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Orzalesi L, Casella D, Santi C, Cecconi L, Murgo R, Rinaldi S, Regolo L, Amanti C, Roncella M, Serra M, Meneghini G, Bortolini M, Altomare V, Cabula C, Catalano F, Cirilli A, Caruso F, Lazzaretti MG, Cataliotti L, Bernini M. Nipple sparing mastectomy: Surgical and oncological outcomes from a national multicentric registry with 913 patients (1006 cases) over a six year period. Breast 2015; 25:75-81. [PMID: 26612083 DOI: 10.1016/j.breast.2015.10.010] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 09/18/2015] [Accepted: 10/25/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Nipple sparing mastectomy is deemed surgically and oncologically safe based on a long lasting literature data from reviews of single institution series. This study aims at evaluating surgical and oncological outcomes of NSM on a large multi-institutional scale, by means of the Italian National registry. METHODS In July 2011 a panel of Italian specialists agreed upon and designed a National database of NSM. Centers with at least 150 cancers per year and following the National follow-up schedule guidelines could participate inserting any NSM case performed, retrospectively and prospectively from that moment on. In March 2015 analysis of data was accomplished. Dataset for this study consists of cases performed in the period between January 1st 2009 and December 31st 2014. RESULTS 913 Women were included in the analysis, for a total of 1006 procedures. Prophylactic mastectomies were 124 (12.3%). MRI utilization increased over time. NSM failure rate, with NAC removal for any reason was 11.5%. NAC necrosis rate was 4.8%. Larger skin-flap necrosis rate was 2.3%. Major surgical complications rate was 4.4%. Oncological outcomes were calculated among primitive EBC cases only: locoregional recurrences rate was 2.9%, NAC recurrence 0.7%. Systemic recurrence rate was 1.0%. Five deaths (0.7%) were registered. CONCLUSIONS More than 10% of NSM procedures are prophylactic mastectomies. MRI is gaining more importance over time. Surgical and oncological results show that NSM is effective. This National multicentric analysis enables a comparison of results with no geographical differences and a "safe" state of the art of NSM in Italy.
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Affiliation(s)
- Lorenzo Orzalesi
- Breast Unit Surgery, Oncology Department, Careggi University Hospital, L.go Brambilla 3, 50134 Florence, Italy.
| | - Donato Casella
- Breast Unit Surgery, Oncology Department, Careggi University Hospital, L.go Brambilla 3, 50134 Florence, Italy.
| | - Caterina Santi
- Breast Unit Surgery, Oncology Department, Careggi University Hospital, L.go Brambilla 3, 50134 Florence, Italy.
| | - Lorenzo Cecconi
- Statistics, Department of Statistics, Informatics and Application "G.Parenti", University of Florence, Viale Morgagni 59, 50134 Florence, Italy.
| | - Roberto Murgo
- Breast Unit Surgery, San Giovanni Rotondo Hospital, Viale Cappuccini 1, 71013 S.Giovanni Rotondo, Foggia, Italy.
| | - Stefano Rinaldi
- Breast Unit Surgery, San Paolo Hospital, Via Capo Scardicchio 92, 70123 Bari, Italy.
| | - Lea Regolo
- Breast Unit Surgery, Maugeri Hospital, Via Maugeri 10, 27100 Pavia, Italy.
| | - Claudio Amanti
- Breast Unit Surgery, Sant'Andrea Hospital, Via di Grottarossa 1035, 00189 Rome, Italy.
| | - Manuela Roncella
- Breast Unit Surgery, Cisanello Hospital, Via Roma 67, 56123 Pisa, Italy.
| | - Margherita Serra
- Breast Unit Surgery, Sant'Orsola Hospital, Via Massarenti 9, 40138 Bologna, Italy.
| | - Graziano Meneghini
- Breast Unit, Montecchio Maggiore Hospital, Via Ca' Rotte 7, 36075 Montecchio Maggiore, Vicenza, Italy.
| | | | - Vittorio Altomare
- Breast Unit, Campus Biomedico Hospital, Via Alvaro del Portillo 200, 00128 Rome, Italy.
| | - Carlo Cabula
- Breast Unit Surgery, Businco Hospital, Via Jenner 1, 09127 Cagliari, Italy.
| | - Francesca Catalano
- Breast Unit, Cannizzaro Hospital, Via Messina 829, 95126 Catania, Italy.
| | - Alfredo Cirilli
- Breast Unit Surgery, Policlinico Hospital, P.zza Giulio Cesare 11, Bari, Italy.
| | - Francesco Caruso
- Breast Unit Surgery, Humanitas Hospital, Via Vittorio Emanuele da Bormida 64, 95126 Catania, Italy.
| | | | - Luigi Cataliotti
- President European Breast Centres Certification, President Senonetwork Italia Onlus, Italy.
| | - Marco Bernini
- Breast Unit Surgery, Oncology Department, Careggi University Hospital, L.go Brambilla 3, 50134 Florence, Italy.
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