidence of disease and limited number of dedicated studies in this population. Improvements in systemic therapies in breast cancer in general are likely to lead to improvements in IBC as well. More dedicated trials are needed to identify additional treatment strategies that may help to improve prognosis for these patients. Additionally, better frameworks for diagnosis, risk stratification based upon factors such as molecular subtype and response to neoadjuvant therapy, will be important to make further progress in IBC.
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Affiliation(s)
- Alexandra B Newman
- Department of Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
- Harvard Medical School, Boston, MA, USA
| | - Filipa Lynce
- Harvard Medical School, Boston, MA, USA.
- Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA.
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA.
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12
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Bhagchandani M, Shukla V, Maurya RK, Chaudhary A, Kumar K. A Comparative Study Between Mastectomy Flap Quilting Sutures with Axillary Drain Versus Conventional Sutures with Axillary and Pectoral Drain in Reducing Post- Modified Radical Mastectomy Seroma Formation. Indian J Surg 2023:1-6. [PMID: 37361396 PMCID: PMC10078008 DOI: 10.1007/s12262-023-03756-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 03/29/2023] [Indexed: 04/08/2023] Open
Abstract
The aim of this study was to compare quilting suture with axillary drain versus conventional sutures with axillary and pectoral drain on the formation of seroma after modified radical mastectomy with axillary lymph node dissection. The study was undertaken among 90 female patients with breast cancer who were candidates for modified radical mastectomy with axillary clearance. The intervention group (N = 43) with quilting and axillary drain placement and the control group (N = 33) without quilting with axillary and pectoral drain placement. All the patients were followed up for complications pertaining to this procedure. There were no significant differences between the two groups with regard to demographic characteristics, comorbidities, pre-operative chemotherapy, post-operative pathological findings, lymph node involvement or clinical staging. The incidence of seroma formation on follow-up was significantly lower in the intervention group than that in the control group (23% versus 58%; p < 0.05) whereas there was no significant difference with respect to flap necrosis, superficial skin necrosis and wound gaping between the two groups. Furthermore, it took a shorter duration for seroma to resolve in the intervention group (4 days versus 9 days; p < 0.001) with a smaller duration of hospital stay (4 days versus 9 days; p < 0.001). The use of quilting sutures for flap fixation in order to obliterate dead space post-modified radical mastectomy with placement of axillary drain significantly reduced seroma formation along with shorter duration of wound drainage and a smaller hospital stay with only slightly increased operative time. Therefore, we recommend quilting of flap as a routine step after mastectomy.
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Affiliation(s)
- Mohit Bhagchandani
- Department of General Surgery, GSVM Medical College, Kanpur, India
- Lucknow, India
| | - Vigya Shukla
- Department of General Surgery, GSVM Medical College, Kanpur, India
| | - R. K. Maurya
- Department of General Surgery, GSVM Medical College, Kanpur, India
| | - Ashish Chaudhary
- Department of General Surgery, GSVM Medical College, Kanpur, India
| | - Kuldeep Kumar
- Department of General Surgery, GSVM Medical College, Kanpur, India
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13
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Zhang J, Sun X, Zhang F, Guo L. Perioperative nursing of patients with breast cancer undergoing modified radical mastectomy. Asian J Surg 2023; 46:1385-1386. [PMID: 36117063 DOI: 10.1016/j.asjsur.2022.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 09/02/2022] [Indexed: 11/25/2022] Open
Affiliation(s)
- Jing Zhang
- Department of Surgical Nursing, Dongyang Maternal and Child Health Hospital, Dongyang, Zhejiang, 322100, PR China
| | - Xiaoying Sun
- Department of Nursing, Dongyang Maternal and Child Health Hospital, Dongyang, Zhejiang, 322100, PR China
| | - Fangyuan Zhang
- Department of Surgical Nursing, Dongyang Maternal and Child Health Hospital, Dongyang, Zhejiang, 322100, PR China
| | - Lanzhong Guo
- Department of Traditional Chinese Medicine, Dongyang Maternal and Child Health Hospital, Dongyang, Zhejiang, 322100, PR China.
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14
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Konara Mudiyanselage SP, Wu YL, Kukreti S, Chen CC, Lin CN, Tsai YT, Ku HC, Fang SY, Wang JD, Ko NY. Dynamic changes in quality of life, psychological status, and body image in women who underwent a mastectomy as compared with breast reconstruction: an 8-year follow up. Breast Cancer 2023; 30:226-240. [PMID: 36319889 DOI: 10.1007/s12282-022-01413-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 10/27/2022] [Indexed: 02/24/2023]
Abstract
BACKGROUND Surgical decisions and methods of surgery highly influence long term QoL for breast cancer (BC) survivors. This study is aimed towards an exploration of the dynamic changes in quality of life (QoL), anxiety/depression status, and body image (BI) among women with BC who received a mastectomy compared with those receiving breast reconstruction (BR) within an 8-year follow-up period. METHODS Women with major BC surgeries were invited to complete the World Health Organization Quality of Life-Brief (WHOQOL-BREF), the European quality of life five dimensions questionnaire (EQ-5D), and a body image scale within 8 years of surgery. Kernel smoothing methods were applied to describe dynamic changes in QoL, anxiety/depression, and BI at different time points. Linear mixed effects models were constructed to identify the interaction between time, different types of surgery, and the determinants of QoL in these patients. RESULTS After 1:10 propensity score matching, a total of 741 women who had undergone a BR and mastectomy were included. The BR group exhibited a high WHOQOL QoL score one to five years after surgery with some fluctuations. The mastectomy group had comparatively stable QoL scores on WHOQOL items and were less depressed/anxious. The BR group generally showed fluctuating, higher BI scores two years after surgery, but they exhibited more anxiety/depression during follow up for 8 years. Medical comorbidities, the status of anxiety/depression, and BI were the major factors influencing all domains and items of the WHOQOL BREF among women with BC. CONCLUSION The mastectomy group showed a decreased trend toward depression in patients with BC. The BR group showed a significant improvement in QoL in the first 5 years with massive fluctuations. These findings should be considered and discussed in patient participatory decision-making and promotion of QoL for breast cancer survivors.
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Affiliation(s)
- Sriyani Padmalatha Konara Mudiyanselage
- International Doctoral Program in Nursing, Department of Nursing, College of Medicine, National Cheng Kung University, No.1, Ta-Hsueh Road, Tainan, 701, Taiwan, ROC.,Operation Theatre Department, The National Hospital of Sri Lanka, Colombo, Sri Lanka
| | - Yi-Lin Wu
- International Doctoral Program in Nursing, Department of Nursing, College of Medicine, National Cheng Kung University, No.1, Ta-Hsueh Road, Tainan, 701, Taiwan, ROC.,Department of Nursing, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No.1, Ta-Hsueh Road, Tainan, 701, Taiwan, ROC
| | - Shikha Kukreti
- Department of Public Health, College of Medicine, National Cheng Kung University, No.1, Ta-Hsueh Road, Tainan, 701, Taiwan, ROC.,Department of Public Health College of Medicine, National Cheng Kung University, No. 1, University Road, Tainan, 70101, Taiwan
| | - Chang-Chun Chen
- International Doctoral Program in Nursing, Department of Nursing, College of Medicine, National Cheng Kung University, No.1, Ta-Hsueh Road, Tainan, 701, Taiwan, ROC
| | - Chia-Ni Lin
- Department of Public Health, College of Medicine, National Cheng Kung University, No.1, Ta-Hsueh Road, Tainan, 701, Taiwan, ROC
| | - Yi-Tseng Tsai
- International Doctoral Program in Nursing, Department of Nursing, College of Medicine, National Cheng Kung University, No.1, Ta-Hsueh Road, Tainan, 701, Taiwan, ROC.,, No. 66, Sec. 2, Changhe Rd., Annan Dist., Tainan, 709, Taiwan
| | - Han-Chang Ku
- International Doctoral Program in Nursing, Department of Nursing, College of Medicine, National Cheng Kung University, No.1, Ta-Hsueh Road, Tainan, 701, Taiwan, ROC.,, No. 66, Sec. 2, Changhe Rd., Annan Dist., Tainan, 709, Taiwan
| | - Su-Ying Fang
- Department of Nursing, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No.1, Ta-Hsueh Road, Tainan, 701, Taiwan, ROC.,Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Jung-Der Wang
- Department of Public Health, College of Medicine, National Cheng Kung University, No.1, Ta-Hsueh Road, Tainan, 701, Taiwan, ROC.,Department of Public Health College of Medicine, National Cheng Kung University, No. 1, University Road, Tainan, 70101, Taiwan
| | - Nai-Ying Ko
- Department of Nursing, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No.1, Ta-Hsueh Road, Tainan, 701, Taiwan, ROC. .,Department of Public Health, College of Medicine, National Cheng Kung University, No.1, Ta-Hsueh Road, Tainan, 701, Taiwan, ROC. .,Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
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15
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Jindal R, Meena S, Bhati S, Patel P, Gulati C, Singh S. Postoperative Analgesic Efficacy of Intraoperative Pectoral Nerve Block for Modified Radical Mastectomy: a Double-Blind Prospective Randomised Interventional Study. Indian J Surg Oncol 2023; 14:215-221. [PMID: 36891452 PMCID: PMC9986367 DOI: 10.1007/s13193-022-01680-x] [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: 07/19/2022] [Accepted: 10/29/2022] [Indexed: 11/16/2022] Open
Abstract
Severe acute postoperative pain following breast surgery increases the risk of persistent pain and affects the recovery of patients. Recently, pectoral nerve (PECs) block has gained significance as a regional fascial block that can provide adequate postoperative analgesia. This study aimed to evaluate the safety and efficacy of PECs II block, which was given intraoperative under direct vision after performing modified radical mastectomy for breast cancer patients. This prospective randomised study was comprised of a PECs II group (n = 30) and a control group (n = 30). Group A patients received 25 ml of 0.25% bupivacaine for PECs II block intraoperatively after the surgical resection was done. Both groups were compared with respect to the demographic and clinical parameters, total intraoperative fentanyl dose, total duration of surgery, postoperative pain score (Numerical Rating Scale) and the analgesic requirement, postoperative complications, postoperative duration of hospital stay, and the outcome. Intraoperative PECs II block was not associated with any increase in the duration of surgery. The postoperative pain scores were significantly higher in the control group till 24 h after the surgery, and so was the postoperative analgesic requirement. Patients in the PECs group were found to have rapid recovery and decreased postoperative complications. Intraoperative PECs II block is not only safe, time-saving procedure but also significantly reduces the postoperative pain and analgesic requirement in breast cancer surgeries. It is also associated with a faster recovery, decreased postoperative complications, and better patient satisfaction.
