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da Costa Vieira RA, Facina G, Tiezzi DG, Urban CDA, de Freitas Junior R. Editorial: Oncoplastic surgery for breast cancer. Front Oncol 2024; 13:1348964. [PMID: 38601945 PMCID: PMC11004482 DOI: 10.3389/fonc.2023.1348964] [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: 12/03/2023] [Accepted: 12/12/2023] [Indexed: 04/12/2024] Open
Affiliation(s)
| | - Gil Facina
- Federal University of São Paulo, São Paulo, Brazil
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Vieira RADC, Paulinelli RR, de Oliveira-Junior I. Extreme oncoplasty: past, present and future. Front Oncol 2024; 13:1215284. [PMID: 38352300 PMCID: PMC10862476 DOI: 10.3389/fonc.2023.1215284] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 11/08/2023] [Indexed: 02/16/2024] Open
Abstract
Breast surgery has evolved from mastectomy to breast-conserving surgery (BCS). Breast oncoplastic surgery later emerged with the inclusion and development of techniques used in plastic surgery for breast neoplasms. Recently, a new paradigm has been considered for mastectomy candidates with large multifocal and multicentric tumours, designated extreme oncoplasty (EO), which has allowed new techniques to be applied to tumours that would have been ineligible for BCS before. There are few publications and no uniform descriptions grouping all the technical possibilities and new indications together. We performed this a review with the objective of evaluating the indications and surgeries performed in the EO context, representing a new perspective for BCS. We observed new indications as extensive microcalcifications, locally advanced breast carcinoma with partial response to chemotherapy, small to moderate-sized non-ptotic central tumours and extreme ptosis. Small breasts are able for EO since the presence of ptosis. New surgeries are reported as disguised geometric compensation, perforators flaps, local/regional flaps, latissimus dorsi miniflap and partial breast amputation. It is important to decrease barriers to oncoplastic surgery if we want to increase the use of EO and BCS rates.
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Affiliation(s)
- René Aloisio da Costa Vieira
- Postgraduate Program in Tocogynecology, Botucatu School of Medicine, Botucatu, SP, Brazil
- Postgraduate Program in Oncology, Barretos Cancer Hospital, Barretos, SP, Brazil
- Department of Surgical Oncology, Division of Breast Surgical Oncology, Muriaé Cancer Hospital, Muriaé, MG, Brazil
- Department of Gynecology and Obstetrics, University of Goiás, Goiania, GO, Brazil
| | - Regis Resende Paulinelli
- Postgraduate Program in Tocogynecology, Botucatu School of Medicine, Botucatu, SP, Brazil
- Department of Mastology and Breast Reconstruction, Barretos Cancer Hospital, Barretos, SP, Brazil
| | - Idam de Oliveira-Junior
- Postgraduate Program in Tocogynecology, Botucatu School of Medicine, Botucatu, SP, Brazil
- Postgraduate Program in Oncology, Barretos Cancer Hospital, Barretos, SP, Brazil
- Department of Mastology and Breast Reconstruction, Barretos Cancer Hospital, Barretos, SP, Brazil
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Rajaee AN, Olson DW, Freelove D, Velupillai N, Buro K, Sondekoppam RV, Özelsel TJP. Comparison of the Quality of Recovery-15 score in patients undergoing oncoplastic breast-conserving surgery under monitored anesthesia care versus general anesthesia: a prospective quality improvement study. Can J Anaesth 2023; 70:1928-1938. [PMID: 37749365 DOI: 10.1007/s12630-023-02567-3] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 04/14/2023] [Accepted: 04/28/2023] [Indexed: 09/27/2023] Open
Abstract
PURPOSE Whether changing the institutional practice from general anesthesia (GA) to monitored anesthesia care (MAC) affects postoperative quality of recovery for oncoplastic breast-conserving surgery (BCS) is currently unknown. We designed this quasi-experimental study to evaluate a quality improvement (QI) initiative instituted in Edmonton, AB, Canada. METHODS We chose a prospective controlled cohort study design for this QI study, where patients underwent oncoplastic BCS under MAC in one hospital and BCS under GA at another hospital (control). A total of 125 patients undergoing surgery between May 2021 and February 2022 were enrolled. Exclusion criteria were male sex, total mastectomy, or age under 18. All other patients were included. The primary outcome was the change in Quality of Recovery-15 score at 24 hr compared with a preoperative baseline. Secondary outcomes included intra- and postoperative time profiles, perioperative analgesic and antiemetic use and length of hospital stay. Statistical analysis included a propensity score analysis to account for confounding variables. RESULTS Sixty-four patients received GA and 61 MAC. No enrolled patients were lost to follow up but two were excluded secondarily. No patients receiving MAC needed conversion to GA or unplanned airway management. Monitored anesthesia care was associated with superior outcomes for the primary outcome (β/SE[β], 3.31; 99.5% confidence interval, 0.45 to 6.17; P = 0.001) and most secondary outcomes, when accounting for confounding factors. CONCLUSIONS A care transformation initiative for patients undergoing oncoplastic BCS under MAC was associated with a higher quality recovery profile and shorter length of stay without any increase in perioperative or postoperative adverse events.
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Affiliation(s)
- Azadeh N Rajaee
- Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - David W Olson
- Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | | | - Nirudika Velupillai
- Department of Mathematics and Statistics, MacEwan University, Edmonton, AB, Canada
| | - Karen Buro
- Department of Mathematics and Statistics, MacEwan University, Edmonton, AB, Canada
| | - Rakesh V Sondekoppam
- Department of Anesthesia, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Timur J-P Özelsel
- Department of Anesthesiology & Pain Medicine, University of Alberta, 2-150 Clinical Sciences Building, 8440 112 Street NW, Edmonton, AB, T6G 2B7, Canada.
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De La Cruz Ku G, Camarlinghi M, Mallouh MP, Torres-Roman JS, Linshaw D, Persing SM, Nardello S, Chatterjee A. The impact of body mass index on oncoplastic breast surgery: A multicenter analysis. J Surg Oncol 2023; 128:1052-1063. [PMID: 37448232 DOI: 10.1002/jso.27397] [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: 06/05/2023] [Revised: 07/05/2023] [Accepted: 07/06/2023] [Indexed: 07/15/2023]
Abstract
BACKGROUND Obesity has nearly tripled in the last 50 years. During the last decades, oncoplastic breast surgery has become an important choice in the surgical treatment of breast cancer. An association exists between higher body mass index (BMI) and wound complications for major operations, but there is scarce literature on oncoplastic surgery. Hence, our aim was to compare the complication rates among patients who underwent oncoplastic surgery, stratified by BMI. METHODS Patient data were analyzed from the National Surgical Quality Improvement Program database (NSQIP) for oncoplastic breast procedures (2005-2020). Patients were stratified according to World Health Organization obesity classifications. Multivariate logistic regression was performed to assess risk factors for complications (overall, operative, and wound-related). RESULTS From a total of 6887 patients who underwent oncoplastic surgery, 4229 patients were nonobese, 1380 had Class 1 obesity (BMI: 30 to <35 kg/m2 ), 737 Class 2 obesity (BMI: 35 to <40 kg/m2 ), and 541 Class 3 obesity (BMI: ≥ 40 kg/m2 ). Greater operative time was found according to higher BMI (p < 0.001). Multivariate analysis adjusted for baseline characteristics showed that patients with obesity Class 2 (odds ratio [OR] = 1.51, 95% confidence interval [CI]: 1.03-2.23, p = 0.037) and 3 (OR = 1.87, 95% CI 1.24-2.83, p = 0.003) had increased risk of overall and wound complications compared with Nonobese patients. Comparing obese with nonobese patients, there were no differences in rates of deep SSI, organ/space SSI, pneumonia, reintubation, pulmonary embolism, deep vein thrombosis, urinary tract infection, stroke, bleeding, postoperative sepsis, length of stay, and readmission. CONCLUSIONS Oncoplastic surgery is a safe procedure for most patients. However, caution should be exercised when performing oncoplastic surgery for patients with Class 2 or 3 obesity (BMI ≥ 35 kg/m2 ), given there was a higher rate of overall and wound-specific complications, compared with patients who were not obese or had Class 1 obesity.
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Affiliation(s)
- Gabriel De La Cruz Ku
- Department of Surgery, University of Massachusetts Medical School, Worcester, Massachusetts, USA
- Universidad Cientifica del Sur, Lima, Peru
| | | | - Michael P Mallouh
- Department of Surgery, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - J Smith Torres-Roman
- South American Center for Education and Research in Public Health, Universidad Norbert Wiener, Lima, Peru
| | - David Linshaw
- Department of Surgery, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Sarah M Persing
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Tufts Medical Center, Boston, Massachusetts, USA
- Division of Surgical Oncology, Department of Surgery, Tufts Medical Center, Boston, Massachusetts, USA
| | - Salvatore Nardello
- Division of Surgical Oncology, Department of Surgery, Tufts Medical Center, Boston, Massachusetts, USA
| | - Abhishek Chatterjee
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Tufts Medical Center, Boston, Massachusetts, USA
- Division of Surgical Oncology, Department of Surgery, Tufts Medical Center, Boston, Massachusetts, USA
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Armstrong K, Maxwell J. Oncoplastic surgery for breast cancer: Global perspectives and trends. J Surg Oncol 2023; 128:967-971. [PMID: 37818917 DOI: 10.1002/jso.27408] [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: 06/16/2023] [Accepted: 07/16/2023] [Indexed: 10/13/2023]
Abstract
Oncoplastic surgery (OPS) is a form of breast conservation that combines definitive oncologic resection with optimal aesthetic outcomes. Various definitions exist, with most focusing on volume displacement techniques to close the lumpectomy defect and redistribute the remaining breast volume over the preserved breast. Although its oncologic safety has been well demonstrated, uptake into practice varies globally. This article details the definition, safety, training opportunities, and practice patterns of OPS on a global scale.
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Affiliation(s)
- Kate Armstrong
- Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Jessica Maxwell
- Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska, USA
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de Oliveira-Junior I, da Costa Vieira RA, Biller G, Sarri AJ, da Silva FCB, Nahás EAP. Factors associated with unsatisfactory cosmetic results in oncoplastic surgery. Front Oncol 2023; 13:1071127. [PMID: 37554162 PMCID: PMC10405917 DOI: 10.3389/fonc.2023.1071127] [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: 10/15/2022] [Accepted: 07/10/2023] [Indexed: 08/10/2023] Open
Abstract
INTRODUCTION Oncoplastic surgery (OS) has expanded the indications for breast-conserving surgery associated with an adequate aesthetic result. However, few studies have described the factors associated with unsatisfactory cosmetic outcomes from this surgical modality. MATERIALS AND METHODS This is a cross-sectional prospective study that included patients undergoing breast-conserving surgery (BCS) with or without OS. The patients self-evaluated the cosmetic results of the breasts posttreatment and had them photographed. The photos were analyzed by BCCT.core. Individual and treatment factors (local and systemic) for all patients were evaluated. These factors were dichotomized according to the use of OS and to the cosmetic result (satisfactory and unsatisfactory). Categorical variables were tested for association with surgical outcome using the chi-square test while numerical variables using the Mann-Whitney U test. Variables with p <0,2 were selected for multivariate analysis. RESULTS Of the 300 patients evaluated, 72 (24,0%) underwent OS. According to the patient self-evaluations, an unsatisfactory cosmetic result from OS was significantly associated with younger age at diagnosis, higher body mass index (BMI) at the time of evaluation, larger tumor size and greater weight of the surgical specimen. According to the BCCT.core, only the laterality of the tumor (left) was significantly associated with an unsatisfactory cosmetic result. In logistic regression, considering OS as a control variable, the risk of an unsatisfactory outcome according to patient self-evaluation was related to the tumor ≥ T2 odds ratio (OR) 1,85 (1,027-3,34) and age at diagnosis < 40 [OR 5,0 (1,84-13,95)]. However, according to the software, the variables were associated with an increased risk of an unsatisfactory outcome were the time interval between surgery and evaluation [OR 1,27 (1,16-1,39)], the presence of lymphedema [OR 2,97 (1,36-6,46)], surgical wound infection [OR 3,6 (1,22-11,16)], tumor location on the left side [OR 3,06 (1,69-5,53)], overweight [OR 2,93 (1,48-5,8)] and obesity [OR 2,52 (1,2-5,31)]. CONCLUSION There is no standard methodology for breast cosmesis evaluation, which influences the factors associated with unsatisfactory results. Younger patients and those with increased BMI, left breast cancer and extensive resections tend to present with unsatisfactory cosmetic results when OS is performed.