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Affiliation(s)
- Rohit Jindal
- Department of Surgical Oncology, Sawai Man Singh Medical College and Hospital, Jaipur, Rajasthan India
| | - Sushila Meena
- Department of Anaesthesiology, Sawai Man Singh Medical College and Hospital, Jaipur, Rajasthan India
| | - Sushil Bhati
- Department of Anaesthesiology, Sawai Man Singh Medical College and Hospital, Jaipur, Rajasthan India
| | - Pinakin Patel
- Department of Surgical Oncology, Sawai Man Singh Medical College and Hospital, Jaipur, Rajasthan India
| | - Chanchal Gulati
- Department of Anaesthesiology, Sawai Man Singh Medical College and Hospital, Jaipur, Rajasthan India
| | - Suresh Singh
- Department of Surgical Oncology, Sawai Man Singh Medical College and Hospital, Jaipur, Rajasthan India
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16
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Elewa AM, Faisal M, Sjöberg F, Abuelnaga ME. Erector spinae plane block versus paravertebral block in analgesic outcomes following breast surgery. BMC Anesthesiol 2023; 23:19. [PMID: 36631777 PMCID: PMC9832786 DOI: 10.1186/s12871-022-01950-9] [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: 11/04/2022] [Accepted: 12/16/2022] [Indexed: 01/13/2023] Open
Abstract
This article represents the response to the inquiries adopted by Dr. Raghuraman M Sethuraman, M.D., regarding our recently published study which compared the erector spinae plane block (ESPB) versus paravertebral block (PVB) regarding postoperative analgesic consumption following breast surgeries (Elewa et al, BMC Anesthesiol 22: 1-9, 2022). We would like to introduce our appreciation and gratitude to the author for his interest in our work, despite being inaccurate in some of his comments.
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Affiliation(s)
- Ahmed M. Elewa
- grid.33003.330000 0000 9889 5690Department of Anaesthesia and intensive care, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Mohammed Faisal
- grid.1649.a000000009445082XDepartment of Surgery, Faculty of Medicine, Suez Canal University hospital, Egypt, General Surgery department, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Folke Sjöberg
- grid.411384.b0000 0000 9309 6304Department of Biomedical and Clinical Sciences (BKV), The Burn Center Linköping University Hospital, Linköping, Sweden
| | - Mohamed E. Abuelnaga
- grid.33003.330000 0000 9889 5690Department of Anaesthesia and Intensive Care, Faculty of Medicine, Suez Canal University, Ard Elgameiat, P.O. Box:41522, Ismailia, Egypt
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17
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Sethuraman RM. Erector spinae plane block versus paravertebral block in breast surgeries. BMC Anesthesiol 2022; 22:408. [PMID: 36577940 PMCID: PMC9795665 DOI: 10.1186/s12871-022-01946-5] [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: 09/22/2022] [Accepted: 12/16/2022] [Indexed: 12/29/2022] Open
Abstract
This article (Correspondence) is in response to the recently published study by Elewa et al. in BMC Anesthesiology that compared the erector spinae plane block (ESPB) versus paravertebral block (PVB) regarding postoperative analgesic consumption following breast surgeries. I greatly appreciate the authors for publishing this study which is one among a very few studies available on this topic. I wish to present my reflections on this article as well as add a few more points on this topic.
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Affiliation(s)
- Raghuraman M. Sethuraman
- grid.444347.40000 0004 1796 3866Department of Anesthesiology, Sree Balaji Medical College & Hospital, BIHER, #7, Works Road, New Colony, Chromepet, Chennai, 600044 India
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Gupta N, Pandey AK, Dimri K, Jyani G, Goyal A, Prinja S. Health-related quality of life among breast cancer patients in India. Support Care Cancer 2022. [PMID: 36222977 DOI: 10.1007/s00520-022-07395-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 10/04/2022] [Indexed: 10/17/2022]
Abstract
PURPOSE This study evaluated the health-related quality of life (HRQoL) among breast cancer patients during various phases of treatment and with different treatment modalities, which helps in monitoring treatment outcomes, assessing the well-being of patients, and conducting health technology assessments. METHODS A total of 534 interviews were conducted among the patients of breast cancer recruited at different stages of disease and with different treatment modalities. HRQoL was determined using EuroQoL five dimensions questionnaire with five levels (EQ-5D-5L), EuroQoL Visual Analogue Scale (EQ VAS), and the EORTC QLQ-BR23 instrument. The utility values were determined based on the Indian EQ-5D-5L value set. The socio-demographic and clinico-therapeutic determinants of HRQoL were evaluated using multiple linear regression. RESULTS The mean utility value of breast cancer patients was 0.602 (SD = 0.311) and mean EQ VAS score was 75 (SD = 12.3). The mean utility value at diagnosis was 0.628, whereas utility value was 0.55, 0.595, and 0.64 for post-surgery, post-chemotherapy, and post-radiotherapy treatment groups, respectively. The most frequently reported problem was pain/discomfort (in 84.3% patients), followed by anxiety/depression (83.5%). On EORTC QLQ-BR23, the maximum symptom scale scores for systemic therapy side effects were reported in the post chemotherapy group. The body image score and future perspective score were better in patients undergoing breast conservative surgery (BCS) compared to patients undergoing modified radical mastectomy. Age, education, and employment status of the patient, type of treatment modality, and use of taxanes are the determinants of HRQoL in breast cancer patients. CONCLUSION Clinical interventions should focus upon management of pain and anxiety. BCS should be offered to all eligible patients as it is associated with better HRQoL. Addressing the factors that independently affect the HRQoL will help in improving the treatment compliance and outcomes.
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Zhao Y, Jin W, Pan P, Feng S, Fu D, Yao J. Ultrasound-guided transversus thoracic muscle plane-pectoral nerve block for postoperative analgesia after modified radical mastectomy: a comparison with the thoracic paravertebral nerve block. Perioper Med (Lond) 2022; 11:39. [PMID: 35883207 PMCID: PMC9327269 DOI: 10.1186/s13741-022-00270-3] [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: 10/09/2021] [Accepted: 06/05/2022] [Indexed: 12/05/2022] Open
Abstract
Background Modified radical mastectomy (MRM) is the most effective and common type of invasive surgery for breast cancer. However, it causes moderate to severe acute pain and even lasts for a long postoperative period. Transversus thoracic muscle plane-pectoral nerve block (TTP-PECS) is a novel and promising interfacial plane block which can provide analgesia for MRM while thoracic paravertebral nerve block (TPVB) is also widely used for this purpose. This study compared the postoperative analgesia between the ultrasound-guided TTP-PECS and TPVB in patients undergoing MRM. Methods In this randomized controlled trial, eighty female breast cancer patients undergoing unilateral MRM with sentinel lymph node dissection (SLND) and axillary dissection (ALND) were enrolled. Patients were randomized to receive either ultrasound-guided TTP-PECS (TTP-PECS group, n = 40) or TPVB (TPVB group, n = 40) with 0.5% ropivacaine 30 ml. Evaluated variables included 24 h postoperative total PCA fentanyl consumption, including PCA background consumption and PCA press consumption (per bolus dosage multiply by the effective pressing times), and intraoperative fentanyl consumption, as well as postoperative flurbiprofen axetil requirement, duration of analgesia, blocking area, pain intensity at rest and during activity, ability to reduce the inflammatory response, and the quality of recovery 40 (QoR-40) score of patients. Results Compared with the TPVB, the main blocking area was T2–T6 in the TTP-PECS group, which was more suitable for the MRM. TTP-PECS has a longer analgesia duration than TPVB; 24 h postoperative total PCA fentanyl consumption, especially the PCA press consumption, and the postoperative flurbiprofen axetil requirement were decreased in the TTP-PECS group than those in the TPVB group. Furthermore, the VAS scores at rest and during activity and inflammatory response were lower in the TTP-PECS group compared with the TPVB group at 12 h postoperatively. Finally, the total QoR-40 score, especially for the scores of pain; emotional state; and patient support were better in the TTP-PECS group. Conclusion Compared with the TPVB, TTP-PECS can provide better postoperative analgesia in patients undergoing MRM, simultaneously reduce the inflammatory response, and prompt early recovery. These results suggest that TTP-PECS is an attractive alternative to TPVB for postoperative analgesia of modified radical mastectomy.
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Affiliation(s)
- Ying Zhao
- Department of Anesthesiology, Kunshan Hospital of Traditional Chinese Medicine, No.189, Chaoyang road, Yushan District, Kunshan, 215300, Jiangsu, China
| | - Weilin Jin
- Department of Anesthesiology, Kunshan Hospital of Traditional Chinese Medicine, No.189, Chaoyang road, Yushan District, Kunshan, 215300, Jiangsu, China
| | - Peng Pan
- Department of Anesthesiology, Kunshan Hospital of Traditional Chinese Medicine, No.189, Chaoyang road, Yushan District, Kunshan, 215300, Jiangsu, China
| | - Shuquan Feng
- Department of Anesthesiology, Kunshan Hospital of Traditional Chinese Medicine, No.189, Chaoyang road, Yushan District, Kunshan, 215300, Jiangsu, China
| | - Danyun Fu
- Department of Anesthesiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No.100, Haining Road, Hong Kou District, Shanghai, 200080, China
| | - Junyan Yao
- Department of Anesthesiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No.100, Haining Road, Hong Kou District, Shanghai, 200080, China.
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20
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Elewa AM, Faisal M, Sjöberg F, Abuelnaga ME. Comparison between erector spinae plane block and paravertebral block regarding postoperative analgesic consumption following breast surgery: a randomized controlled study. BMC Anesthesiol 2022; 22:189. [PMID: 35717148 PMCID: PMC9206353 DOI: 10.1186/s12871-022-01724-3] [Citation(s) in RCA: 2] [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] [Received: 11/03/2021] [Accepted: 06/06/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Pain control following breast surgery is of utmost importance in order to reduce the chance of chronic pain development, and facilitate early rehabilitation. The erector spinae plane block (ESPB) is a recently developed regional anaesthesia procedure successfully used for different types of surgical procedures including thoracic and abdominal surgeries. METHODS A double-blind, randomized, controlled trial was conducted on 90 patients who were scheduled for modified radical mastectomy (MRM). Patients were randomly categorized into groups I (women who underwent ESPB), II (women who underwent paravertebral block (PVB), and III (women who underwent general anaesthesia). RESULTS The ESPB (4.9 ± 1.2 mg) and PVB (5.8 ± 1.3 mg) groups had significantly lower total morphine consumption than the control group had (16.4 ± 3.1 mg; p < 0.001). Notably, patients in the ESPB group had insignificantly lower morphine consumption than those in the PVB group had (p = 0.076). Moreover, patients in the ESPB and PVB groups had a significantly longer time to first required anaesthesia than those in the control group (7.9 ± 1.2 versus 7.5 ± 0.9 versus 2 ± 1.2 h, respectively; p < 0.001). The postoperative visual analog scale scores were lower in the ESPB and PVB groups than in the control group on the first 24 h after the procedure (p < 0.001). CONCLUSION ESPB and PVB provide effective postoperative analgesia for women undergoing MRM. The ESPB appears to be as effective as the PVB. TRIAL REGISTRATION The study was registered before the enrolment of the first patient at the Pan African Clinical Trial Registry ( www.pactr.org ) database. Identification number for the registry is (PACTR202008836682092).
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Affiliation(s)
- Ahmed M. Elewa
- grid.33003.330000 0000 9889 5690Department of anaesthesia, critical care and pain management, Faculty of Medicine, Suez Canal University, Ard Elgameiat, Ismailia, Egypt
| | - Mohammed Faisal
- grid.33003.330000 0000 9889 5690Department of Surgery, Faculty of Medicine, Suez Canal University, Ismailia, Egypt ,grid.1649.a000000009445082XGeneral Surgery Department, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Folke Sjöberg
- grid.411384.b0000 0000 9309 6304Department of Biomedical and Clinical Sciences (BKV), Linköping University Hospital, Linköping, Sweden
| | - Mohamed E. Abuelnaga
- grid.33003.330000 0000 9889 5690Department of anaesthesia, critical care and pain management, Faculty of Medicine, Suez Canal University, Ard Elgameiat, Ismailia, Egypt
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21
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Hu ZT, Sun G, Wang ST, Li K. Combined thoracic paravertebral block and interscalene brachial plexus block for modified radical mastectomy: A case report. World J Clin Cases 2022; 10:5741-5747. [PMID: 35979098 PMCID: PMC9258351 DOI: 10.12998/wjcc.v10.i17.5741] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 01/14/2022] [Accepted: 04/04/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Modified radical mastectomy (MRM) is the most common surgical treatment for breast cancer. General anesthesia poses a challenge in fragile MRM patients, including cardiovascular instability, insufficient postoperative pain control, nausea and vomiting. Thoracic paravertebral block (TPVB) is adequate for simple mastectomy, but its combination with interscalene brachial plexus block (IBPB) has not yet been proved to be an effective anesthesia method for MRM.
CASE SUMMARY We describe our experience of anesthesia and pain management in 10 patients with multiple comorbidities. An ultrasound-guided TPVB was placed at T2-T3 and T5-T6, and combined with IBPB, with administration of 10, 15 and 5 mL of 0.5% ropivacaine, respectively. A satisfactory anesthetic effect was proved by the absence of ipsilateral tactile sensation within 30 min. Propofol 3 mg/kg/h and oxygen supplementation via a nasal cannula were administered during surgery. None of the patients required additional narcotics, vasopressors, or conversion to general anesthesia. The maximum pain score was 2 on an 11-point numerical rating scale. Two patients required one dose of celecoxib 8 h postoperatively and none reported nausea or emesis.
CONCLUSION This case series demonstrated that combined two-site TPVB and small-volume IBPB with sedation can be used as an alternative anesthetic modality for MRM, providing good postoperative analgesia.
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Affiliation(s)
- Zhou-Ting Hu
- Department of Anesthesia, China-Japan Union Hospital of Jilin University, Changchun 130033, Jilin Province, China
| | - Guang Sun
- Department of Breast Surgery, China-Japan Union Hospital of Jilin University, Changchun 130033, Jilin Province, China
| | - Shen-Tong Wang
- Department of Anesthesia, China-Japan Union Hospital of Jilin University, Changchun 130033, Jilin Province, China
| | - Kai Li
- Department of Anesthesia, China-Japan Union Hospital of Jilin University, Changchun 130033, Jilin Province, China
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Xu Y, He J, Qian C, Yang C. Molecular phenotypes and clinical characterization of familial hereditary breast cancer among half and full sisters. BMC Womens Health 2022; 22:145. [PMID: 35501747 PMCID: PMC9063105 DOI: 10.1186/s12905-022-01732-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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 04/21/2022] [Indexed: 11/30/2022] Open
Abstract
Background Preliminary clinical observations show that contemporaneous hereditary breast cancer (CHBC) patients suffered breast cancer at an early age, which requires further analysis. Methods 38 familial hereditary breast cancer patients (18 CHBC patients and 20 non-CHBC patients) were screened out and 152 non-hereditary breast cancer patients were used as control subjects. Clinical pathologic subtypes, age, tumor location, histological grade, lymph node metastasis, and molecular phenotype expression (ER, PR, HER-2, Ki-67, CK5/6, E-cad, P63, and P120) were compared across all subgroups. Results The incidence of CHBC was 9.47% (18/190) in breast cancer patients. The average ages of onset of CHBC patients, non-CHBC patients, and non-hereditary breast cancer patients were 49.06 ± 6.42, 60.75 ± 9.95 and 61.69 ± 14.34 respectively; whereas there were no significant differences with respect to pathological type or tumor location. There were significant differences in some histological grading (grade II/III), lymph node metastasis and PR expression between hereditary and non-hereditary breast cancers (P < 0.05; P < 0.05 and P < 0.005, respectively). Significantly different HER-2 expression was observed when comparing all hereditary or CHBC patients with non-hereditary breast cancers (P < 0.05 and P < 0.005, respectively). There were significant differences in E-cad and P63 between contemporaneous hereditary and non-hereditary breast cancers (P < 0.005 and P < 0.05, respectively). Conclusions CHBC patients accounted for 9.47% (18/190) of breast cancer patients, had earlier disease onset, and showed differences compared to non-hereditary breast cancer patients with respect to molecular phenotype and clinical characteristics.
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Affiliation(s)
- Yingjie Xu
- Department of General Surgery, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, 1111 XianXia Road, Shanghai, 200336, China
| | - Jun He
- Department of General Surgery, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, 1111 XianXia Road, Shanghai, 200336, China
| | - Chen Qian
- Department of General Surgery, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, 1111 XianXia Road, Shanghai, 200336, China
| | - Chengguang Yang
- Department of General Surgery, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, 1111 XianXia Road, Shanghai, 200336, China.
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Li L, Yang Y, Li W, Zhao X, He J, Mei S, Guo X, Zhang X, Ran J. Latissimus dorsi myocutaneous flap repair is effective after neoadjuvant chemotherapy for locally advanced breast cancer. World J Surg Oncol 2022; 20:134. [PMID: 35477520 PMCID: PMC9044592 DOI: 10.1186/s12957-022-02598-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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 04/16/2022] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To describe the clinical outcome and physical condition of patients with locally advanced breast cancer (LABC) who received neoadjuvant chemotherapy followed by mastectomy and latissimus dorsi myocutaneous flap repair. METHODS A retrospective review of 142 patients with locally advanced breast cancer was selected from 1156 breast cancer patients in the South and North areas of The Affiliated Calmette Hospital of Kunming Medical University between May 2008 and December 2018. RESULTS All participants (n = 142) were women aged 40-55 years (average age 47.35 ± 0.43 years) who received neoadjuvant chemotherapy followed by mastectomy and latissimus dorsi flap repair. The median follow-up period was 16 months (range 12-24 months). For stage of disease, there were 19 cases (13%) in stage IIB, 31 cases (22%) in stage IIIA, 39 cases (28%) in stage IIIB, and 53 cases (37%) in stage IIIC, which were statistically significant with the physical condition of patients (≤ 0.001). Neoadjuvant chemotherapy was administered to shrink the tumors, and an average tumor size decrease from 10.05 ± 1.59 cm × (8.07 ± 1.54) cm to 6.11 ± 1.72 cm × (3.91 ± 1.52) cm (P < 0.001) was considered statistically significant. A t test was used for the ECOG score statistics, and the results showed that the scores were statistically significant (≤ 0.001) before and after neoadjuvant chemotherapy and after surgery. CONCLUSIONS Neoadjuvant chemotherapy is an accepted treatment option for patients with locally advanced breast cancer, and the use of a latissimus dorsi musculocutaneous flap for post-mastectomy reconstruction may improve the patients' physical condition. Our results indicated that this strategy was safe and feasible.
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Affiliation(s)
- Lu Li
- Department of Breast Surgery, The Affiliated Calmette Hospital of Kunming Medical University, No. 1228, Beijing Road, Panlong District, Kunming, 650224, Yunnan, China
| | - Yue Yang
- Department of Breast Surgery, The Affiliated Calmette Hospital of Kunming Medical University, No. 1228, Beijing Road, Panlong District, Kunming, 650224, Yunnan, China
| | - Wang Li
- Department of Hepatopancreatobiliary Surgery, The Affiliated Calmette Hospital of Kunming Medical University, No. 1228, Beijing Road, Panlong District, Kunming, 650224, Yunnan, China
| | - Xian Zhao
- Department of Plastic Surgery, The Affiliated Calmette Hospital of Kunming Medical University, No. 1228, Beijing Road, Panlong District, Kunming, 650224, Yunnan, China
| | - Jia He
- Department of Plastic Surgery, The Affiliated Calmette Hospital of Kunming Medical University, No. 1228, Beijing Road, Panlong District, Kunming, 650224, Yunnan, China
| | - Shuo Mei
- Department of Breast Surgery, The Affiliated Calmette Hospital of Kunming Medical University, No. 1228, Beijing Road, Panlong District, Kunming, 650224, Yunnan, China
| | - Xuejun Guo
- Department of Breast Surgery, The Affiliated Calmette Hospital of Kunming Medical University, No. 1228, Beijing Road, Panlong District, Kunming, 650224, Yunnan, China
| | - Xibin Zhang
- Department of Hepatopancreatobiliary Surgery, The Affiliated Calmette Hospital of Kunming Medical University, No. 1228, Beijing Road, Panlong District, Kunming, 650224, Yunnan, China
| | - Jianghua Ran
- Department of Hepatopancreatobiliary Surgery, The Affiliated Calmette Hospital of Kunming Medical University, No. 1228, Beijing Road, Panlong District, Kunming, 650224, Yunnan, China.
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Wu HX, Lin ZW, Song TY, Piao YS. Efficacy of breast conservative surgery versus modified radical mastectomy for triple-negative breast cancer: A systematic review and meta-analysis. Asian J Surg 2022; 45:1491-1493. [PMID: 35331585 DOI: 10.1016/j.asjsur.2022.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 03/03/2022] [Indexed: 11/02/2022] Open
Affiliation(s)
- Hong-Xing Wu
- Key Laboratory of Science and Technology Department in Jilin Province, Cancer Research Center, Medical College of Yanbian University, Yanji, Jilin Province, China; Department of Clinical Medicine, Medical College of Yanbian University, Yanji, Jilin Province, China
| | - Zi-Wen Lin
- Department of Clinical Medicine, Medical College of Yanbian University, Yanji, Jilin Province, China
| | - Tian-Ye Song
- Department of Clinical Medicine, Medical College of Yanbian University, Yanji, Jilin Province, China
| | - Ying-Shi Piao
- Key Laboratory of Science and Technology Department in Jilin Province, Cancer Research Center, Medical College of Yanbian University, Yanji, Jilin Province, China.
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Guo XY, Sun GY, Wang HM, Liu M, Zhang YJ, Zhang N, Tang Y, Zhao XR, Jing H, Fang H, Wen G, Guo QS, Wu HF, Wang XH, Ma CY, Li YX, Cheng J, Shi M, Wang SL. Effect of postmastectomy radiotherapy on pT 1-2N 1 breast cancer patients with different molecular subtypes. Breast 2021; 61:108-117. [PMID: 34942430 PMCID: PMC8695355 DOI: 10.1016/j.breast.2021.12.013] [Citation(s) in RCA: 1] [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: 10/09/2021] [Revised: 11/28/2021] [Accepted: 12/13/2021] [Indexed: 12/24/2022] Open
Abstract
Objective To clarify the effect of postmastectomy radiotherapy (PMRT) on pT1-2N1 breast cancer patients with different molecular subtypes. Methods We retrospectively analyzed the data of 5442 patients with pT1-2N1 breast cancer treated using modified radical mastectomy in 11 hospitals in China. Univariate, multivariate, and propensity score matching (PSM) analyses were used to evaluate the effect of PMRT on locoregional recurrence (LRR). Results With a median follow-up duration of 63.8 months, the 5-year LRR rates were 4.0% and 7.7% among patients treated with and without PMRT, respectively (p < 0.001). PMRT was independently associated with reduced LRR after adjustments for confounders (p < 0.001). After grouping the patients according to the molecular subtype of cancer and conducting PSM, we found that the 5-year LRR rates among patients treated with and without PMRT (in that order) were as follows: luminal HER2-negative cancer, 1.9% and 6.5% (p < 0.001); luminal HER2-positive cancer, 3.8% and 13.7% (p = 0.041); HER2-overexpressing cancer, 10.2% and 15.5% (p = 0.236); and triple-negative cancer, 4.6% and 15.9% (p = 0.002). Among patients with HER2-overexpressing and triple-negative cancers, the LRR hazard rate displayed a dominant early peak, and was extremely low after 5 years. However, patients with luminal cancer continued to have a long-lasting high annual LRR hazard rate during follow-up. Conclusion PMRT significantly reduced the LRR risk in patients with pT1-2N1 luminal and triple-negative breast cancers, but had no effect on the LRR risk in patients with HER2-overexpressing cancer. Patients with different molecular subtypes displayed different annual LRR patterns, and the late recurrence of the luminal subtype suggests the necessity of long-term follow-up to evaluate the efficacy of PMRT. PMRT reduces LRR of pT1-2N1 luminal and triple-negative breast cancers. PMRT has no effect on the LRR of HER2-overexpressing breast cancer. Different molecular subtypes display different annual LRR patterns. Late LRR beyond 5 years is observed in luminal breast cancers.