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Affiliation(s)
- Idam de Oliveira-Junior
- Postgraduate Program of Tocogynecology, Botucatu Medical School, Sao Paulo State University, UNESP, Sao Paulo, Brazil
- Postgraduate Program of Oncology, Barretos Cancer Hospital, Sao Paulo, Brazil
- Nucleous of Mastology, Barretos Cancer Hospital, Sao Paulo, Brazil
| | - René Aloísio da Costa Vieira
- Postgraduate Program of Tocogynecology, Botucatu Medical School, Sao Paulo State University, UNESP, Sao Paulo, Brazil
- Postgraduate Program of Oncology, Barretos Cancer Hospital, Sao Paulo, Brazil
| | - Gabriele Biller
- Postgraduate Program of Oncology, Barretos Cancer Hospital, Sao Paulo, Brazil
- Faculty of Health Sciences of Barretos Dr. Paulo Prata (FACISB) School of Medicine, Sao Paulo, Brazil
| | - Almir José Sarri
- Nucleous of Mastology, Barretos Cancer Hospital, Sao Paulo, Brazil
| | - Fabíola Cristina Brandini da Silva
- Postgraduate Program of Oncology, Barretos Cancer Hospital, Sao Paulo, Brazil
- Nucleous of Mastology, Barretos Cancer Hospital, Sao Paulo, Brazil
| | - Eliana Aguiar Petri Nahás
- Postgraduate Program of Tocogynecology, Botucatu Medical School, Sao Paulo State University, UNESP, Sao Paulo, Brazil
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Martins LL, Barbosa RF, Guerreiro FC, Andresen C, Pereira MJ, Pinho CJ, Rebelo MA, Ribeiro MM. A Two-Year Retrospective Analysis of the Clinical Outcomes of Immediate Submuscular Breast Reconstructions With Native® Acellular Dermal Matrix. Cureus 2023; 15:e41343. [PMID: 37546031 PMCID: PMC10399605 DOI: 10.7759/cureus.41343] [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] [Accepted: 07/03/2023] [Indexed: 08/08/2023] Open
Abstract
BACKGROUND Implant-based submuscular breast reconstruction (SBR) can be performed with the aid of acellular dermal matrices (ADM) for implant coverage on their inferolateral pole, aiming at providing a biological interface for hiding the implant and therefore reducing the risk of complications. The purpose of this study is to assess the long-term post-operative outcomes obtained using the SBR-specific Native® ADM (DECO med s.r.l., Marcon, Venice, Italy). METHODS All cases of Native®-assisted immediate SBR performed at our institution between October 2016 and March 2020 were retrospectively analysed. Demographic and surgical data were collected, and post-operative outcomes, including minor and major complications, were evaluated. Particular attention was paid to complications emerging before and after patient discharge. Dependence analyses were performed to uncover statistically significant relationships between risk factors and reconstructive outcomes. RESULTS Data on 100 patients were collected, for a total of 128 breasts. The mean age of the cohort was 49.5 years, the mean BMI was 23.4 kg/m2, and the mean follow-up was 24 months. Out of this, 14.1% of patients received pre-operative radiotherapy, while 16.4% underwent post-mastectomy radiotherapy. Breasts appeared to develop short-term minor complications more likely during hospitalisation (11.7% vs. 7.8%), while short-term major complications occurred more often after discharge (7.8% vs. 15.6%). The most frequent long-term complications were capsular contracture and contour defects (both 9.4%). Risk factors that showed a statistically significant relationship with complications were pre- and post-mastectomy radiotherapy and post-operative chemotherapy. CONCLUSIONS The retrospective analysis showed results in line with clinical outcomes reported in the literature for the same reconstructive technique. The use of Native® ADM in SBR is safe and effective in the long term.
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Affiliation(s)
- Larissa L Martins
- Department of Plastic, Reconstructive, Craniomaxillofacial and Hand Surgery and Microsurgery Unit, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, PRT
- Department of Plastic Surgery, Hospital da Prelada, Porto, PRT
| | - Rui F Barbosa
- Department of Plastic and Reconstructive Surgery, Instituto Português de Oncologia do Porto Francisco Gentil, EPE, Porto, PRT
| | - Frederico C Guerreiro
- Department of Reconstructive and Maxillofacial Plastic Surgery, Centro Hospitalar de Lisboa Ocidental, Lisbon, PRT
| | - Carolina Andresen
- Department of Plastic, Reconstructive, Craniomaxillofacial and Hand Surgery and Microsurgery Unit, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, PRT
| | - Miguel J Pereira
- Department of Plastic and Reconstructive Surgery, Instituto Português de Oncologia do Porto Francisco Gentil, EPE, Porto, PRT
| | - Carlos J Pinho
- Department of Plastic and Reconstructive Surgery, Instituto Português de Oncologia do Porto Francisco Gentil, EPE, Porto, PRT
| | - Marco A Rebelo
- Department of Plastic and Reconstructive Surgery, Instituto Português de Oncologia do Porto Francisco Gentil, EPE, Porto, PRT
| | - Matilde M Ribeiro
- Department of Plastic and Reconstructive Surgery, Instituto Português de Oncologia do Porto Francisco Gentil, EPE, Porto, PRT
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Businaro Fernandes João T, de Oliveira VM, Bagnoli F, Bastos MCS, Rinaldi JF, Brenelli FP, Mateus EF. How well are Brazilian mastologists (breast surgeons) trained in breast reconstruction and oncoplastic surgery? A study of the impact of a breast reconstruction and oncoplastic surgery improvement course. Front Oncol 2023; 13:1139461. [PMID: 37287926 PMCID: PMC10242663 DOI: 10.3389/fonc.2023.1139461] [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: 01/07/2023] [Accepted: 04/24/2023] [Indexed: 06/09/2023] Open
Abstract
Introduction The breasts are a female symbol, impacts self-image and self-esteem. Breast reconstructive and oncoplastic surgeries have an important role in minimizing injuries. In Brazil less than a third of public health system (SUS) users have access to immediate reconstructive surgery. The low rate of breast reconstructions has multiple causes and the deficiency in availability and surgeons' technical qualification play a role. In 2010, the Breast Reconstruction and Oncoplastic Surgery Improvement Course was created by professors of the Mastology Department of Santa Casa de São Paulo and State University of Campinas (UNICAMP). The objectives of this study were to evaluate the impact of the techniques learned on patients' management by the surgeons enrolled in the Course, as well as to characterize their profile. Methods All students enrolled in the Improvement Course between 2010 and 2018 were invited to answer an online questionnaire. Students who did not agree to answer the questionnaire or answered them incompletely were excluded. Results Total students included: 59. The mean age: 48.9 years, male (72%) with more than 5 years of Mastology practice (82.2%), from all regions of Brazil, 1.7% from the North, 33.9% from the Northeast, 44.1% from the Southeast, and 12% from the South. Most of the students considered they had little or no knowledge of breast reconstruction (74.6%) and 91,5% did not consider they had enough aptitude to perform breast reconstructions after finishing residency. After the Course, 96.6% considered themselves apt to perform such surgeries. Over 90% of the students considered the Course had impacted their practice and changed their surgical strategy view. Before the Course, 84.8% of the students stated that less than half of their patients who were operated on for breast cancer had breast reconstruction, compared to 30.5% after the Course. Conclusion The Breast Reconstruction and Oncoplastic Surgery Improvement Course studied here positively impacted the mastologists' management of patients. New training centers worldwide can help a lot of women with breast cancer.
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Affiliation(s)
- Thais Businaro Fernandes João
- Irmandade da Santa Casa de Misericórdia de São Paulo (ISCMSP); Faculty of Medical Sciences of Santa Casa de São Paulo (FCMSCSP), São Paulo, Brazil
| | - Vilmar Marques de Oliveira
- Irmandade da Santa Casa de Misericórdia de São Paulo (ISCMSP); Faculty of Medical Sciences of Santa Casa de São Paulo (FCMSCSP), São Paulo, Brazil
| | - Fábio Bagnoli
- Irmandade da Santa Casa de Misericórdia de São Paulo (ISCMSP); Faculty of Medical Sciences of Santa Casa de São Paulo (FCMSCSP), São Paulo, Brazil
| | - Maria Carolina Soliani Bastos
- Irmandade da Santa Casa de Misericórdia de São Paulo (ISCMSP); Faculty of Medical Sciences of Santa Casa de São Paulo (FCMSCSP), São Paulo, Brazil
| | - José Francisco Rinaldi
- Irmandade da Santa Casa de Misericórdia de São Paulo (ISCMSP); Faculty of Medical Sciences of Santa Casa de São Paulo (FCMSCSP), São Paulo, Brazil
| | - Fabrício Palermo Brenelli
- State University of Campinas (UNICAMP), Campinas, Brazil
- Beneficiência Portuguesa de São Paulo, São Paulo, Brazil
| | - Evandro Fallaci Mateus
- Irmandade da Santa Casa de Misericórdia de São Paulo (ISCMSP); Faculty of Medical Sciences of Santa Casa de São Paulo (FCMSCSP), São Paulo, Brazil
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Pelorca RJF, de Oliveira-Junior I, da Costa Vieira RA. Oncoplastic surgery for Paget's disease of the breast. Front Oncol 2023; 13:1151932. [PMID: 37265790 PMCID: PMC10231681 DOI: 10.3389/fonc.2023.1151932] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 05/02/2023] [Indexed: 06/03/2023] Open
Abstract
Introduction Paget's disease of the breast (PDB) is a rare nipple entity associated with multifocality. Due to its location, resection of the entire nipple-areolar complex is necessary. Historically central quadrantectomy and mastectomy have the surgical treatments of choice. The feasibility of oncoplastic breast surgery (OBS) for PDB is unknown. Methods This was a retrospective study performed in a Brazilian oncological hospital. We evaluated the factors related to the performance of OBS in PDB. In addition, the impact of OBS on local recurrence and survival was analysed. Comparisons were made between groups using the chi-square test, Mann-Whitney U test, and Kaplan-Meier method. To assess the impact factor of the variables on the performance of OBS, logistic regression was performed. Results Eighty-five patients were evaluated. OBS was performed in 69.4% (n=59), and of these, 16 (27.2%) were symmetrized with contralateral surgery. Mastectomy without reconstruction was performed in 28.3% of the patients. The primary procedure performed was mastectomy with reconstruction (n=38; 44.7%), and the preferential technique for immediate reconstruction was skin-sparing mastectomy with prosthesis; for late reconstruction, the preferred technique was using the latissimus dorsi. Breast conserving-surgery was performed in 27.0% (n=23), primarily using the plug-flap technique (OBS). Age was associated with the use of OBS; as patients aged 40-49 exhibited a higher rate of OBS (p = 0.002; odds ratio 3.22). OBS did not influence local recurrence (p=1.000), overall survival (p=0.185), or cancer-specific survival (p=0.418). Conclusion OBS improves options related to surgical treatment in PDB without affecting local recurrence or survival rates.