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Affiliation(s)
- Xin-Yuan Guo
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Guang-Yi Sun
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hong-Mei Wang
- Department of Radiation Oncology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Min Liu
- Department of Radiation Oncology, First Hospital of Jilin University, Changchun, China
| | - Yu-Jing Zhang
- Department of Radiation Oncology, Sun Yat-sen University Affiliated Tumor Hospital, Guangzhou, China
| | - Na Zhang
- Department of Radiation Oncology, Liaoning Cancer Hospital, Shenyang, China
| | - Yu Tang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xu-Ran Zhao
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hao Jing
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hui Fang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ge Wen
- Department of Radiation Oncology, Sun Yat-sen University Affiliated Tumor Hospital, Guangzhou, China; Department of Radiation Oncology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Qi-Shuai Guo
- Department of Radiation Oncology, Affiliated Cancer Hospital of Chongqing University, Chongqing, China
| | - Hong-Fen Wu
- Department of Radiation Oncology, Jilin Cancer Hospital, Changchun, China
| | - Xiao-Hu Wang
- Department of Radiation Oncology, Gansu Cancer Hospital, Lanzhou, China
| | - Chang-Ying Ma
- Department of Radiation Oncology, Qiqihaer First Hospital, Qiqihaer, China
| | - Ye-Xiong Li
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jing Cheng
- Department of Breast Oncology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| | - Mei Shi
- Department of Radiation Oncology, Xijing Hospital, Fourth Military Medical University, Xi'an, China.
| | - Shu-Lian Wang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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Zhang F, Wang X, Guo H. The Role of Preoperative Breast Reconstruction Information in Selection of Immediate Reconstruction After Modified Radical Mastectomy-A Randomized Study. Aesthetic Plast Surg 2021; 45:2708-2713. [PMID: 34494129 DOI: 10.1007/s00266-021-02567-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 08/29/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Immediate breast reconstruction has become an important supplement after modified radical mastectomy. The role of preoperative breast reconstruction information has not been widely popularized in China. It may play an important role in choosing immediate breast reconstruction. In this paper, we investigated whether there was an effect of the role of preoperative breast reconstruction information on the difference about choosing immediate breast reconstruction after modified radical mastectomy at signing the operation consent. METHODS From 2015 January to March 2018, newly admitted 100 patients with breast carcinoma must receive modified radical mastectomy. All these patients' conditions met the requirements of immediate breast reconstruction. Patient age, breast reconstruction cognition, marital status, education, and family economics were recorded. They were randomly classified into two groups (A & B). Preoperative breast reconstruction information was designed and prepared. When it came to signing operation consent, Group A received preoperative breast reconstruction information and Group B did not receive it. We recorded whether they were willing to receive immediate breast reconstruction in different groups. RESULTS There was no significant difference in patient age, breast reconstruction cognition, marital status, education, and family economics (P > 0.05). Thirty-two patients agreed to receive breast reconstruction and 18 patients did not agree to receive breast reconstruction in Group A when 24 patients agreed to receive breast reconstruction and 26 patients did not agree to receive breast reconstruction in Group B. There was a statistical significance (P < 0.05) between the above two groups. CONCLUSION Preoperative breast reconstruction information may be a vital role for explaining about choosing immediate breast reconstruction after modified radical mastectomy at signing the operation consent. LEVEL OF EVIDENCE II This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Long Q, Zhang J, Qi J, Fan Y, Li H. Analysis of factors influencing postoperative drainage time in breast cancer. Gland Surg 2021; 10:3272-3282. [PMID: 35070887 PMCID: PMC8749090 DOI: 10.21037/gs-21-697] [Citation(s) in RCA: 1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 11/04/2021] [Indexed: 01/03/2024]
Abstract
BACKGROUND To investigate the related factors affecting the postoperative indwelling time of drainage tubes (hereinafter referred to as drainage time) in breast cancer (BC) and evaluate the effect of Pseudomonas aeruginosa-mannose-sensitive hemagglutinin (PA-MSHA) preparation on reducing postoperative drainage time. METHODS The clinical data of 165 BC patients in our hospital, including the postoperative drainage time and occurrence of seroma and related complications (such as fever, incision infection, and flap necrosis) after extubation, were retrospectively analyzed. Univariate, multivariate, and stratified analyses were used to determine the correlations between 15 factors including age, body weight, body mass index (BMI), and PA-MSHA preparation, and the postoperative total drainage volume and drainage time. RESULTS Age, BMI, and PA-MSHA preparation were independent factors affecting the postoperative drainage volume and drainage time of BC patients. Age and BMI were positively correlated with postoperative drainage volume and drainage time (P≤0.004, P≤0.037). PA-MSHA preparation significantly reduced the postoperative total drainage volume and drainage time (P<0.001), decreased the incidence of seroma after extubation (P=0.024), and did not increase complications (P>0.05). CONCLUSIONS Obese and elderly patients were at a significantly high risk of a high drainage volume and long drainage time. Local treatment with PA-MSHA preparation had the advantages of reducing postoperative drainage volume, reducing drainage time, preventing seroma, and not increasing complications, and was a safe and effective treatment. For BC patients aged over 60 years and with a BMI ≥25, the intraoperative local spraying of wounds with PA-MSHA preparation to reduce postoperative drainage times is a valuable option.
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Affiliation(s)
- Quanyi Long
- Department of Breast Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Jia Zhang
- Department of Breast Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Jiahao Qi
- Linzi District Center for Disease Control and Prevention, Zibo, China
| | - Yuan Fan
- Department of Breast Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Hongjiang Li
- Department of Breast Surgery, West China Hospital, Sichuan University, Chengdu, China
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Bawoke G, Kejela S, Alemayehu A, Bogale GT. Experience with modified radical mastectomy in a low-income country: a multi-center prospective observational study. BMC Surg 2021; 21:371. [PMID: 34670543 PMCID: PMC8527696 DOI: 10.1186/s12893-021-01374-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 10/11/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Modified radical mastectomy is the procedure of choice in centers with little to no radiotherapy services. Studying the in-hospital outcome and complications associated with the procedure is important in low-income countries. METHODS This is a multi-center prospective observational study involving all patients operated with modified radical mastectomy with curative intent. RESULTS A total of 87 patients were studied with 10.3% of which were male and 54% were between the age of 30-49 years. Clinical stage IIB and IIIA were reported in 33 (37.9%) and 25 (28.7%) respectively and 62.1% had clinically positive lymph nodes at presentation. All of the studied patients underwent curative surgery, with an average lymph node dissection of 10.2 ± 0.83. Seroma rate was 17.2% and was significantly associated with diabetes (AOR: 6.2 (CI 1.5-8.7)) and neoadjuvant chemotherapy (AOR: 8.9 (CI 1.2-14.2)). Surgical site infection occurred in 14.9% and was significantly associated with Retroviral infections (AOR: 4.2 (CI 2.1-5.8)) and neoadjuvant chemotherapy (AOR: 1.8 (CI 1.3-3.9)). No in-hospital mortality occurred during the course of the study. CONCLUSION Seroma rate was lower than published studies while surgical site infections rate was higher. Neoadjuvant chemotherapy was associated with increase in seroma and surgical site infection rates. Additionally, diabetes increased the rate of seroma. Surgical site infections were higher in patients with retroviral infections.
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Affiliation(s)
- Giziew Bawoke
- Department of Surgery, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Segni Kejela
- Department of Surgery, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
| | - Abebe Alemayehu
- Department of Surgery, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Girmaye Tamirat Bogale
- Department of Surgery, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Mooghal M, Javaid RH, Khan W, Muneeb M, Khan WA, Ahmad A, Barohi LB, Rahim K, Tahseen H, Gul A. COVID 19 pandemic: Effect on management of patients with breast cancer; single center retrospective cohort study. Int J Surg Open 2021; 35:100386. [PMID: 34568622 DOI: 10.1016/j.ijso.2021.100386] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 08/04/2021] [Accepted: 08/05/2021] [Indexed: 12/24/2022]
Abstract
Background (SARS-COV-2) infection, led to a pandemic affecting many countries, resulting in hospitals diverting most of their resources to fight the pandemic. Breast cancer, already a healthcare dilemma, is also affected in this scenario. Our aim was to find out the impact of COVID-19 on presentation of breast cancer stage and its effects on overall onco-surgical management. Methods This cohort single-centered retrospective review was carried out at our hospital, over a period of 18 months. Females with known breast cancer were included in the study. Data was collected on performas by a single researcher. Effect of COVID pandemic on presentation stage and its impact on overall management was studied. SPSS 23.0 used for data analysis. A 95% CI was used. Descriptive statistics were presented as range/means. Categorical data was analyzed by Fisher exact test, t-test was applied to numerical data, p value ≤ 0.05 was considered significant. Results Out of 87 patients presenting with suspicious lump, 69 who had malignancy on histo-pathology were included in study. Twelve out of 69 were COVID positive. Sixty patients presented with advanced stage (≥stage 2b) out of which 21 underwent upstaging of disease due to delay in presentation/management. We found that 9 out of 12 (majority) Covid positive patients had disease upstaging. Overall main reason for delay in presentation was found to be unawareness of disease. Conclusion We concluded that COVID-19 pandemic had no impact on presentation delay, breast cancer management/treatment and disease upstaging as compared to figures available for our population before the pandemic. However, our study showed significant correlation between disease upstaging and COVID status. This led us to reconsider our preformed protocols for COVID positive breast cancer patients. Our results can be used by future researchers to investigate if COVID itself can contributes in patho-physiology of upstaging in breast cancer or not.
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Tang W, Luo G, Lu Y, Chen C, Liu H, Li Y. Application of a new serratus anterior plane block in modified radical mastectomy under ultrasound guidance: A prospective, randomized controlled trial. J Clin Anesth 2021; 74:110377. [PMID: 34118568 DOI: 10.1016/j.jclinane.2021.110377] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 05/13/2021] [Accepted: 05/22/2021] [Indexed: 12/20/2022]
Abstract
STUDY OBJECTIVES Post-operative pain is a significant concern following modified radical mastectomy in breast cancer patients. The serratus anterior plane block has recently been described as an effective technique for post-operative analgesia of modified radical mastectomy. The purpose of this study was to evaluate the analgesic efficacy and safety of a new serratus anterior plane (SAP) block for post-operative pain of mastectomy. DESIGN A randomized controlled trial. SETTING Single university teaching hospital, from October 2019 to April 2020. PATIENTS Eighty-seven female breast cancer patients aged 30-81 years scheduled for unilateral modified radical mastectomy. INTERVENTIONS Participants were randomly allocated to receive either general anesthesia plus SAP block (SAP block group, n = 43) or general anesthesia alone (Control group, n = 44). A single injection of 20 ml of 0.5% ropivacaine was administered into fascial plane between the pectoralis major and the serratus anterior in SAP block group. In the Control group, no block intervention was applied. MEASUREMENTS The primary outcome measure of the study was the VAS pain scores at different time-points (1, 6, 12, 24, 48 h) after modified radical mastectomy whereas the secondary outcome measures were the consumption of opioid analgesics. MAIN RESULTS Breast cancer patients in SAP block group had lower VAS pain scores compared with the Control group during the early post-operative period (1 h and 6 h after modified radical mastectomy), both at rest and with movement. In addition, the consumption of propofol was similar in two groups (P = 0.406), and the consumption of sufentanil and remifentanil in SAP block group were significantly lower than that of Control group (P = 0.000 and P = 0.000, respectively). CONCLUSIONS SAP block significantly attenuated post-operative pain and decreased opioids consumption in breast cancer patients undergoing modified radical mastectomy. TRIAL REGISTRATION This trial is registered in the Chinese Clinical Trial Registry (ChiCTR1900026989).
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Affiliation(s)
- Weixiang Tang
- Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, China
| | - Guangtao Luo
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, China.
| | - Yao Lu
- Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, China
| | - Chen Chen
- Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, China
| | - Hu Liu
- Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, China
| | - Yuanhai Li
- Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, China.
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Liu J, Yu H, He Y, Yan T, Ding Y, Chu J, Gao N, Lin X, Xu Y, He G. Feasibility of modified radical mastectomy with nipple-areola preservation combined with stage I prosthesis implantation using air cavity-free suspension hook in patients with breast cancer. World J Surg Oncol 2021; 19:108. [PMID: 33838675 PMCID: PMC8037831 DOI: 10.1186/s12957-021-02220-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 11/09/2020] [Accepted: 03/31/2021] [Indexed: 11/25/2022] Open
Abstract
Background Mastoscopic surgery is proven to have lower incidence of postoperative complications and better postoperative recovery than traditional breast cancer surgery. This study aimed to examine the feasibility of mastoscopic modified radical mastectomy (MRM) with skin nipple-areola preservation under air cavity-free suspension hook and stage I silicone prosthesis implantation (SMALND) compared with routine MRM. Methods This was a retrospective study of patients who underwent MRM for breast cancer at the Shengjing Hospital Affiliated to China Medical University between January 1, 2019, and June 30, 2019. Surgical outcomes, complications, satisfaction, and quality of life (Functional Assessment of Cancer Therapy-Breast [FACT-B] [Chinese version]) were compared between the two groups. Results A total of 87 patients were enrolled, with 30 underwent SMALND and 57 underwent routine MRM. The intraoperative blood loss in the SMALND group was lower than in the control group (165.3±44.1 vs. 201.4±52.7 ml, P=0.001), the operation time was longer (220.5±23.9 vs. 155.6±9.2 min, P<0.001), daily axillary drainage volume was smaller (20.2±3.6 vs. 24.1±3.0 ml, P<0.001), daily subcutaneous drainage volume was smaller (15.5±2.3 vs. 19.3±3.5 ml, P<0.001), the discharge time was shorter (7.5±1.6 vs. 9.0±1.8 days, P<0.001), and FACT-B scores were higher (83.8±5.6 vs. 72.1±4.6, P<0.001). The overall satisfaction was higher in the SMALND group than in the controls (76.7% vs. 54.4%, P=0.041). Compared with the controls, the occurrence rates of nipple and flap necrosis, upper limb edema, and paraesthesia in the SMALND group were lower within 6 months (all P<0.05). Conclusions Compared with traditional MRM, SMALND had better surgical outcomes, higher satisfaction, higher quality of life, and lower complication rates.
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Affiliation(s)
- Jiaqi Liu
- First Ward of Thyroid Breast Surgery, Central Hospital of Zibo, Zibo, China
| | - Heshan Yu
- First Ward of Thyroid Breast Surgery, Central Hospital of Zibo, Zibo, China
| | - Yuxiao He
- Department of Breast Surgery, Shengjing Hospital of China Medical University, Shenyang, China
| | - Ting Yan
- School of Medical Technology, Zibo Vocational Institute, Zibo, China
| | - Yu Ding
- First Ward of Thyroid Breast Surgery, Central Hospital of Zibo, Zibo, China
| | - Jun Chu
- First Ward of Thyroid Breast Surgery, Central Hospital of Zibo, Zibo, China
| | - Ning Gao
- First Ward of Thyroid Breast Surgery, Central Hospital of Zibo, Zibo, China
| | - Xiaona Lin
- First Ward of Thyroid Breast Surgery, Central Hospital of Zibo, Zibo, China
| | - Yanbin Xu
- First Ward of Thyroid Breast Surgery, Central Hospital of Zibo, Zibo, China
| | - Guijin He
- Department of Second Breast Surgery, Shengjing Hospital of China Medical University, Shenyang, China.
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Hong B, Bang S, Oh C, Park E, Park S. Comparison of PECS II and erector spinae plane block for postoperative analgesia following modified radical mastectomy: Bayesian network meta-analysis using a control group. J Anesth 2021; 35:723-733. [PMID: 33786681 DOI: 10.1007/s00540-021-02923-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 03/13/2021] [Indexed: 12/29/2022]
Abstract
The present study compared the effects of pectoral nerve block II (PECS II) and erector spinae plane (ESP) block for postoperative analgesia in patients who underwent modified radical mastectomy by performing a network meta-analysis (NMA) using indirect comparison with systemic analgesia. Studies comparing the analgesic effects of PECS II and ESP block were searched on MEDLINE, PubMed, EMBASE and the Cochrane Library. The primary outcome of this study was cumulative opioid consumption for 24 h postoperatively. Pain score during this period was also assessed. NMA was performed to compare the postoperative analgesic effects of plane blocks and systemic analgesia. A search of databases identified 17 studies, with a total of 1069 patients, comparing the analgesic efficacies of PECS II block, ESP block, and systemic analgesia. Compared with systemic analgesia, mean difference of opioid consumption was - 10 mg (95% credible interval [CrI] - 15.0 to - 5.6 mg) with PECS II block and - 5.7 mg (95% CrI - 11.0 to - 0.7 mg) with ESP block. Relative to systemic analgesia, PECS II block showed lower pain scores over the first postoperative 24 h, whereas ESP block did not. PECS II block showed the highest surface under the cumulative ranking curves for both opioid consumption and pain score. Both PECS II and ESP blocks were shown to be more effective than systemic analgesia regarding postoperative analgesia following modified radical mastectomy, and between the two blocks, PECS II appeared to have favorable analgesic effects compared to ESP block.
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Affiliation(s)
- Boohwi Hong
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Daejeon, Korea
- Department of Anesthesiology and Pain Medicine, College of Medicine, Chungnam National University, Daejeon, Korea
| | - Seunguk Bang
- Department of Anesthesiology and Pain Medicine, Daejeon St. Mary's Hospital, Daejeon, Korea
- Department of Anesthesiology and Pain Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Chahyun Oh
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Eunhye Park
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Seyeon Park
- Department of Nursing, Chungnam National University, Daejeon, Korea.
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Shah SB, Chawla R, Pahade A, Mittal A, Bhargava AK, Kumar R. Comparison of pectoralis plane blocks with ketamine-dexmedetomidine adjuncts and opioid-based general anaesthesia in patients undergoing modified radical mastectomy. Indian J Anaesth 2020; 64:1038-1046. [PMID: 33542567 PMCID: PMC7852431 DOI: 10.4103/ija.ija_8_20] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 05/14/2020] [Accepted: 10/19/2020] [Indexed: 01/21/2023] Open
Abstract
Background and Aims: Regional anaesthesia attenuates surgical stress-response, provides superior analgesia, reduces recovery time with early mobilisation and is opioid-sparing [addresses post-operative nausea vomiting (PONV), constipation, immunosuppression and cancer-progression concerns with opioids]. Hence, we studied pectoralis (PECS) blocks for modified radical mastectomy (MRM). Methods: A prospective, interventional, double-blind, randomised, parallel-arm, active-controlled study comparing two anaesthetic techniques for post-operative pain relief in70 adult American Society of Anesthesiologists grade I/II carcinoma breast patients undergoing MRM was conducted. Patients were randomised to Group-O (opioids, sevoflurane) and Group-P (PECS-block, pre-incisional intravenous (IV) ketamine (0.5 mg/kg), pre-incisional IVdexmedetomidine (1 μg/kg over 10 min, then 0.6 μg/kg/h). Data were subjected to statistical analysis using the Statistical Package for Social Sciences, version-23 and independent sample t-test/Welch test for equality of means and expressed as dotted box-whisker plots. Nominal categorical intergroup data was compared using Chi-squared test/Fisher's exact test. P<0.05 was considered statistically significant. Clinical significance was calculated. Results: Higher Visual Analogue Scale (VAS)-scores were recorded in Group-O versus Group-P, immediately post-extubation [mean (SD) 3.6 ± 1.5 and 0.76 ± 0.6] and at 1h (3.1 ± 1.2 and1.4 ± 0.5), 2h (2.5 ± 0.9 and 1.2 ± 0.6) and 4h (2.2 ± 0.5 and 1.7 ± 0.9) respectively. At 8h and 24h post-surgery VAS was comparable. Cumulative-VAS was lower in Group-P. Intraoperative haemodynamics were comparable. Incidence of PONV and constipation was higher in Group-O where each patient received average 27.46 mg morphine-equivalents of opioids. Time to discharge from surgical intensive care unit was 2h shorter in Group-P. Conclusion: Pre-emptive PECS-blocks supplemented with low-dose ketamine and dexmedetomidine comprise a practical and useful alternative technique to the standard opioid-based general anaesthetic technique for MRM.