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Affiliation(s)
- Rafael José Fábio Pelorca
- Programa de Pós-Graduação em Tocoginecologia, Faculdade de Medicina de Botucatu, Botucatu, SP, Brazil
| | - Idam de Oliveira-Junior
- Programa de Pós-Graduação em Tocoginecologia, Faculdade de Medicina de Botucatu, Botucatu, SP, Brazil
- Programa de Pós-Graduação em Oncologia, Barretos Cancer Hospital, Barretos, SP, Brazil
- Departamento de Mastologia e Reconstrução Mamária, Barretos Cancer Hospital, Barretos, SP, Brazil
| | - René Aloisio da Costa Vieira
- Programa de Pós-Graduação em Tocoginecologia, Faculdade de Medicina de Botucatu, Botucatu, SP, Brazil
- Programa de Pós-Graduação em Oncologia, Barretos Cancer Hospital, Barretos, SP, Brazil
- Departamento de Cirurgia Oncológica, Divisão de Mastologia, Hospital de Câncer de Muriaé, Muriaé, MG, Brazil
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Naccour J, El-Helou E. Factors influencing the decision-making process for breast surgery in women likely to face breast cancer: a cross-sectional study. Ann Med Surg (Lond) 2023; 85:1648-1654. [PMID: 37229100 PMCID: PMC10205190 DOI: 10.1097/ms9.0000000000000577] [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] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 03/22/2023] [Indexed: 05/27/2023] Open
Abstract
Breast cancer (BC) is one of the main neoplasia affecting women worldwide. Breast conserving surgery (BCS) or modified radical mastectomy (Mx) are both applicable with no difference between patients treated by these surgeries in terms of quality of life, local recurrence rate, and overall survival. The surgical decision today favors the surgeon-patient dialog, in which the patient is involved in the therapeutic decision. Several factors influence the decision-making process. This study aims to investigate these factors in Lebanese women likely to face BC and before being operated on, unlike other studies that targeted patients who had already been operated on. Methods The authors conducted a study to investigate the factors influencing the choice of breast surgery. To be eligible for this study, participants had to be Lebanese women, with no age limit and willing to participate voluntarily. A questionnaire form was used to collect data related to patient demographics, health, surgery, and relevant factors. Data analysis was performed by statistical tests using IBM SPSS Statistics software (version 25) and Microsoft Excel spreadsheet (Microsoft 365). Significant factors (defined as P<0.05) were than used to determine the factors that influenced women's decision-making. Results Data from 380 participants were analyzed. The majority of participants were young (41.58% were between 19 and 30 years old), living in Lebanon (93.3%), and had a bachelor's degree or higher (83.95%). Almost half of the women (55.26%) are married and have children (48.95%). Among the participants, 97.89% had no personal history of BC, and 95.79% had not undergone any breast surgery. The majority of participants indicated that their primary care physician and surgeon influenced their decision on the type of surgery they take (56.32 and 61.58%, respectively). Only 18.16% of respondents said they had no preference for Mx over BCS. While the others listed their reasons and concerns for choosing Mx, including: concern about recurrence (40.26%), concern about residual cancer (31.05%). 17.89% of the participants justify the reason for choosing Mx rather than BCS, by the fact that they lack information on BCS. Most of the participants confirmed the importance of clarifying all information about BC and treatment options before being affected by a malignancy (71.84%) of which 92.28% preferred to participate in the next online lectures about this topic. The assumption of equal variance is assumed. Indeed, according to the Levene Test (F=1.354; P<0.05), there is a significant difference between the age categories of the group that prefers Mx (2.08) and the group that does not prefer Mx over BCS (1.77). Based on an independent samples t-test (t(380)=2.200; P<0.05). On the other hand, the preference of Mx over BCS is statistically dependent on the choice of contralateral prophylactic mastectomy. Indeed, according to the χ2-test, the relationship between the two variables is significant (χ2 (2)=8.345; P<0.05). The 'Phi' statistic measures the intensity of the relationship between the two variables in question (φ=0.148); therefore, the relationship between the preference of Mx rather than BCS and the asking of contralateral prophylactic Mx is strong and significant (P<0.05). However, there was no statistically significant dependence between the preference of Mx and the other factors studied (P>0.05). Conclusion BC poses a problem for affected women, especially when they are asked to choose between a Mx or a BCS. Several complex factors affect and influence their decision and lead them to decide. Understanding these factors helps us to properly help these women choose. In this study, the authors demonstrated all the factors that can influence the choice of Lebanese women prospectively, and we stressed the need to explain all the modalities before being diagnosed.
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11
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Karamchandani MM, Jonczyk MM, De La Cruz Ku G, Gaffney KA, Wareham C, Nardello S, Persing SM, Homsy C, Chatterjee A. The adoption of oncoplastic surgery: Is there a learning curve? J Surg Oncol 2023. [PMID: 37092965 DOI: 10.1002/jso.27294] [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: 04/03/2023] [Revised: 04/12/2023] [Accepted: 04/16/2023] [Indexed: 04/25/2023]
Abstract
INTRODUCTION Oncoplastic surgery (OPS) is a form of breast conservation surgery involving partial mastectomy followed by volume displacement or replacement surgery. As the field of OPS is growing, we sought to determine if there was a learning curve to this surgery. METHODS A retrospective chart review was conducted of all patients who underwent OPS over a 6-year period with a single surgeon formally trained in both Plastic Surgery and Breast Oncology. Cumulative summation analysis (CUSUM) was performed on mean operative time to generate the learning curve and learning curve phases. Outcomes were compared between phases to determine significance. RESULTS Mean operative time decreased significantly across the 6-year period, generating three distinct learning curve phases: Learner phase (cases 1-23), Competence phase (24-73), and Mastery phase (74 and greater). The overall positive margin rate was 10.9% and there was no significant difference in rates between phases (p = 0.49). Overall complication rates, reoperation rates, and locoregional recurrence remained the same across all phases (p = 0.16; p = 0.65; p = 0.41). The rate of partial nipple loss decreased between phases (p = 0.02). CONCLUSION As with many complex operations, there does appear to be a learning curve with OPS, as the operative time and the rates of partial nipple loss decreased over time.
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Affiliation(s)
| | - Michael M Jonczyk
- Department of Surgery, Lahey Hospital & Medical Center, Burlington, Massachusetts, USA
| | - Gabriel De La Cruz Ku
- Department of Surgery, UMass Memorial Medical Center, Worcester, Massachusetts, USA
- Universidad Cientifica del Sur, Lima, Peru
| | - Kerry A Gaffney
- Department of Surgery, Tufts Medical Center, Boston, Massachusetts, USA
| | - Carly Wareham
- Department of Surgery, Tufts Medical Center, Boston, Massachusetts, USA
| | - Salvatore Nardello
- Department of Surgery, Division of Surgical Oncology, Tufts Medical Center, Boston, Massachusetts, USA
| | - Sarah M Persing
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Tufts Medical Center, Boston, Massachusetts, USA
- Department of Surgery, Division of Surgical Oncology, Tufts Medical Center, Boston, Massachusetts, USA
| | - Christopher Homsy
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Tufts Medical Center, Boston, Massachusetts, USA
| | - Abhishek Chatterjee
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Tufts Medical Center, Boston, Massachusetts, USA
- Department of Surgery, Division of Surgical Oncology, Tufts Medical Center, Boston, Massachusetts, USA
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12
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Ramirez AL, Townsend AN, Weber L, Piccinini PS, Wolfe EM, Taylor MW, Haglund TA, Shraiteh MA, Hannan R, Fader ME, Ragheb J, Wolfe SA, Steinberg JP. An Oncoplastic Approach to Primary Pediatric Pterygomaxillary Osteosarcoma. Cleft Palate Craniofac J 2023:10556656231154814. [PMID: 36972482 DOI: 10.1177/10556656231154814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
Abstract
Osteosarcomas arising within the pterygomaxillary/infratemporal fossa region are rare among the pediatric population. Survival rates are most influenced by tumor resection with negative margins, which can be dependent on surgical accessibility of the tumor site. The pterygomaxillary/infratemporal fossa location poses several challenges to safe and adequate tumor resection, including proximity of the facial nerve and great vessels and scarring associated with traditional transfacial approaches. In this article, we present the case of a 6-year-old boy with an osteosarcoma of the left pterygomaxillary/infratemporal fossa region successfully managed with an "oncoplastic" approach, incorporating the use of CAD/CAM and mixed reality technologies.
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Affiliation(s)
- Ashley L Ramirez
- Division of Plastic Surgery, 5447Nicklaus Children's Hospital, Miami, FL, USA
| | | | - Lee Weber
- Division of Plastic Surgery, 5447Nicklaus Children's Hospital, Miami, FL, USA
| | - Pedro S Piccinini
- Division of Plastic Surgery, 5447Nicklaus Children's Hospital, Miami, FL, USA
| | - Erin M Wolfe
- Division of Plastic Surgery, 5447Nicklaus Children's Hospital, Miami, FL, USA
| | - Marek W Taylor
- Division of Plastic Surgery, 5447Nicklaus Children's Hospital, Miami, FL, USA
| | - Thomas A Haglund
- Cardiovascular Surgery Advanced Projects Laboratory, Nicklaus Children's Hospital, Miami, FL, USA
| | - Muhanad A Shraiteh
- Cardiovascular Surgery Advanced Projects Laboratory, Nicklaus Children's Hospital, Miami, FL, USA
| | - Robert Hannan
- Cardiovascular Surgery Advanced Projects Laboratory, Nicklaus Children's Hospital, Miami, FL, USA
| | - Maggie E Fader
- Division of Hematology/Oncology, Nicklaus Children's Hospital, Miami, FL, USA
| | - John Ragheb
- Division of Neurosurgery, Nicklaus Children's Hospital, Miami, FL, USA
| | - S Anthony Wolfe
- Division of Plastic Surgery, 5447Nicklaus Children's Hospital, Miami, FL, USA
| | - Jordan P Steinberg
- Division of Plastic Surgery, 5447Nicklaus Children's Hospital, Miami, FL, USA
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13
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Jonczyk MM, Homsy C, Naber S, Chatterjee A. Examining a decade of racial disparity in partial mastectomy and oncoplastic surgery. J Surg Oncol 2023; 127:541-549. [PMID: 36507913 DOI: 10.1002/jso.27173] [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: 07/06/2022] [Revised: 10/25/2022] [Accepted: 12/01/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND OBJECTIVES Understanding racial disparity is crucial to addressing health equity and access to care. Our study aims to examine racial differences in breast conserving surgery (BCS) utilization rates and determine how these rates have changed over time. METHODS This retrospective cohort analysis utilized the NSQIP database to identify women diagnosed with breast cancer who underwent BCS procedures between 2008 and 2019. Racial utilization trends were analyzed using a Cochran-Armitage test and Index of Disparity analysis. RESULTS In the 12-year period, 202 492 women underwent a breast cancer surgery, of which 47% underwent BCS. Within the BCS subgroup, oncoplastic surgery utilization increased from 3% to 10%, leading to a declining proportion of partial mastectomies: 97% to 90.0% (both p < 0.01). The racial index of disparity for overall BCS patients decreased from 7% to 6%, remained unchanged (1%) for partial mastectomies, and significantly decreased in oncoplastics (23%-7.6%). CONCLUSION BCS represents a mainstay option for early-staged breast cancer interventions, this study demonstrate promising progress in decreasing the index of disparity among races and persistent racial inequalities.