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Affiliation(s)
- Shagun B Shah
- Department of Anaesthesiology, Rajiv Gandhi Cancer Institute and Research Centre, Rohini, Delhi, India
| | - Rajiv Chawla
- Department of Anaesthesiology, Rajiv Gandhi Cancer Institute and Research Centre, Rohini, Delhi, India
| | - Akhilesh Pahade
- Department of Anaesthesiology, Rajiv Gandhi Cancer Institute and Research Centre, Rohini, Delhi, India
| | - Amit Mittal
- Department of Anaesthesiology, Rajiv Gandhi Cancer Institute and Research Centre, Rohini, Delhi, India
| | - Ajay K Bhargava
- Department of Anaesthesiology, Rajiv Gandhi Cancer Institute and Research Centre, Rohini, Delhi, India
| | - Rajeev Kumar
- Department of Breast Oncosurgery Unit, Rajiv Gandhi Cancer Institute and Research Centre, Rohini, Delhi, India
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Kaur U, Shamshery C, Agarwal A, Prakash N, Valiveru RC, Mishra P. Evaluation of postoperative pain in patients undergoing modified radical mastectomy with pectoralis or serratus-intercostal fascial plane blocks. Korean J Anesthesiol 2020; 73:425-433. [PMID: 32987492 PMCID: PMC7533170 DOI: 10.4097/kja.20159] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 09/14/2020] [Indexed: 11/10/2022] Open
Abstract
Background Regional nerve blocks are an integral part of multimodal analgesia and should be chosen based on their efficacy, convenience, and minimal side effects. Here, we compare the use of pectoral (PEC II) and serratus-intercostal fascial plane (SIFP) blocks in breast carcinoma cases undergoing modified radical mastectomy in terms of the postoperative analgesic efficacy and shoulder mobility. Methods The primary outcome of this prospective controlled study was to compare the postoperative static and dynamic pain scores, and the secondary outcome was to assess the shoulder pain, range of shoulder joint motion, and hemodynamic parameters. Sixty patients were randomly allocated to three groups and given general anesthesia. All patients received paracetamol, diclofenac, and rescue doses of tramadol based on the institute's acute pain service policy. No block was performed in group C (control), whereas groups P and S received PEC II and SIFP blocks, respectively, before surgical incision. Results The groups were comparable in terms of age, weight, height, and body mass index distribution. Dynamic pain relief was significantly better 12 and 24 h postoperatively in groups P (P = 0.034, P = 0.040 respectively) and S (P = 0.012 and P = 0.017, respectively) compared to group C. Shoulder pain relief and shoulder mobility were better in group S, while the hemodynamic parameters were more stable in group P. Conclusions Both SIFP and PEC blocks have comparable dynamic and static pain relief with better shoulder pain scores in patients receiving SIFP.
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Affiliation(s)
- Ushkiran Kaur
- Department of Anesthesiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Chetna Shamshery
- Department of Anesthesiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Anil Agarwal
- Department of Anesthesiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Neel Prakash
- Department of Anesthesiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Ramya Chakrapani Valiveru
- Department of Endocrine Surgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Prabhaker Mishra
- Department of Biostatistics and Health Informatics, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Vettuparambil A, Subramanya C. Flap Fixation as a Technique for Reducing Seroma Formation in Patients Undergoing Modified Radical Mastectomy: an Institutional Experience. Indian J Surg Oncol 2020; 12:48-53. [PMID: 33814831 DOI: 10.1007/s13193-020-01220-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 04/01/2020] [Accepted: 09/15/2020] [Indexed: 11/28/2022] Open
Abstract
Formation of seroma most frequently occurs after mastectomy and axillary surgery. This study is intended at creating data on whether flap fixation has any role in reducing the seroma formation in patients undergoing the modified radical mastectomy. A prospective comparative study was conducted among 61 patients scheduled for modified radical mastectomy from 1st of January 2017 to 31st of December 2017. Patients were divided into two groups. In the flap fixation group (N = 30), the skin flaps were sutured to the pectoral muscle with Vicryl 3-0 sutures, and in the control group (N = 31), the wound was closed in the conventional methods at the edges. Closed suction drain was used in both groups. Flap fixation group showed a significantly lower frequency of seroma formation compared with the control group. In the flap fixation group, the drain was removed earlier compared with the control group. Mean value of the total amount of fluid drained for the study group was significantly lower than that of control. Flap fixation is a surgical technique which appears to reduce the total volume of fluid drained, the development of seroma, and the need for seroma aspirations.
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Affiliation(s)
- Ajith Vettuparambil
- Department of surgery, DM Wayanad Institute of Medical Sciences, Wayanad, Kerala 673577 India
| | - Chandrashekar Subramanya
- Department of General Surgery, Mysore Medical College and Research Institute, Mysore, Karnataka 570001 India
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Bhat V, Roshini AP, Ramesh R. Does Quality of Life Among Modified Radical Mastectomy and Breast Conservation Surgery Patients Differ? A 5-Year Comparative Study. Indian J Surg Oncol 2019; 10:643-648. [PMID: 31857758 DOI: 10.1007/s13193-019-00962-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 08/06/2019] [Indexed: 10/26/2022] Open
Abstract
Breast cancer is the most common cancer among females worldwide, of whom more than 80% survive for more than 5 years. Hence, ensuring a good quality of life (QOL) is essential to achieve holistic approach in treating patients. A cross-sectional study was conducted to compare the QOL in women who underwent modified radical mastectomy (MRM) and breast conservation surgery (BCS) for breast cancer in the last 5 years. QOL was evaluated based on the long-term quality of life-breast cancer (LTQOL-BC) questionnaire. A greater percentage of women who underwent MRM complained of difficulty in completing their house work compared with the BCS group (50% compared with 31%). Twenty-five percent (6) of the women who had undergone MRM reported feeling of being incomplete as women, along with a lack of femininity. However, more than 80% of the women in both groups said that they felt stronger as survivors and derived strength from their experience. There were significant differences in the quality of life of women from both groups in terms of physical function and body image, with the BCS group appearing to have a better QOL.
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Affiliation(s)
- Vivek Bhat
- 1St. John's Medical College and Hospital, Bengaluru, Karnataka India
| | - A P Roshini
- 1St. John's Medical College and Hospital, Bengaluru, Karnataka India
| | - Rakesh Ramesh
- 2Department of Surgical Oncology, St. John's Medical College and Hospital, Bengaluru, Karnataka India
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Abstract
Objective: To investigate the effect of neoadjuvant chemotherapy combined with surgery on locally advanced breast cancer and its prognosis. Methods: One hundred and fifty-four patients with locally advanced breast cancer who were admitted to our hospital from February 2014 to April 2015 were selected as the study subjects. They were divided into an observation group and a control group according to the principle of random equalization, 77 each group. The observation group was treated with TAC scheme, neoadjuvant chemotherapy combined with modified radical resection, and continuously treated with the same scheme after operation until the end of the course of treatment. The control group was treated with modified radical resection and TAC scheme. The clinical efficacy of the two groups was observed, and the perioperative indications, prognosis and occurrence of adverse reactions were compared between the two groups. Results: The total effective rate of the observation group was 76.62%, significantly higher than that of the control group (55.84%, P<0.05). The observation group had shorter operation time and hospitalization time and less bleeding amount compared to the control group (P<0.05). The metastasis rate and recurrence rate of the observation group were significantly lower than those of the control group (P<0.05); there was a significant difference between the two groups (P<0.05). The one-year and three-year survival rates of the observation group were significantly higher than those of the control group (P<0.05). There was no significant difference in the incidence of adverse reactions between the two groups after operation (P>0.05). Conclusion: Preoperative neoadjuvant chemotherapy in combination with TAC scheme can reduce the difficulty of operation, improve the curative effect of patients, significantly improve the prognosis of patients and prolong the survival time, which is worth clinical application.
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Affiliation(s)
- Haixia Zhao
- Haixia Zhao Department of General Surgery C (Breast Surgery), Binzhou People's Hospital, Shandong, 256610, China
| | - Jinying Zhang
- Jinying Zhang Department of Cardio-Thoracic Surgery B, Binzhou people's Hospital, 256603, China
| | - Yanxia Lu
- Yanxia Lu Department of Critical Care Medicine, Binzhou people's Hospital, 256603, China
| | - Jihai Jin
- Jihai Jin Department of General Surgery C (Breast Surgery), Binzhou People's Hospital, Shandong, 256610, China
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Galán Gutiérrez JC, Tobera Noval B, Sáenz Abós FJ, González Rodríguez M, Fernández Meré LA, Sopena Zubiria LA. Combination of thoracic blocks as a main anesthetic tecnique in modified radical mastectomy for patients with severe respiratory disease. Rev Esp Anestesiol Reanim (Engl Ed) 2019; 66:157-162. [PMID: 30503529 DOI: 10.1016/j.redar.2018.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 06/06/2018] [Revised: 09/26/2018] [Accepted: 10/21/2018] [Indexed: 06/09/2023]
Abstract
The addition of ultrasound to locoregional anaesthesia in the last few years has led to the description of various fascial thoracic blocks with analgesic purposes: PECS 1 and 2 block, serratus plane block, serratus intercostal fascial block, blockade in the plane of the thoracic transverse muscle..., which have been added to other well-known nerve blocks, such as thoracic paravertebral block or intercostal block. In this sense, locoregional anaesthesia has been universally recommended in patients with severe respiratory processes in order to avoid ventilatory support and subsequent weaning that considerably increases postoperative morbidity and mortality rates. However, as regards thoracic wall and axillary hollow, there are very few references which detail the use of nerve or fascial blocks as a main anaesthetic method. Two extreme cases are presented of multi-pathological patients with serious respiratory disease who successfully underwent a modified radical mastectomy plus surgery in the axillary space using a combination of ultrasound-guided thoracic blocks that allowed surgery without general anaesthesia, avoiding mechanical ventilation, and maintaining spontaneous breathing throughout the surgical procedure. The main indications of the anaesthetic blocks used are described, focusing on the performance of the technique and underlining, in a novel way, the possibility of facing aggressive surgery at the level of the armpit with only locoregional anaesthesia.
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Affiliation(s)
- J C Galán Gutiérrez
- Servicio de Anestesiología y Reanimación, Hospital Universitario Central de Asturias, Oviedo, España.
| | - B Tobera Noval
- Servicio de Obstetricia y Ginecología, Hopital de Cabueñes, Gijón, España
| | - F J Sáenz Abós
- Servicio de Anestesiología y Reanimación, Hospital Universitario Central de Asturias, Oviedo, España
| | - M González Rodríguez
- Servicio de Anestesiología y Reanimación, Hospital Universitario Central de Asturias, Oviedo, España
| | - L A Fernández Meré
- Servicio de Anestesiología y Reanimación, Hospital Universitario Central de Asturias, Oviedo, España
| | - L A Sopena Zubiria
- Unidad de Cirugía Mayor Ambulatoria, Servicio de Anestesiología y Reanimación, Hospital Universitario Central de Asturias, Oviedo, España
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Tripathy S, Mandal I, Rao PB, Panda A, Mishra T, Kar M. Opioid-free anesthesia for breast cancer surgery: A comparison of ultrasound guided paravertebral and pectoral nerve blocks. A randomized controlled trial. J Anaesthesiol Clin Pharmacol 2019; 35:475-480. [PMID: 31920230 PMCID: PMC6939549 DOI: 10.4103/joacp.joacp_364_18] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [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: 12/21/2022] Open
Abstract
Background and Aims: Pectoral block (PECS)-based anesthesia without opioids decreases analgesic requirement, pain scores and post-operative nausea vomiting (PONV) compared to conventional opioid-based general anesthesia in patients undergoing modified radical mastectomy and axillary dissection (MRM-AD). We compared PECS versus Paravertebral Block (PVB) in providing an opioid free, nerve block-based regimen. Outcomes of interest were post-operative analgesic requirement, duration of analgesia, PONV and patient and surgeon satisfaction. Material and Methods: This randomised controlled study involved 58 adult ASA I-III patients posted for MRM-AD. After randomization patients were induced with propofol and maintained on spontaneous ventilation with isoflurane (0.8-1.0 MAC) through i-gel. Ultrasound-guided PECS or PV blocks (30 ml of 0.1% lignocaine + 0.25% bupivacaine + 1 μg/kg dexmedetomidine) were administered. Post-operative pain scores, non-opioid analgesic requirement over 24 hours, PONV, satisfaction of surgeon and patient were measured. Results: Between the two groups, there was no difference in demographics, ASA status, location and volume of breast tumour excised or the duration of surgery. The time from block to incision was significantly longer in the PV group (P = 0.01). There was no difference between the two groups in terms of intra and post-operative parameters, and the median VAS scores for pain at rest or during shoulder abduction were similarly low in both the groups. Conclusion: Both blocks result in equally prolonged analgesia and preclude requirement of opioid analgesics intra and post-operatively. PECS block is associated with lesser time to allow incision. Complications are low in both the groups. Routine use of these blocks to avoid opioids may be studied further.