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Affiliation(s)
- Michael M Jonczyk
- Department of General Surgery, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA.,Department of Surgery, Tufts Medical Center, Boston, Massachusetts, USA
| | - Christopher Homsy
- Department of Surgery, Tufts Medical Center, Boston, Massachusetts, USA
| | - Stephen Naber
- Department of Pathology and Laboratory Medicine, Tufts Medical Center, Boston, Massachusetts, USA
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14
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Vieira RADC, Bailão-Junior A, de Oliveira-Junior I. Does breast oncoplastic surgery improve quality of life? Front Oncol 2023; 12:1099125. [PMID: 36713564 PMCID: PMC9877289 DOI: 10.3389/fonc.2022.1099125] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 12/28/2022] [Indexed: 01/15/2023] Open
Abstract
Breast Oncoplastic Surgery (OS) has established itself as a safe procedure associated with the treatment of breast cancer, but the term is broad, encompassing procedures associated with breast-conserving surgeries (BCS), conservative mastectomies and fat grafting. Surgeons believe that OS is associated with an increase in quality of life (QOL), but the diversity of QOL questionnaires and therapeutic modalities makes it difficult to assess from the patient's perspective. To answer this question, we performed a search for systematic reviews on QOL associated with different COM procedures, and in their absence, we selected case-control studies, discussing the main results. We observed that: (1) Patients undergoing BCS or breast reconstruction have improved QoL compared to those undergoing mastectomy; (2) In patients undergoing BCS, OS has not yet shown an improvement in QOL, a fact possibly influenced by patient selection bias; (3) In patients undergoing mastectomy with reconstruction, the QoL results are superior when the reconstruction is performed with autologous flaps and when the areola is preserved; (4) Prepectoral implants improves QOL in relation to subpectoral implant-based breast reconstruction; (5) ADM do not improves QOL; (6) In patients undergoing prophylactic mastectomy, satisfaction is high with the indication, but the patient must be informed about the potential complications associated with the procedure; (7) Satisfaction is high after performing fat grafting. It is observed that, in general, OS increases QOL, and when evaluating the procedures, any preservation or repair, or the use of autologous tissues, increases QOL, justifying OS.
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Affiliation(s)
- René Aloisio da Costa Vieira
- Programa de Pós-Graduação em Tocoginecologia, Faculdade de Medicina de Botucatu, Botucatu/SP, Brazil,Programa de Pós-Graduação em Oncologia, Hospital de Câncer de Barretos, Barretos/SP, Brazil,Departamento de Cirurgia Oncológica, Divisão de Mastologia, Hospital de Câncer de Muriaé, Muriaé/MG, Brazil,Active Member of European Organisation for Research and Treatment (EORTC) Quality of life Group, Brussels, Belgium,*Correspondence: René Aloisio da Costa Vieira,
| | - Antônio Bailão-Junior
- Programa de Pós-Graduação em Tocoginecologia, Faculdade de Medicina de Botucatu, Botucatu/SP, Brazil,Departamento de Mastologia e Reconstrução Mamária, Hospital de Câncer de Barretos, Barretos/SP, Brazil
| | - Idam de Oliveira-Junior
- Programa de Pós-Graduação em Tocoginecologia, Faculdade de Medicina de Botucatu, Botucatu/SP, Brazil,Programa de Pós-Graduação em Oncologia, Hospital de Câncer de Barretos, Barretos/SP, Brazil,Departamento de Mastologia e Reconstrução Mamária, Hospital de Câncer de Barretos, Barretos/SP, Brazil
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15
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Kumar Yadav S, Sharma D, Bala Sharma D, Mishra A, Agarwal P. Low-cost solutions incorporated in a standard surgical pathway for early breast cancer: A pilot study. Trop Doct 2023; 53:81-84. [PMID: 36426550 DOI: 10.1177/00494755221141932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
We present the results of incorporation of low-cost solutions to provide a standard surgical care for early breast cancer (EBC) patients. This surgical pathway consists of a low-cost vacuum-assisted core needle biopsy, sentinel lymph node biopsy (SLNB) using low-cost methylene blue and fluorescin dyes under local anesthesia and oncoplastic breast surgery. Patients assessed as clinically node-negative axilla underwent such treatment. SLNB using low-cost dyes was performed without any complication. Oncoplastic surgical techniques were opted for in 32 patients, and the lumps were all excised with a ∼1-cm all-around margin on the final histopathological examination. Standard breast cancer surgery can be provided in low-resource settings to eligible EBC patients with low-cost solutions.
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Affiliation(s)
| | | | | | - Arpan Mishra
- 534313Department of Surgery, NSCB Medical College, Jabalpur, India
| | - Pawan Agarwal
- 534313Department of Surgery, NSCB Medical College, Jabalpur, India
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16
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Orsaria P, Grasso A, Soponaru G, Carnevale F, Scorsone V, Ippolito E, Pantano F, Sammarra M, Piccolo C, Altomare M, Perrone G, Altomare V. Subaxillary Replacement Flap Compared with the Round Block Displacement Technique in Oncoplastic Breast Conserving Surgery: Functional Outcomes of a Feasible One Stage Reconstruction. Curr Oncol 2022; 29:9377-90. [PMID: 36547150 DOI: 10.3390/curroncol29120736] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 11/25/2022] [Accepted: 11/26/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND For selected women diagnosed with breast cancer (BC), partial reconstructive techniques involve displacement or replacement procedures to improve cosmesis without compromising oncological safety. This study aims to evaluate the surgical outcomes of the round block (RB) compared with the subaxillary flap (SF) technique for patients with upper outer tumor. PATIENTS AND METHODS Thirty-three patients treated with oncoplastic conserving surgery (15 RB and 18 SF) were enrolled in this retrospective study. After carrying out a comparison of baseline characteristics, all cases were recruited for postoperative evaluation of oncological and cosmetic parameters. Moreover, we investigated several scoring combinations to check whether they could discriminate surgeon and patient satisfaction according to different functional results. RESULTS Median age (p < 0.05), average tumor size (p > 0.05), estimated resection volume (p > 0.05), and nodal involvement (p > 0.05) were slightly higher in the SF group. A greater frequency of DCIS (p < 0.05) in the RB series correlated with reintervention for positive margins (p > 0.001). At a mean follow-up of 19 months, no locoregional recurrences were recorded and early and late complications were comparable (p > 0.05). The overall satisfaction with cosmesis was characterized by similar proportions of good results (p > 0.05), with some details more related to each procedure. CONCLUSION The proposed techniques represent effective solutions for reshaping that follows upper outer wide excision, achieving comparable complication rates, low reinterventions, and good aesthetic results in relation to technical and social functioning evaluations. However, it is crucial to establish a careful patient selection in order to manage correct surgical planning while predicting any potential sequelae or complication.
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17
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Mason EJ, Di Leone A, Franco A, D'Archi S, Rianna C, Sanchez AM, Murando F, Accetta C, Scardina L, Terribile DA, Masetti R, Franceschini G. Oncoplastic Breast Surgery versus Conservative Mastectomy in the Management of Large Ductal Carcinoma In Situ (DCIS): Surgical, Oncological, and Patient-Reported Outcomes. Cancers (Basel) 2022; 14. [PMID: 36428718 DOI: 10.3390/cancers14225624] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 11/13/2022] [Accepted: 11/14/2022] [Indexed: 11/18/2022] Open
Abstract
Oncoplastic level II breast-conserving surgery (OPS2) allows for wider excisions than standard breast-conserving surgery, but the literature on this technique in the treatment of DCIS is scarce. This study compares OPS2 to conservative mastectomy (CM) in patients undergoing surgery for large DCIS. The clinical, radiological, surgical, and post-operative data of 147 patients who underwent either CM or OPS2 for large DCIS between 2007 and 2021 were retrospectively reviewed. The surgical, oncological, and patient-reported outcomes (PRO) were analyzed and compared between the two groups. The surgical outcomes were similar, in terms of margin involvement (p = 0.211), complication rate (p = 0.827), and re-excision rate (p = 1). The rate of additional surgery for cosmetic optimization was significantly lower in the OPS2 group: only 1 (1.8%) patient required surgical adjustments versus 24 (26.4%) patients in the CM group (p < 0.001). The mean hospital stay was lower in the OPS2 group (p < 0.001). The oncological outcomes did not differ between the two groups (p = 0.662). The PRO analysis showed better outcomes in the OPS2 group, which achieved statistical significance in the sexual well-being module (p = 0.015). Skin sensitivity loss was also significantly lower in the OPS2 group (p < 0.001). When feasible, OPS2 should be considered in the treatment of large DCIS, as it is safe and shows high levels of patient satisfaction.
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18
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Pawlak N, Karamchandani M, Wareham C, Gaffney K, Zaccardelli A, Nardello S, Persing S, Chatterjee A, Homsy C. Comparing oncoplastic breast reduction with immediate symmetry surgery to standard breast reduction surgery: Are postoperative complications worse? J Surg Oncol 2022; 126:956-961. [PMID: 35801636 DOI: 10.1002/jso.27009] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 06/27/2022] [Accepted: 06/29/2022] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Oncoplastic breast reduction mammoplasty (ORM) is an excellent treatment option for women with breast cancer and macromastia undergoing breast conservation therapy. Here, we aim to better understand the risks associated with ORM compared to standard reduction mammoplasty (SRM). METHODS A retrospective chart review was performed of patients undergoing ORM or SRM from 2015 to 2021. Primary outcomes included the occurrence of major or minor postoperative complications in the two groups and delays to adjuvant therapy (>90 days) among the women undergoing ORM. RESULTS Women in the ORM group (n = 198) were significantly older (p < 0.001) with a higher prevalence of smoking (p < 0.001), diabetes mellitus (p < 0.01), and a Charlson comorbidity index ≥ 3 (p < 0.001) compared to women undergoing SRM (n = 177). After controlling for potential confounders, there were no significant between-group differences in the odds of developing postoperative complications (odds ratio = 0.80, 95% confidence interval: 0.36-1.69). Only 3% (n = 4) of the 150 women undergoing adjuvant radiation or chemotherapy experienced delays related to postoperative complications. CONCLUSION ORM has a similar safety profile as SRM, despite the older age and higher number of comorbidities often seen in patients undergoing ORM, and is a safe option for achieving contralateral symmetry at the time of partial mastectomy without delays to adjuvant therapy.
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Affiliation(s)
- Natalie Pawlak
- Tufts University School of Medicine, Boston, Massachusetts, USA
| | | | - Carly Wareham
- Department of Surgery, Tufts Medical Center, Boston, Massachusetts, USA
| | - Kerry Gaffney
- Department of Surgery, Tufts Medical Center, Boston, Massachusetts, USA
| | | | - Salvatore Nardello
- Department of Surgery, Tufts Medical Center Community Care, Boston, Massachusetts, USA
| | - Sarah Persing
- Department of Surgery, Tufts Medical Center, Boston, Massachusetts, USA
| | | | - Christopher Homsy
- Department of Surgery, Tufts Medical Center, Boston, Massachusetts, USA
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Mátrai Z, Kelemen P, Kósa C, Maráz R, Paszt A, Pavlovics G, Sávolt Á, Simonka Z, Tóth D, Kásler M, Kaprin A, Krivorotko P, Vicko F, Pluta P, Kolacinska-Wow A, Murawa D, Jankau J, Ciesla S, Dyttert D, Sabol M, Zhygulin A, Avetisyan A, Bessonov A, Lázár G. Modern Breast Cancer Surgery 1st Central-Eastern European Professional Consensus Statement on Breast Cancer. Pathol Oncol Res 2022; 28:1610377. [PMID: 35783360 PMCID: PMC9240205 DOI: 10.3389/pore.2022.1610377] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 04/29/2022] [Indexed: 12/16/2022]
Abstract
This text is based on the recommendations accepted by the 4th Hungarian Consensus Conference on Breast Cancer, modified on the basis of the international consultation and conference within the frames of the Central-Eastern European Academy of Oncology. The recommendations cover non-operative, intraoperative and postoperative diagnostics, determination of prognostic and predictive markers and the content of cytology and histology reports. Furthermore, they address some specific issues such as the current status of multigene molecular markers, the role of pathologists in clinical trials and prerequisites for their involvement, and some remarks about the future.
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Affiliation(s)
- Zoltán Mátrai
- Department of Breast and Sarcoma Surgery, National Institute of Oncology, Budapest, Hungary
| | - Péter Kelemen
- Department of Breast and Sarcoma Surgery, National Institute of Oncology, Budapest, Hungary
| | - Csaba Kósa
- Department of Surgery, University of Debrecen, Debrecen, Hungary
| | - Róbert Maráz
- Bács-Kiskun County Teaching Hospital, Kecskemét, Hungary
| | - Attila Paszt
- Department of Surgery, Faculty of Medicine, SZTE ÁOK, University of Szeged, Szeged, Hungary
| | | | - Ákos Sávolt
- Department of Breast and Sarcoma Surgery, National Institute of Oncology, Budapest, Hungary
| | - Zsolt Simonka
- Department of Surgery, Faculty of Medicine, SZTE ÁOK, University of Szeged, Szeged, Hungary
| | - Dezső Tóth
- Department of Surgery, University of Debrecen, Debrecen, Hungary
| | - Miklós Kásler
- Minister of Human Capacities, Government of Hungary, Budapest, Hungary
| | - Andrey Kaprin
- National Medical Research Radiological Center of the Ministry of Health of the Russian Federation, Russian Academy of Sciences, Moscow, Russia
| | - Petr Krivorotko
- N.N.Petrov National Medical Research Center of Oncology, St. Petersburg, Russia
| | - Ferenc Vicko
- Medical Faculty Novi Sad, Oncology Institute of Vojvodina Sremska Kamenica, University of Novi Sad, Novi Sad, Serbia
| | - Piotr Pluta
- Department of Surgical Oncology and Breast Diseases, Polish Mother’s Memorial Hospital–Research Institute in Lodz, Lodz, Poland
| | - Agnieszka Kolacinska-Wow
- Department of Head and Neck Cancer Surgery, Medical University of Lodz, Lodz, Poland
- Department of Surgical Oncology, Cancer Center, Medical University of Lodz, Lodz, Poland
| | - Dawid Murawa
- Clinic of Surgical Oncology, Poznan University of Medical Sciences, Poznan, Poland
- General and Oncological Surgery Clinic, Karol Marcinkowski University Hospital, Zielona Gora, Poland
| | - Jerzy Jankau
- Plastic Surgery Department, Medical University of Gdańsk/University Hospitals, Gdansk, Poland
| | - Slawomir Ciesla
- General and Oncological Surgery Clinic, Karol Marcinkowski University Hospital, Zielona Gora, Poland
| | - Daniel Dyttert
- Department of Surgical Oncology, St. Elisabeth Cancer Institute, Medical Faculty, Comenius University, Bratislava, Slovakia
| | - Martin Sabol
- Department of Surgical Oncology, St. Elisabeth Cancer Institute, Medical Faculty, Comenius University, Bratislava, Slovakia
| | | | | | - Alexander Bessonov
- Breast Cancer Department of the LOKOD, N.N.Petrov National Medical Research Center of Oncology, St. Petersburg, Russia
| | - György Lázár
- Department of Surgery, Faculty of Medicine, SZTE ÁOK, University of Szeged, Szeged, Hungary
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20
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Kim HI, Kim BS, Kim YS, Yi HS, Park JH, Choi JH, Jung SU, Kim HY. Review of 107 Oncoplastic Surgeries Using an Acellular Dermal Matrix with the Round Block Technique. J Clin Med 2022; 11:jcm11113005. [PMID: 35683394 PMCID: PMC9181173 DOI: 10.3390/jcm11113005] [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: 04/19/2022] [Revised: 05/20/2022] [Accepted: 05/24/2022] [Indexed: 02/05/2023] Open
Abstract
The round block technique (RBT) is an oncoplastic surgery method that uses volume displacement techniques after partial mastectomy. However, cosmetic problems occur after tissue rearrangement in patients with small breasts or those in whom a large amount of breast tissue is excised. Therefore, we used an acellular dermal matrix (ADM) when the volume was insufficient after tissue rearrangement. Patients who underwent breast reconstruction using the ADM with the RBT after breast-conserving surgery (BCS) were included. The ADM graft was performed in two layers. First, it was placed on the glandular flap, and the patient was then seated to ascertain the degree of deformity. If the volume was insufficient, a graft was also performed under the skin flap. Overall, 107 oncoplastic surgeries were performed. Tumors were most commonly located in the upper outer quadrant of the breast, and the mean resected breast tissue was 27.1 g. Seroma was the most common complication, but it improved with several aspirations. There were no major complications or cosmetic problems requiring reoperation. Therefore, if the ADM was used for defects that could not be reconstructed with the RBT alone, safe and cosmetically good results could be obtained.
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Affiliation(s)
- Hong-Il Kim
- Department of Plastic and Reconstructive Surgery, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan 49267, Korea; (H.-I.K.); (B.-S.K.); (Y.-S.K.); (H.-S.Y.); (J.-H.P.)
| | - Byeong-Seok Kim
- Department of Plastic and Reconstructive Surgery, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan 49267, Korea; (H.-I.K.); (B.-S.K.); (Y.-S.K.); (H.-S.Y.); (J.-H.P.)
| | - Yoon-Soo Kim
- Department of Plastic and Reconstructive Surgery, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan 49267, Korea; (H.-I.K.); (B.-S.K.); (Y.-S.K.); (H.-S.Y.); (J.-H.P.)
| | - Hyung-Suk Yi
- Department of Plastic and Reconstructive Surgery, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan 49267, Korea; (H.-I.K.); (B.-S.K.); (Y.-S.K.); (H.-S.Y.); (J.-H.P.)
| | - Jin-Hyung Park
- Department of Plastic and Reconstructive Surgery, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan 49267, Korea; (H.-I.K.); (B.-S.K.); (Y.-S.K.); (H.-S.Y.); (J.-H.P.)
| | - Jin-Hyuk Choi
- Department of Surgery, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan 49267, Korea; (J.-H.C.); (S.-U.J.)
| | - Sung-Ui Jung
- Department of Surgery, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan 49267, Korea; (J.-H.C.); (S.-U.J.)
| | - Hyo-Young Kim
- Department of Plastic and Reconstructive Surgery, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan 49267, Korea; (H.-I.K.); (B.-S.K.); (Y.-S.K.); (H.-S.Y.); (J.-H.P.)
- Correspondence: ; Tel.: +82-51-990-6131
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21
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Di Leone A, Franco A, Terribile DA, Magno S, Fabi A, Sanchez AM, D'Archi S, Scardina L, Natale M, Mason EJ, Murando F, Marazzi F, Orlandi A, Paris I, Visconti G, Palazzo A, Masiello V, Barone Adesi L, Salgarello M, Masetti R, Franceschini G. Level II Oncoplastic Surgery as an Alternative Option to Mastectomy with Immediate Breast Reconstruction in the Neoadjuvant Setting: A Multidisciplinary Single Center Experience. Cancers (Basel) 2022; 14:1275. [PMID: 35267583 DOI: 10.3390/cancers14051275] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 02/19/2022] [Accepted: 02/25/2022] [Indexed: 02/05/2023] Open
Abstract
Oncoplastic surgery level II techniques (OPSII) are used in patients with operable breast cancer. There is no evidence regarding their safety and efficacy after neoadjuvant chemotherapy (NAC). The aim of this study was to compare the oncological and aesthetic outcomes of this technique compared with those observed in mastectomy with immediate breast reconstruction (MIBR), in post-NAC patients undergoing surgery between January 2016 and March 2021. Local disease-free survival (L-DFS), regional disease-free survival (R-DFS), distant disease-free survival (D-DFS), and overall survival (OS) were compared; the aesthetic results and quality of life (QoL) were evaluated using BREAST-Q. A total of 297 patients were included, 87 of whom underwent OPSII and 210 of whom underwent MIBR. After a median follow-up of 39.5 months, local recurrence had occurred in 3 patients in the OPSII group (3.4%), and in 13 patients in the MIBR group (6.1%) (p = 0.408). The three-year L-DFS rates were 95.1% for OPSII and 96.2% for MIBR (p = 0.286). The three-year R-DFS rates were 100% and 96.4%, respectively (p = 0.559). The three-year D-DFS rate were 90.7% and 89.7% (p = 0.849). The three-year OS rates were 95.7% and 95% (p = 0.394). BREAST-Q highlighted significant advantages in physical well-being for OPSII. No difference was shown for satisfaction with breasts (p = 0.656) or psychosocial well-being (p = 0.444). OPSII is safe and effective after NAC. It allows oncological and aesthetic outcomes with a high QoL, and is a safe alternative for locally advanced tumors which are partial responders to NAC.