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Affiliation(s)
- Swagata Tripathy
- Department of Anesthesia and Intensive Care, AIIMS, Bhubaneswar, Odisha, India
| | - Indraprava Mandal
- Department of Anesthesia and Intensive Care, AIIMS, Bhubaneswar, Odisha, India
| | | | - Aparajita Panda
- Department of Anesthesia and Intensive Care, AIIMS, Bhubaneswar, Odisha, India
| | - Tushar Mishra
- Department of General Surgery, AIIMS, Bhubaneswar, Odisha, India
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Akkoca M, Ateş MP, Yılmaz KB, İmamoğlu İ, Balas Ş, Tokgöz S, Akıncı M, Karabacak H, Ünlü E. The effect of lateral pectoral nerve sparing technique and radiotherapy on the pectoralis major muscle applied with modified radical mastectomy. Asian J Surg 2018; 42:501-506. [PMID: 30268639 DOI: 10.1016/j.asjsur.2018.08.003] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 08/14/2018] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND/OBJECTIVE The aim of this study was to evaluate with electromyography (EMG) the effect of lateral pectoral nerve sparing technique (LPNST) and radiotherapy (RT) on the lateral pectoral nerve (LPN) in patients applied with modified radical mastectomy (MRM). METHODS The study included 66 patients who underwent MRM surgery. The patients were separated into 2 groups as those applied with LPNST and those who underwent standard surgery (Control group). Within these 2 groups, patients were again separated as those who received or did not receive RT. The EMG evaluations were made by a neurology specialist blinded to the patient groups. RESULTS The mean age of the patients was 53.3 ± 10.6 years. Standard surgery was applied to 33 (50%) patients and LPNST to 33 (50%) patients, RT was applied to 32 (48.5%) patients and not to 34 (51.5%) patients. In the EMG evaluation, latency was 2.1 ms (1.4-3.2) in the LPNST and 3.7 ms (1.9-12.4) in the control (p <0.001) and amplitude values were 9650 mV (3120-36900) in the LPNST and 4780 mV (510-12.4) in the control (p <0.001). The latency values in the Control receiving and not receiving RT were 4.0 ms (1.9-12.4) and 2.6 ms (1.9-6.2) respectively (p <0.05). The latency values of the patients receiving and not receiving RT in the LPNST were 2.2 ms (1.8-3.2) and 2.0 ms (1.4-2.4) respectively (p <0.05). In the Control and LPNST Group, no significant difference was determined between receiving and not receiving RT groups in respect of amplitude values (p >0.05). CONCLUSION The results of this study demonstrated that electromyographically the latency and amplitude values were better protected in the LPNST group. It was also seen that RT increased the formation of nerve damage in both groups.
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Affiliation(s)
- Muzaffer Akkoca
- University of Health Science, Dışkapı Yıldırım Beyazıt Research and Training Hospital, Department of General Surgery, Ankara, Turkey.
| | - Mehlika Panpallı Ateş
- University of Health Science, Dışkapı Yıldırım Beyazıt Research and Training Hospital, Department of Neurology, Ankara, Turkey
| | - Kerim Bora Yılmaz
- University of Health Science, Dışkapı Yıldırım Beyazıt Research and Training Hospital, Department of General Surgery, Ankara, Turkey
| | - İnanç İmamoğlu
- University of Health Science, Dışkapı Yıldırım Beyazıt Research and Training Hospital, Department of Medical Oncology, Ankara, Turkey
| | - Şener Balas
- University of Health Science, Dışkapı Yıldırım Beyazıt Research and Training Hospital, Department of General Surgery, Ankara, Turkey
| | - Serhat Tokgöz
- University of Health Science, Dışkapı Yıldırım Beyazıt Research and Training Hospital, Department of General Surgery, Ankara, Turkey
| | - Melih Akıncı
- University of Health Science, Dışkapı Yıldırım Beyazıt Research and Training Hospital, Department of General Surgery, Ankara, Turkey
| | - Harun Karabacak
- University of Health Science, Dışkapı Yıldırım Beyazıt Research and Training Hospital, Department of General Surgery, Ankara, Turkey
| | - Ece Ünlü
- University of Health Science, Dışkapı Yıldırım Beyazıt Research and Training Hospital, Department of Physical Therapy and Rehabilitation, Ankara, Turkey
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Rastogi K, Sharma S, Gupta S, Agarwal N, Bhaskar S, Jain S. Dosimetric comparison of IMRT versus 3DCRT for post-mastectomy chest wall irradiation. Radiat Oncol J 2018; 36:71-78. [PMID: 29621872 PMCID: PMC5903359 DOI: 10.3857/roj.2017.00381] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 09/18/2017] [Accepted: 10/18/2017] [Indexed: 12/25/2022] Open
Abstract
Purpose To compare the dose distribution of three-dimensional conformal radiation therapy (3DCRT) with intensity-modulated radiation therapy (IMRT) for post-mastectomy radiotherapy (PMRT) to left chest wall. Materials and Methods One hundred and seven patients were randomised for PMRT in 3DCRT group (n = 64) and IMRT group (n = 43). All patients received 50 Gy in 25 fractions. Planning target volume (PTV) parameters—Dnear-max (D2), Dnear-min (D98), Dmean, V95, and V107—homogeneity index (HI), and conformity index (CI) were compared. The mean doses of lung and heart, percentage volume of ipsilateral lung receiving 5 Gy (V5), 20 Gy (V20), and 55 Gy (V55) and that of heart receiving 5 Gy (V5), 25 Gy (V25), and 45 Gy (V45) were extracted from dose-volume histograms and compared. Results PTV parameters were comparable between the two groups. CI was significantly improved with IMRT (1.127 vs. 1.254, p < 0.001) but HI was similar (0.094 vs. 0.096, p = 0.83) compared to 3DCRT. IMRT in comparison to 3DCRT significantly reduced the high-dose volumes of lung (V20, 22.09% vs. 30.16%; V55, 5.16% vs. 10.27%; p < 0.001) and heart (V25, 4.59% vs. 9.19%; V45, 1.85% vs. 7.09%; p < 0.001); mean dose of lung and heart (11.39 vs. 14.22 Gy and 4.57 vs. 8.96 Gy, respectively; p < 0.001) but not the low-dose volume (V5 lung, 61.48% vs. 51.05%; V5 heart, 31.02% vs. 23.27%; p < 0.001). conclusions For left sided breast cancer, IMRT significantly improves the conformity of plan and reduce the mean dose and high-dose volumes of ipsilateral lung and heart compared to 3DCRT, but 3DCRT is superior in terms of low-dose volume.
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Affiliation(s)
- Kartick Rastogi
- Department of Radiotherapy, Sawai Man Singh Medical College and Attached Group of Hospitals, Jaipur, India
| | - Shantanu Sharma
- Department of Radiotherapy, Sawai Man Singh Medical College and Attached Group of Hospitals, Jaipur, India
| | - Shivani Gupta
- Department of Radiotherapy, Sawai Man Singh Medical College and Attached Group of Hospitals, Jaipur, India
| | - Nikesh Agarwal
- Department of Radiotherapy, Sawai Man Singh Medical College and Attached Group of Hospitals, Jaipur, India
| | - Sandeep Bhaskar
- Department of Radiotherapy, Sawai Man Singh Medical College and Attached Group of Hospitals, Jaipur, India
| | - Sandeep Jain
- Department of Radiotherapy, Sawai Man Singh Medical College and Attached Group of Hospitals, Jaipur, India
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Shuja J, Ahmad I, Arshad S, Manzoor H, Kakar S, Ahmad K. A Case Report of Triple-Positive Micropapillary Carcinoma of the Male Breast. Breast Care (Basel) 2018; 13:192-194. [PMID: 30069180 DOI: 10.1159/000486665] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Background Micropapillary carcinoma (MPC), a morphologically distinct subtype of invasive ductal carcinoma, of the male breast is an exceedingly uncommon disease. Case Report Herein, we report a case of triple-positive MPC of the male breast with axillary lymph node involvement and no recurrence for over 2 years. Specifically, a 60-year-old male patient presented with a hard, elastic, and well-defined painless mass in the right breast. The patient underwent unilateral (right) modified radical mastectomy with axillary clearance. Histopathology revealed MPC grade 3 and metastasis in 16/16 lymph nodes. Hormone receptor analysis demonstrated strong positivity (total score 08) for estrogen/progesterone receptors and overexpression (score 3+) of human epidermal growth factor receptor 2. The patient received adjuvant chemotherapy (6 courses of CAF: cyclophosphamide, doxorubicin, and 5-fluorouracil), radiation, and tamoxifen. The patient has remained disease-free for over 2 years. Conclusion This study demonstrates that triple-positive MPC of the male breast as a rare malignancy appears to respond promisingly to multimodality treatment.
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Affiliation(s)
- Jamila Shuja
- Center for Nuclear Medicine and Radiotherapy (CENAR), Quetta, Pakistan
| | - Iftikhar Ahmad
- Institute of Radiotherapy and Nuclear Medicine (IRNUM), Peshawar, Pakistan
| | - Sidra Arshad
- Agha Khan University Hospital, Karachi, Pakistan
| | - Hina Manzoor
- Center for Nuclear Medicine and Radiotherapy (CENAR), Quetta, Pakistan
| | | | - Khushnaseeb Ahmad
- Center for Nuclear Medicine and Radiotherapy (CENAR), Quetta, Pakistan
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Faridi SH, Singh KD, Lodhi M. Concomitant Presence of Carcinoma of Breast in a Patient with Early-Onset Cataract: First Case Report of a Potential Association. J Clin Diagn Res 2017; 11:PD05-PD07. [PMID: 28658846 DOI: 10.7860/jcdr/2017/26913.9894] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 01/21/2017] [Accepted: 03/22/2017] [Indexed: 11/24/2022]
Abstract
A recent nation-wide population based retrospective cohort study from Taiwan in 2014 suggested a propensity of developing breast cancer in young females with early-onset cataract. We report here a case of a young non-obese female who presented to us with a large lump in the right breast with skin nodules and bilateral painless progressive diminution of vision. Patient was diagnosed to be suffering from locally advanced carcinoma of right breast with axillary metastasis (Stage III B) and bilateral early-onset nuclear cataract. Patient was started on taxane and anthracycline based neoadjuvant chemotherapy and after three cycles of chemotherapy patient showed partial response (≈50% reduction of tumour mass). Patient underwent small incision cataract surgery in left eye after the first cycle of chemotherapy. However, the patient was lost before any operative intervention could be done as she died in a road traffic accident. Possible mechanism of development of breast cancer in patients with early-onset cataract is discussed. This is the first reported case of a patient of early-onset cataract developing breast cancer as well as the first reported case of concomitant presence of early-onset bilateral cataract with breast cancer.