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22
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Altomare V, Orsaria P, Grasso A, Caggiati L, Ippolito E, Pantano F, Sammarra M, Altomare C, Perrone G, Gullotta G, Carino R. Preoperative Ultrasound-guided Sub-areolar Biopsy in Predicting Occult Nipple Involvement in Breast Cancer Patients: Proposal for a Methodological Approach. In Vivo 2022; 36:839-847. [PMID: 35241540 DOI: 10.21873/invivo.12771] [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: 11/03/2021] [Revised: 12/17/2021] [Accepted: 12/20/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM The prediction of a sub-areolar tissue infiltration in breast cancer (BC) patients could be helpful in selecting the best functional outcome according to several reconstructive oncoplastic or radical techniques. This study aims to evaluate the diagnostic performance of preoperative ultrasound (US) guided sub-areolar biopsy (SAB) in detecting occult nipple involvement, in comparison with the definitive pathological examination of tissue after surgery. PATIENTS AND METHODS We prospectively recorded clinical and pathological data of 46 consecutive patients scheduled for breast conserving surgery or nipple-areola sparing mastectomy. All cases underwent preoperative SAB and the results were compared with the histopathology of the dissected tumors and their biological characteristics. All parameters were correlated with nipple involvement by univariate and multivariate analysis. RESULTS The sensitivity, specificity, overall accuracy, positive predictive value, and negative predictive value of the SAB examination for nipple staging were 60%, 97.5%, 75% and 95.2%, respectively. According to the clinicopathological features, the bivariate analysis did not show a significant interaction between patient age, tumor size or type, lymph node status, lymphatic vascular invasion, histologic grade, ER, PR, Ki-67 status, HER2 amplification, multifocal or multicentric disease and positive NAC assessment (p>0.05). CONCLUSION A preoperative sample of retroareolar tissue obtained by US-guided biopsy could be considered a reproducible, mini-invasive diagnostic procedure useful to facilitate immediate breast reconstruction with implants or through conservative oncoplastic approaches, thereby guiding clinical practice.
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Affiliation(s)
- Vittorio Altomare
- Department of Breast Surgery, Campus Bio-Medico University, Rome, Italy
| | - Paolo Orsaria
- Department of Breast Surgery, Campus Bio-Medico University, Rome, Italy;
| | - Antonella Grasso
- Department of Breast Surgery, Campus Bio-Medico University, Rome, Italy
| | - Lorenza Caggiati
- Department of Breast Surgery, Campus Bio-Medico University, Rome, Italy
| | - Edy Ippolito
- Department of Radiation Oncology, Campus Bio-Medico University, Rome, Italy
| | - Francesco Pantano
- Department of Medical Oncology, Campus Bio-Medico University, Rome, Italy
| | - Matteo Sammarra
- Department of Radiology, Campus Bio-Medico University, Rome, Italy
| | - Carlo Altomare
- Department of Radiology, Campus Bio-Medico University, Rome, Italy
| | - Giuseppe Perrone
- Department of Anatomical Pathology, Campus Bio-Medico University, Rome, Italy
| | - Gabriella Gullotta
- Department of Anatomical Pathology, Campus Bio-Medico University, Rome, Italy
| | - Rita Carino
- Department of Breast Surgery, Campus Bio-Medico University, Rome, Italy
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23
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Malata CM, See IJL, Kazzazi F, Forouhi P, Di Pace B. Combining the Grisotti Flap With a Secondary Dermoglandular Pedicle for Partial Breast Reconstruction Following Contiguous Central-Inferior Segment Breast Cancer Excision. Case Reports Plast Surg Hand Surg 2021; 8:203-207. [PMID: 34881350 PMCID: PMC8648006 DOI: 10.1080/23320885.2021.2008801] [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] [Indexed: 10/31/2022]
Abstract
A 61-year-old patient (38DD) with multifocal invasive ductal carcinomas requested breast-conserving surgery. An innovative two pedicle combination using a laterally-based Grisotti flap and an inferomedially-based secondary pedicle was designed to reconstruct a combined central breast (NAC included) and inferior segment resection defect. Satisfactory cosmesis with clear resection margins was achieved.
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Affiliation(s)
- Charles M Malata
- Department of Plastic and Reconstructive Surgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.,Anglia Ruskin School of Medicine, Anglia Ruskin University, Cambridge, UK.,Cambridge Breast Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Isabel Jia Le See
- Department of Plastic and Reconstructive Surgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.,Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Fawz Kazzazi
- Clinical School of Medicine, University of Cambridge, Cambridge, UK.,The Royal London Hospital, Barts NHS Health Trust, London, UK
| | - Parto Forouhi
- Cambridge Breast Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Bruno Di Pace
- Department of Plastic and Reconstructive Surgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.,Anglia Ruskin School of Medicine, Anglia Ruskin University, Cambridge, UK.,Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", PhD School of Translational Medicine of Development and Active Aging, University of Salerno, Salerno, Italy
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24
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Roy PM, Bharti K, Sinha S, Khanna S, Mehta Y. Acute perioperative hyperlactatemia in oncoplastic reconstructive surgeries: What is the significance? J Anaesthesiol Clin Pharmacol 2021; 37:416-418. [PMID: 34759554 PMCID: PMC8562435 DOI: 10.4103/joacp.joacp_297_19] [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] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 05/20/2020] [Accepted: 06/14/2020] [Indexed: 11/22/2022] Open
Abstract
Background and Aims: We aim to study the significance of intraoperative hyperlactatemia in reconstructive oncoplastic surgery. Material and Methods: A retrospective observational study was conducted on a cohort of patients who underwent reconstructive oncoplastic surgery with free flap for oral cancer over a 6-month period. The study population was divided into two groups based on peak lactate levels. Group N with peak lactate level less than 2 mmol/L and Group H peak lactate level more than 2 mmol/L. The various parameter studied were patient's comorbidities; intraoperative events (vasopressor requirement, blood transfusion, and duration of surgery); postoperative parameters including the need for re- exploration and duration of stay in hospital and intensive care unit. Results: The study demonstrates that intraoperative rise of lactate was not influenced by comorbidities. None of the intraoperative parameters studied influenced the lactate levels. Baseline lactate level was found to correlate with peak lactate level intraoperatively. But it was observed that there was normalization of lactate level within 24 hours postoperatively in both the groups. There was no difference in outcome parameters in the two groups. Conclusion: Intraoperative hyperlactatemia is not a significant prognostic factor for outcome in oncoplastic reconstructive surgery.
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Affiliation(s)
- Preety M Roy
- Department of Anaesthesia and Critical Care, Medanta The Medicity, Gurugram, Haryana, India
| | - Kamal Bharti
- Department of Anaesthesia and Critical Care, Medanta The Medicity, Gurugram, Haryana, India
| | - Sudha Sinha
- Department of Anaesthesia and Critical Care, Medanta The Medicity, Gurugram, Haryana, India
| | - Sangeeta Khanna
- Department of Anaesthesia and Critical Care, Medanta The Medicity, Gurugram, Haryana, India
| | - Yatin Mehta
- Department of Anaesthesia and Critical Care, Medanta The Medicity, Gurugram, Haryana, India
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25
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Chen Y, Chen Q, Dong J, Liu D, Huang L, Xie F, Zeng W, Li W, Zhong S. Modified Grisotti flap technique in centrally located breast cancer: case report. Gland Surg 2021; 10:2867-2873. [PMID: 34733734 DOI: 10.21037/gs-21-176] [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: 03/21/2021] [Accepted: 08/02/2021] [Indexed: 11/06/2022]
Abstract
Traditionally, breast cancer patients with centrally located mass always receive mastectomy or the combination of central excision and primary closure. With the development of modern oncoplastic breast-conserving techniques, these patients can conserve their breast, and achieve satisfactory cosmetic outcome as well as clear margin. A variety of techniques are available to deal with centrally located breast cancers (CLBCs). Among these techniques, Grisotti flap technique is special, because it is easy to handle, and only causes minor injury by using a local rotational dermoglandular flap to fill the defection of central part. However, in our clinical practice, we find a lot of women in south China have special properties. Such as short distance from inframammary liner to the nipple, long distance from midclavicular to the nipple, and large breast diameter. Simply apply the Grisotti flap technique to those patients is not very suitable that drive us to modify this technique to suit our patients. We adopt the idea that use pedicled skin flap with skin island to replace the central defection to modify Grisotti flap technique. And applied this technique to two patients. We find modified Grisotti flap technique for Paget's disease or CLBC had good cosmetic results as well as safety in suitable patients. In the future, we can use superior pedicle with skin island for ptotic breasts, and lateral pedicle is suitable for patients without large and ptotic breasts.
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Affiliation(s)
- Ying Chen
- Department of Breast Surgery, Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou, China
| | - Qianjun Chen
- Department of Breast Surgery, Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou, China
| | - Jingjing Dong
- Department of Anesthesia, Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou, China
| | - Dan Liu
- Department of Breast Surgery, Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou, China
| | - Lezhen Huang
- Department of Breast Surgery, Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou, China
| | - Fengfeng Xie
- Department of Breast Surgery, Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou, China
| | - Weijie Zeng
- Department of Breast Surgery, Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou, China
| | - Wenxia Li
- Department of Breast Surgery, Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou, China
| | - Shaowen Zhong
- Department of Breast Surgery, Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou, China
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26
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Finlay B, Kollias V, Hall KA, Clement Z, Bingham J, Whitfield R, Kollias J, Bochner M. Long-term outcomes of breast reconstruction and the need for revision surgery. ANZ J Surg 2021; 91:1751-1758. [PMID: 34375030 DOI: 10.1111/ans.17118] [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: 01/05/2021] [Revised: 07/15/2021] [Accepted: 07/17/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Breast reconstruction (BR) often forms part of a patient's breast cancer journey. Revision surgery may be required to maintain the integrity of a BR, although this is not commonly reported in the literature. Different reconstructive methods may have differing requirements for revision. It is important for patients and surgeons to understand the factors leading to the need for revision surgery. METHODS This retrospective cohort study analyses BRs performed by oncoplastic breast surgeons in public and private settings between 2005 and 2014, with follow-up until December 2018. Surgical and patient factors were examined, including types of BR, complications and reasons for revision surgery. RESULTS A total of 390 women with 540 reconstructions were included, with a median follow-up of 61 months. Twenty-eight percent (151/540) of reconstructions required at least one revision operation. Overall, implant-based reconstructions (direct-to-implant [DTI] and two-stage expander-implant) had a higher revision rate compared to pedicled flap reconstructions (odds ratio 1.91, 95% confidence interval 1.08, 3.38). DTI reconstructions had the highest odds, and pedicled flap without implants the lowest odds of requiring revision. Post-reconstruction radiotherapy increased the chance of revision surgery, while pre-reconstruction radiotherapy did not. Odds of revision were higher in implant-based reconstructions compared to pedicled flap reconstructions that had radiotherapy. Other factors increasing the rates of revision surgery were being a current smoker and post-operative infection. CONCLUSION Almost one-third of reconstructive patients require revision surgery. Autologous pedicled flap reconstructions have lower rates of revision compared to implant-based reconstructions. Radiotherapy increases the need for revision surgery, particularly in implant-based reconstructions.
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Affiliation(s)
- Ben Finlay
- Breast and Endocrine Surgery Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Victoria Kollias
- Breast and Endocrine Surgery Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Kelly A Hall
- Adelaide Health Technology Assessment, School of Public Health, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Zackariah Clement
- Breast and Endocrine Surgery Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Janne Bingham
- Breast and Endocrine Surgery Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia.,Discipline of Surgery, Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Robert Whitfield
- Breast and Endocrine Surgery Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - James Kollias
- Breast and Endocrine Surgery Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia.,Discipline of Surgery, Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Melissa Bochner
- Breast and Endocrine Surgery Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia.,Discipline of Surgery, Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
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27
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Hussein O, Roshdy S, Hamdy O, Denewer A. Pectoralis major myo-parenchymal flap for local reconstruction of partial mastectomy defects. Description of a new technique. Breast Dis 2021; 41:31-36. [PMID: 34275886 DOI: 10.3233/bd-201042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Breast conservation is the standard of care treatment for early breast cancer. Several oncoplastic approaches have been described for the reconstruction of partial breast defects. The multiplicity of techniques indicates that the ideal reconstructive technique is yet to be identified. There has been a recent emphasis on minimizing the magnitude of surgery. In this report, we describe our experience of using the pectoralis major muscle to fill relatively large post-tumorectomy breast defects. PATIENTS AND TECHNIQUE Nine patients were operated on for malignant breast lesions. Tumorectomy resection with surgical margin rendered a 40-50% breast defect. The parenchymal defect was repaired with an advancement muscle flap of the ipsilateral pectoralis major muscle. RESULTS All patients experienced a non-eventful postoperative course. The early cosmetic outcome was excellent in four patients, good in another four, and fair in one patient. CONCLUSION The pectoralis major flap is useful for local repair of upper half partial breast defects in non-ptosed, cup A-B breasts.
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Affiliation(s)
- Osama Hussein
- Surgery Department, Mansoura University Oncology Center, Mansoura, Egypt
| | - Sameh Roshdy
- Surgery Department, Mansoura University Oncology Center, Mansoura, Egypt
| | - Omar Hamdy
- Surgery Department, Mansoura University Oncology Center, Mansoura, Egypt
| | - Adel Denewer
- Surgery Department, Mansoura University Oncology Center, Mansoura, Egypt
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28
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Dabiri C, Hotton J, Wehbe K, Gornes H, Garbar C, Guillemin F, Ceccato V. Assessment of the Grisotti oncoplastic procedure for the management of central breast tumors. Breast J 2021; 27:595-602. [PMID: 34251074 DOI: 10.1111/tbj.14256] [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: 01/14/2021] [Revised: 04/30/2021] [Accepted: 04/30/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The Grisotti technique consists to excise central breast tumor with nipple areolar and mobilize a dermo-glandular flap which is de-epithelized in order to reshape the breast and recreate an areola. The objective was to assess oncological results, postoperative side-effects, and patient and surgeon satisfaction rates resulting from this technique. MATERIALS AND METHODS From September 2016 to December 2019, 38 patients have been treated with a central breast tumor using the Grisotti technique. RESULTS The mean age was 61.6 ± 11. The median body mass index was 27 kg/m² [20-42]. Thirty one patients benefited from a sentinel lymph node dissection. Preoperative histology found a majority of invasive ductal carcinomas (IDC) (71%). There were no intraoperative complications, and the average operating time was 90 min [60-200]. Postoperative histology found IDC associated with ductal carcinoma in situ in 28 patients. The surgical margins were invaded in two patients (reoperated by mastectomy after adjuvant treatment) and invasion of a margin of less than 1 mm in another six patients (supplemented by re-excision). The main postoperative complications were an abscess of the operating site and a partial necrosis of the neo-areola. The appearance of the breasts after radiotherapy gives a high satisfaction rate, both for patients and for surgeons. CONCLUSION The Grisotti technique is an easily reproducible procedure without major complications. It makes it possible to perform a carcinological satisfactory central lumpectomy, correction of the central glandular defect, and reconstruction of a new areola.
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Affiliation(s)
- Clément Dabiri
- Department of Surgical Oncology, Institut Godinot, Reims, France
| | - Judicael Hotton
- Department of Surgical Oncology, Institut Godinot, Reims, France
| | - Karl Wehbe
- Department of Surgical Oncology, Institut Godinot, Reims, France
| | - Hugo Gornes
- Department of Surgical Oncology, Institut Godinot, Reims, France
| | - Christian Garbar
- Department of Pathological Anatomy and Cytology, Institut Godinot, Reims, France
| | | | - Vivien Ceccato
- Department of Surgical Oncology, Institut Godinot, Reims, France
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29
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Cantürk NZ, Şimşek T, Özkan Gürdal S. Oncoplastic Breast-Conserving Surgery According to Tumor Location. Eur J Breast Health 2021; 17:220-233. [PMID: 34263149 DOI: 10.4274/ejbh.galenos.2021.2021-1-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 01/19/2021] [Accepted: 03/28/2021] [Indexed: 12/01/2022]
Abstract
The use of oncoplastic breast surgery is an essential cornerstone for breast cancer management. The main aim of breast cancer surgery is to obtain an adequate oncological safety margin. Still, the cosmetic outcome also seems important for social and psychological wellbeing and quality of life. After breast-conserving surgery, the remaining breast may be reconstructed with volume displacement or volume replacement techniques. A better cosmetic outcome can be achieved by selecting appropriate surgical techniques according to tumor location. In this review, we show each technique step-by-step based on the tumor's location for each quadrant. The most important thing is to select the technique first for oncological safety and then for better cosmesis.
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Affiliation(s)
- Nuh Zafer Cantürk
- Department of General Surgery, Kocaeli University School of Medicine, Kocaeli, Turkey
| | - Turgay Şimşek
- Department of General Surgery, Kocaeli University School of Medicine, Kocaeli, Turkey
| | - Sibel Özkan Gürdal
- Department of General Surgery, Tekirdağ University School of Medicine, Tekirdağ, Turkey
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30
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Hauerslev KR, Overgaard J, Damsgaard TE, Hvid HM, Balling E, Fischer L, Christiansen P. Oncoplastic breast surgery versus conventional breast conserving surgery - a prospective follow-up study of subjective loco-regional late morbidity. Acta Oncol 2021; 60:750-759. [PMID: 33788646 DOI: 10.1080/0284186x.2021.1900907] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background and aim: Few studies have focused on the symptoms of loco-regional morbidity in shoulders, arms, and breasts related to oncoplastic breast surgery (OPS). This study aimed to determine if a difference exists in the prevalence or variety of subjective symptoms of shoulder, arm, and breast morbidity in patients undergoing OPS compared with patients receiving conventional breast conserving surgery (C-BCS). Cosmetic result and body image were included as secondary endpoints.Methods: This prospective follow-up study with 18 months of questionnaire-based follow-up included women with breast cancer or ductal carcinoma in situ. They were divided into two groups - C-BCS or OPS - depending on type of surgery performed. Furthermore, patient, disease, and treatment characteristics were recorded.Results: Among 334 completers, 229 (69%) received C-BCS and 105 (31%) received OPS. Participants were comparable regarding age, comorbidity, BMI, re-excision rate (15-16%), and axillary surgery. As for tumor characteristics, a more advanced disease stage was shown in the OPS than in the C-BCS group with larger tumor and lumpectomy size, more multifocality, and the corresponding following systemic adjuvant therapy.The questionnaire revealed that the two groups were comparable with no significant differences in frequency or variety of symptoms of shoulder and arm morbidity. Overall, participants were highly satisfied with the cosmetic results in both groups and no significant inter-group differences were observed.Conclusion: In patients with larger tumors, breast conserving surgery utilizing oncoplastic techniques yields results regarding subjective shoulder, arm, and breast morbidity as well as cosmetic outcome comparable with those of C-BCS performed on smaller tumors.Trial registration: ClinicalTrials.gov, registration number: NCT02159274 (2014).HIGHLIGHTSSubjective symptoms of shoulder, arm, and breast morbidity are comparable when oncoplastic breast surgery is compared to conventional breast conserving surgery.The variety of symptoms of shoulder and arm morbidity following oncoplastic surgery does not differ from symptoms following conventional breast conserving surgery.The cosmetic outcome following oncoplastic breast surgery is comparable to breast conserving surgery without oncoplastic techniques.
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Affiliation(s)
- Katrine Rye Hauerslev
- Department of Plastic and Breast Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Jens Overgaard
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Helle Mikel Hvid
- Department of Plastic and Breast Surgery, Aalborg University Hospital, Aalborg, Denmark
| | - Eva Balling
- Breast Clinic, Regional Hospital Viborg, Viborg, Denmark
| | - Lone Fischer
- Department of Plastic and Breast Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Peer Christiansen
- Department of Plastic and Breast Surgery, Aarhus University Hospital, Aarhus, Denmark
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31
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Char S, Bloom JA, Erlichman Z, Jonczyk MM, Chatterjee A. A comprehensive literature review of patient-reported outcome measures (PROMs) among common breast reconstruction options: What types of breast reconstruction score well? Breast J 2021; 27:322-329. [PMID: 33565192 DOI: 10.1111/tbj.14186] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [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: 10/11/2020] [Revised: 01/16/2021] [Accepted: 01/20/2021] [Indexed: 01/21/2023]
Abstract
PURPOSE Breast cancer continues to be the most prevalent cancer affecting women. Many reconstructive options exist after oncologic resection. Breast reconstruction can have a lasting impact on many areas of the patient's life, and therefore, a high consideration for patient satisfaction is crucial. Patient-reported outcome measures (PROMs) provide an important tool in the evaluation of different surgical methodologies. The aim of this comprehensive systematic review is to look at various surgical modalities in breast reconstruction as they relate to patient satisfaction. METHODS A PubMed PRISMA search was performed. Criteria for inclusion included nipple-sparing or skin-sparing mastectomy with autologous or implant-based reconstruction, level 2 volume displacement or volume replacement oncoplastic surgery, and measurement of patient-reported outcomes using the BREAST-Q or other validated PROMs. From the data set, weighted proportions were generated and analyzed using the Kruskal-Wallis rank sum test and a post hoc Dunn's test. RESULTS After obtaining 254 full text copies, 43 articles met inclusion criteria and were included. Analysis of BREAST-Q data showed oncoplastic breast surgery was significantly preferred over mastectomy regardless of the type of reconstruction. Nipple-sparing was significantly preferred over skin-sparing mastectomy, autologous reconstruction was significantly preferred over implant-based reconstruction, and prepectoral implant placement was preferred over subpectoral implant placement. Validated PROMs other than BREAST-Q showed similar trends in all but type of mastectomy. CONCLUSIONS In this comprehensive systematic review, oncoplastic surgery showed the most favorable PROMs when compared to other reconstructive modalities. Autologous was preferred over implant-based reconstruction, and prepectoral was preferred over subpectoral implant placement.
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Affiliation(s)
- Sydney Char
- Tufts University School of Medicine, Boston, Massachusetts, USA
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Smolanka II, Bagmut IY, Sheremet MI, Lyashenko AO, Movchan OV, Smolanka II, Loboda AD, Kolisnyk IL, Sydorchuk LP, Lazaruk OV. Delayed breast reconstruction with tram-flap and various modifications after radical mastectomy. J Med Life 2021; 14:847-852. [PMID: 35126757 PMCID: PMC8811661 DOI: 10.25122/jml-2021-0354] [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: 09/28/2021] [Accepted: 12/01/2021] [Indexed: 11/19/2022] Open
Abstract
This study describes the experience of radical mastectomies with simultaneous breast reconstruction using TRAM flap in patients with inflammatory breast cancer. The study aimed to evaluate the effectiveness of primary breast reconstruction using the TRAM-flap procedure in patients with an inflammatory form of breast cancer. Our work is associated with some deviation from generally accepted standards: delayed breast reconstruction after radical mastectomy for inflammatory breast cancer. We describe the experience of radical mastectomies with the simultaneous reconstruction of the breast using a TRAM flap in patients with inflammatory breast cancer. This study included 12 patients diagnosed with breast cancer stages IIIB and IIIC. Almost all patients (eleven out of twelve patients) underwent radical mastectomy with one-stage reconstruction using a TRAM flap after chemotherapy. Two years later, one patient (8.3%) showed disease progression in the form of distant metastases in the bones of the spine. One patient (8.3%) had a regional relapse in the displaced flap near the postoperative scar. The rest of the patients (83.4%) showed no signs of continuing the disease. Patients with one-stage breast reconstruction improved socially, and their subjective well-being was better than those who underwent radical mastectomy without reconstruction. Experience in performing one-stage reconstructions in the surgical treatment of patients with inflammatory breast cancer is a reason for restrained optimism regarding the possibility and feasibility of these operations.