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Affiliation(s)
- Shahbaz Habib Faridi
- Assistant Professor, Department of Surgery, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Kaushal Deep Singh
- Senior Resident, Department of Surgery, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Mehershree Lodhi
- Junior Resident, Department of Microbiology, King George Medical University, Lucknow, Uttar Pradesh, India
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Patel DS, Khandeparkar SGS, Joshi AR, Kulkarni MM, Dhande B, Lengare P, Phegade LA, Narkhede K. Immunohistochemical Study of MUC1, MUC2 and MUC5AC Expression in Primary Breast Carcinoma. J Clin Diagn Res 2017; 11:EC30-EC34. [PMID: 28571146 DOI: 10.7860/jcdr/2017/26533.9707] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 02/20/2017] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Breast Cancer (BC) is the second most common cancer among women in India and accounts for 7% of global burden of BC and one-fifth of all Cancers (CA) among women in India. AIM This study was conducted for studying the expression of MUC1, MUC2 and MUC5AC in breast carcinoma. MATERIALS AND METHODS Fifty cases of primary breast carcinoma diagnosed between years 2013 to 2015 were included in the study. Manual tissue array technique was applied for cases subjected to Immunohistochemistry (IHC). An analysis of the expression of IHC markers (MUC1, MUC2, MUC5AC, ER, PR and HER2/neu) was attempted. Results were subjected to statistical analysis. They were considered to be significant when the p-value was less than 0.05. RESULTS The positivity for MUC1, MUC2 and MUC5AC in BC was 58%, 8% and 6% and for ER, PR and HER2 was 48%, 36% and 64% respectively. There was a significant correlation between MUC1 expression and ER and PR positivity. There was a significant correlation between MUC2 expression and ER positivity. No significant association was observed between MUC2 and PR expression, MUC5AC expression and ER and PR positivity. There was statistically significant correlation between negative MUC2 and MUC5AC expression and histopathological grade. It was noted that MUC2 and MUC5AC negative tumours were associated with higher tumour stage though not statistically significant. It was noted that MUC5AC negative tumours showed higher frequency of lymphovascular invasion though not statistically significant. CONCLUSION Our experience with the present study highlights the role of mucins in the development and progression of BC.
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Affiliation(s)
- Daxesh Shivabhai Patel
- Postgraduate Student, Department of Pathology, Smt. Kashibai Navale Medical College and General Hospital, Pune, Maharashtra, India
| | | | - Avinash R Joshi
- Professor, Department of Pathology, Smt. Kashibai Navale Medical College and General Hospital, Pune, Maharashtra, India
| | - Maithili Mandar Kulkarni
- Associate Professor, Department of Pathology, Smt. Kashibai Navale Medical College and General Hospital, Pune, Maharashtra, India
| | - Bhagyashree Dhande
- Postgraduate Student, Department of Pathology, Smt. Kashibai Navale Medical College and General Hospital, Pune, Maharashtra, India
| | - Pranoti Lengare
- Postgraduate Student, Department of Pathology, Smt. Kashibai Navale Medical College and General Hospital, Pune, Maharashtra, India
| | - Lokesh Ashok Phegade
- Postgraduate Student, Department of Pathology, Smt. Kashibai Navale Medical College and General Hospital, Pune, Maharashtra, India
| | - Ketan Narkhede
- Postgraduate Student, Department of Pathology, Smt. Kashibai Navale Medical College and General Hospital, Pune, Maharashtra, India
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Huang YS, Chen JLY, Huang CS, Kuo SH, Jaw FS, Tseng YH, Ko WC, Chang YC. High mammographic breast density predicts locoregional recurrence after modified radical mastectomy for invasive breast cancer: a case-control study. Breast Cancer Res 2016; 18:120. [PMID: 27906044 PMCID: PMC5134100 DOI: 10.1186/s13058-016-0784-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 11/22/2016] [Indexed: 12/14/2022] Open
Abstract
Background We aimed to evaluate the influence of mammographic breast density at diagnosis on the risk of cancer recurrence and survival outcomes in patients with invasive breast cancer after modified radical mastectomy. Methods This case-control study included 121 case-control pairs of women diagnosed with invasive breast cancer between 2004 and 2009, and who had undergone modified radical mastectomy and had mammographic breast density measured before or at diagnosis. Women with known locoregional recurrence or distant metastasis were matched by pathological disease stage, age, and year of diagnosis to women without recurrence. Locoregional recurrence was defined as recurrence in the ipsilateral chest wall, or axillary, internal mammary, or supraclavicular nodes. The median follow-up duration was 84.0 months for case patients and 92.9 months for control patients. Results Patients with heterogeneously dense (50–75% density) and extremely dense (>75% density) breasts had an increased risk of locoregional recurrence (hazard ratios 3.1 and 5.7, 95% confidence intervals 1.1–9.8 and 1.2–34.9, p = 0.043 and 0.048, respectively) than did women with less dense breasts. Positive margins after surgery also increased the risk of locoregional recurrence (hazard ratio 3.3, 95% confidence interval 1.3–8.3, p = 0.010). Multivariate analysis that included dense breasts (>50% density), positive margin, no adjuvant radiotherapy, and no adjuvant chemotherapy revealed that dense breasts were significant factors for predicting locoregional recurrence risk (hazard ratio 3.6, 95% confidence interval 1.2–11.1, p = 0.025). Conclusions Our results demonstrate that dense breast tissue (>50% density) increased the risk of locoregional recurrence after modified radical mastectomy in patients with invasive breast cancer. Additional prospective studies are necessary to validate these findings. Trial registration The study is retrospectively registered with ClinicalTrials.gov, number NCT02771665, on May 11, 2016.
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Affiliation(s)
- Yu-Sen Huang
- Institute of Biomedical Engineering, College of Medicine and College of Engineering, National Taiwan University, Taipei, Taiwan.,Department of Medical Imaging, National Taiwan University Hospital and National Taiwan University College of Medicine, No. 7, Chung-Shan S. Rd., Taipei, 100, Taiwan.,Department of Medical Imaging, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan
| | - Jenny Ling-Yu Chen
- Institute of Biomedical Engineering, College of Medicine and College of Engineering, National Taiwan University, Taipei, Taiwan.,Department of Oncology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.,Department of Radiation Oncology, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan
| | - Chiun-Sheng Huang
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Sung-Hsin Kuo
- Department of Oncology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Fu-Shan Jaw
- Institute of Biomedical Engineering, College of Medicine and College of Engineering, National Taiwan University, Taipei, Taiwan
| | - Yao-Hui Tseng
- Department of Medical Imaging, National Taiwan University Hospital and National Taiwan University College of Medicine, No. 7, Chung-Shan S. Rd., Taipei, 100, Taiwan
| | - Wei-Chun Ko
- Department of Medical Imaging, National Taiwan University Hospital and National Taiwan University College of Medicine, No. 7, Chung-Shan S. Rd., Taipei, 100, Taiwan
| | - Yeun-Chung Chang
- Department of Medical Imaging, National Taiwan University Hospital and National Taiwan University College of Medicine, No. 7, Chung-Shan S. Rd., Taipei, 100, Taiwan.
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Gupta K, Rastogi B, Gupta PK, Singh I, Singh VP, Jain M. Dexmedetomidine infusion as an anesthetic adjuvant to general anesthesia for appropriate surgical field visibility during modified radical mastectomy with i-gel®: a randomized control study. Korean J Anesthesiol 2016; 69:573-578. [PMID: 27924197 PMCID: PMC5133228 DOI: 10.4097/kjae.2016.69.6.573] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 07/26/2016] [Accepted: 07/28/2016] [Indexed: 12/20/2022] Open
Abstract
Background Modified radical mastectomy is associated with appreciable blood loss, while endotracheal intubation leads to elevated hemodynamic responses. The present study aimed to evaluate the clinical efficacy of dexmedetomidine infusion as an anesthetic adjuvant to general anesthesia during modified radical mastectomy with I-Gel. Methods Sixty adult consenting female patients, of American Society of Anesthesiologists physical status 1 to 2 and aged 4,065 years, were blindly randomized into two groups of 30 patients each. The patients in Group I received intravenous dexmedetomidine at a loading dose of 1 µg/kg over 10 min, followed by maintenance infusion of 0.4 to 0.7 µg/kg/h, while patients in Group II were administered an identical amount of saline infusion until 15 min prior to the end of surgery. The primary end point was bleeding at the surgical field and hemodynamic changes; requirement of isoflurane, intraoperative fentanyl consumption and recovery time were assessed as secondary outcomes. Results The patients receiving dexmedetomidine infusion showed significantly less bleeding at the surgical field (P < 0.05). A statistically significant reduction was also observed in the percentage of isoflurane required (0.82 ± 0.80%) to maintain the systolic blood pressure between 100 and 110 mmHg in patients receiving dexmedetomidine infusion compared with the Group II (1.50 ± 0.90%). The mean intraoperative fentanyl consumption in patients in the Group I was also significantly lower compared with that of the Group II (38.43 ± 5.40 µg vs. 75.12 ± 4.60 µg). The mean recovery time from anesthesia did not show any clinically significant difference between the groups. Conclusions Dexmedetomidine infusion can be used safely to decrease the bleeding at the surgical field with smooth recovery from anesthesia.
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Affiliation(s)
- Kumkum Gupta
- Department of Anaesthesiology and Critical Care, Subharti Medical College, Swami Vivekanand University, Meerut, India
| | - Bhawana Rastogi
- Department of Anaesthesiology and Critical Care, Subharti Medical College, Swami Vivekanand University, Meerut, India
| | - Prashant K Gupta
- Department of Radiodiagnosis and Interventional Imaging, Subharti Medical College, Swami Vivekanand University, Meerut, India
| | - Ivesh Singh
- Department of Anaesthesiology and Critical Care, Subharti Medical College, Swami Vivekanand University, Meerut, India
| | - Vijendra Pal Singh
- Department of Anaesthesiology and Critical Care, Subharti Medical College, Swami Vivekanand University, Meerut, India
| | - Manish Jain
- Department of Anaesthesiology and Critical Care, Subharti Medical College, Swami Vivekanand University, Meerut, India
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Zhang B, Song Q, Zhang B, Tang Z, Xie X, Yang H, He J, Li H, Li J, Li J, Fan J, Huang R, Zhang H, Qiao Y. A 10-year (1999 ~ 2008) retrospective multi-center study of breast cancer surgical management in various geographic areas of China. Breast 2013; 22:676-81. [PMID: 23391660 DOI: 10.1016/j.breast.2013.01.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2012] [Revised: 01/07/2013] [Accepted: 01/10/2013] [Indexed: 02/06/2023] Open
Abstract
PURPOSE To study the change of surgical treatments for breast cancer in China over the recent 10 years and the relationship between such a changes and social economical development. METHODS The data were extracted from the 10-year database of female primary breast cancer at 7 tertiary hospitals from various geographic areas in China. The Chi-square Cochran-Armitage trend test was used to measure the difference. RESULTS Over the 10 year period, mastectomy showed a decline trend while breast conserving surgeries increased. The modified radical mastectomy was the primarily surgical treatment. Among various types of mastectomies, modified radical mastectomy was increasing while Halsted radical mastectomy had shown a decrease trend; no significant changes were observed for the simple mastectomy. Halsted radical mastectomy and breast conserving surgery were used in a higher proportion in high economic areas than low economic areas, while the modified radical mastectomy has been underused in hospitals from high economic areas. CONCLUSIONS Modified radical mastectomy was the overall most common choice of operation in China. Breast conserving surgery has been less popular but had been showing an increasing trend. Halsted radical mastectomy has still been in use but showing a decrease these years. Surgeries were not adherent to guidelines completely and needed further effective training.
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