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Affiliation(s)
| | | | - Michael Ivanovicha Sheremet
- Surgery Department No.1, Bukovinian State Medical University, Chernivtsi, Ukraine,* Corresponding Author: Michael Ivanovich Sheremet, Surgery Department No. 1 of Bukovinian State Medical University, Holovna str., 191, 58018, Chernivtsi, Ukraine. Phone: 0956064607; E-mail:
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Kelemen P, Újhelyi M, Pukancsik D, Sávolt Á, Kovács E, Zaka Z, Sándor Z, Mátrai Z. Evaluation of the modified Regnault “B” technique as a standard level II oncoplastic breast-conserving surgery. Orv Hetil 2020; 161:1002-1011. [PMID: 32469841 DOI: 10.1556/650.2020.31738] [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: 01/27/2020] [Accepted: 03/02/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION AND AIM This study aimed to describe the modified Regnault "B" oncoplastic technique as a standard volume-displacement level II oncoplastic breast-conserving surgery and the related clinicopathological study. METHOD A retrospective, single-centre study was performed between April 2012 and October 2018 involving 215 breast-cancer patients. Patient characteristics and postoperative complications were recorded, and the quality of life was rated by questionnaires. Aesthetic outcomes were evaluated with BCCT.core software and a five-point Likert scale. RESULTS The mean patient age was 53 years (range: 29-81 years), with a median follow-up of 47 months (range: 7-85 months). The average surgery time was 47 min (range: 35-85 min) and the pathological average size of the tumours was 33 mm (range: 18-58 mm). Due to positive surgical margins, 13 (6%) completion re-excisions and 3 (1.4%) mastectomies were performed. In total, 16 complications (7.4%) were recorded. The median Likert scale score was 4.2, and the median overall aesthetic outcome assessed by BCCT.core was 1.3 points. According to the quality of life questionnaire, average points of the results demonstrated a high level of patient satisfaction. CONCLUSION In medium- to large-breasted patients, the modified Regnault "B" technique is a safe and repeatable level II volume-displacement oncoplastic breast-conservation technique. This technique allows extended removal (20-50% of breast tissue) of T1-T3 tumours from the upper outer quadrant and the border of outer quadrants of the breast with improved aesthetic results. The advantage of this technique is that contralateral symmetrisation is not required, while disadvantage of this technique is the skin incision on the breast skin envelope that can make some difficulties when completion mastectomy is required with immediate reconstruction. Orv Hetil. 2020; 161(24): 1002-1011.
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Affiliation(s)
- Péter Kelemen
- Daganatsebészeti Központ, Emlő-Lágyrész Daganatsebészeti Osztály,Országos Onkológiai Intézet Budapest, Ráth György u. 7-9., 1122
| | - Mihály Újhelyi
- Daganatsebészeti Központ, Emlő-Lágyrész Daganatsebészeti Osztály,Országos Onkológiai Intézet Budapest, Ráth György u. 7-9., 1122
| | - Dávid Pukancsik
- Daganatsebészeti Központ, Emlő-Lágyrész Daganatsebészeti Osztály,Országos Onkológiai Intézet Budapest, Ráth György u. 7-9., 1122
| | - Ákos Sávolt
- Daganatsebészeti Központ, Emlő-Lágyrész Daganatsebészeti Osztály,Országos Onkológiai Intézet Budapest, Ráth György u. 7-9., 1122
| | - Eszter Kovács
- Radiológiai Diagnosztikai Centrum,Országos Onkológiai Intézet Budapest
| | - Zoltán Zaka
- Sugárterápiás Centrum,Országos Onkológiai Intézet Budapest
| | - Zsuzsa Sándor
- Sebészi és Molekuláris Daganatpatológiai Centrum,Országos Onkológiai Intézet Budapest
| | - Zoltán Mátrai
- Daganatsebészeti Központ, Emlő-Lágyrész Daganatsebészeti Osztály,Országos Onkológiai Intézet Budapest, Ráth György u. 7-9., 1122
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Tse T, Knowles S, Bélec J, Caudrelier JM, Lock M, Brackstone M, Arnaout A. Consensus statement on tumour bed localization for radiation after oncoplastic breast surgery. ACTA ACUST UNITED AC 2020; 27:e326-e331. [PMID: 32669940 DOI: 10.3747/co.27.5977] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Oncoplastic surgery (ops) is becoming the new standard of care for breast-conserving surgery, leading to some challenges with adjuvant radiation, particularly when accurate tumour bed (tbd) delineation is needed for focused radiation (that is, accelerated partial breast irradiation or boost radiation). Currently, no guidelines have been published concerning tbd localization for adjuvant targeted radiation after ops. Methods A modified Delphi method was used to establish consensus by a panel of 20 experts in surgical and radiation oncology at the Canadian Locally Advanced Breast Cancer National Consensus Group and in a subsequent online member survey. Results These are the main recommendations:■ Surgical clips are necessary and should, at a minimum, be placed along the 4 side walls of the cavity, plus 1-4 clips at the posterior margin if necessary.■ Operative reports should include pertinent information to help guide the radiation oncologists.■ Breast surgeons and radiation oncologists should have a basic understanding of ops techniques and work on "speaking a common language."■ Careful consideration is needed when determining the value of targeted radiation, such as boost, in higher-level ops procedures with extensive tissue rearrangement. Conclusions The panel developed a total of 6 recommendations on tbd delineation for more focused radiation therapy after ops, with more than 80% agreement on each statement. All are summarized, together with the corresponding evidence or expert opinion.
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Affiliation(s)
- T Tse
- Department of Surgery, University of Ottawa, Ottawa, ON
| | - S Knowles
- Department of Surgery, Western University, London, ON
| | - J Bélec
- Department of Radiation Oncology, University of Ottawa, Ottawa, ON
| | - J M Caudrelier
- Department of Radiation Oncology, University of Ottawa, Ottawa, ON
| | - M Lock
- Department of Radiation Oncology, Western University, London, ON
| | - M Brackstone
- Department of Surgery, Western University, London, ON
| | - A Arnaout
- Department of Surgery, University of Ottawa, Ottawa, ON
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Lim GH, Choo CH, Allen JC, Ng RP. Factors influencing decisions on contralateral symmetrisation procedure among patients with breast cancer. Singapore Med J 2020; 63:42-46. [PMID: 32460447 DOI: 10.11622/smedj.2020076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Oncoplastic breast conserving surgery (OBCS) can cause breast asymmetry. Although contralateral breast surgery to achieve symmetry was offered to these patients, the uptake of symmetrisation was variable. We aimed to determine the factors that deter patients with breast cancer undergoing OBCS from taking up symmetrisation. METHODS All patients with breast cancer who underwent OBCS of displacement type but no symmetrisation were prospectively surveyed to explore social, economic, psychological and physical reasons against symmetrisation. RESULTS 28 patients participated in a survey administered at a mean 21.6 (range 2-47) months after OBCS. A combination of factors, such as worry and desire to treat breast cancer first (67.9%), not being overly concerned about breast cosmesis (57.1%) and fear of pain from additional operation (28.6%) deterred patients from immediate symmetrisation. Worry and desire to treat breast cancer first was the most important single factor for 50% of patients. Reasons for no delayed symmetrisation included not being overly concerned about breast cosmesis (70.4%), fear of breast cancer recurrence (48.1%) and being happy with current breast cosmesis (33.3%), with the former two reasons equally cited as the single most important deterrent by 30% of patients each. CONCLUSION A combination of factors may deter patients from symmetrisation. The most significant factors deterring OBCS among patients were worry and desire to treat breast cancer first for immediate symmetrisation, and not being overly concerned about breast cosmesis and fear of breast cancer recurrence for delayed symmetrisation. Reassurance of these patients may increase their uptake of symmetrisation, thereby improving patient cosmesis and satisfaction.
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Affiliation(s)
- Geok Hoon Lim
- Breast Department, KK Women's and Children's Hospital, Singapore.,Duke-NUS Medical School, Singapore
| | - Chih Huei Choo
- Department of Psychological Medicine, KK Women's and Children's Hospital, Singapore
| | - John C Allen
- Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore
| | - Ruey Pyng Ng
- Division of Nursing, KK Women's and Children's Hospital, Singapore
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Vivace B, Kachare S, Ablavsky M, Abell S, Meredith L, Kapsalis C, Choo J, Wilhelmi B. Breast Reconstruction With Local Flaps: Don't Forget Grandma. Eplasty 2019; 19:e23. [PMID: 31885766 PMCID: PMC6916609] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Objective: Lateral breast defects of various causes can be reconstructed with random patterned local flaps utilizing oncoplastic techniques. These local flaps are used frequently in other areas but are infrequent in breast reconstruction despite affording excellent utility in small lateral defects. We sought to demonstrate this with a case series involving 5 patients who underwent oncoplastic breast surgery with random patterned flap reconstruction. Methods: From 2016 to 2017, 3 different varieties of random flaps were used in 5 women requiring lateral breast defect reconstruction secondary to resection of localized cancer or cutaneous lesion. The local flaps included a rhomboid flap, the bilobed flap, and a rotational flap. Patients were then evaluated in the clinic 10 to 12 months postoperatively for complications, symmetry, and satisfaction of reconstruction. Results: In 4 of 5 patients, the local flap remained fully viable and there was no incidence of seroma, infection, or further complications. One patient developed a post-operative hematoma requiring evacuation and a second patient experienced distal flap necrosis and delayed wound healing. Patients reported satisfaction with the reconstruction. Conclusions: Several random patterned local flaps exist for a variety of breast defects. They can yield excellent cosmetic results, high patient satisfaction, and bolster a low rate of complications. Our case series emphasizes the utility of random patterned flaps for lateral breast oncoplastic reconstruction.
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Affiliation(s)
| | - Swapnil D. Kachare
- bDivision of Plastic and Reconstructive Surgery, Department of Surgery, University of Louisville, Louisville, KY
| | - Michael Ablavsky
- bDivision of Plastic and Reconstructive Surgery, Department of Surgery, University of Louisville, Louisville, KY
| | - Sara R. Abell
- aSchool of Medicine, University of Louisville, Louisville, KY
| | | | | | - Joshua H. Choo
- bDivision of Plastic and Reconstructive Surgery, Department of Surgery, University of Louisville, Louisville, KY
| | - Bradon J. Wilhelmi
- bDivision of Plastic and Reconstructive Surgery, Department of Surgery, University of Louisville, Louisville, KY,Correspondence:
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Hagemann F, Geiger P, Luczak C, Perabò M, Degenhardt T, Schenck T, Mahner S, Harbeck N, Ditsch N. [Breast cancer - a modern approach in oncoplastic surgery]. MMW Fortschr Med 2019; 161:47-50. [PMID: 31414430 DOI: 10.1007/s15006-019-0784-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Lee S, Jung Y, Bae Y. Dermoglandular rotation flap with subaxillary advancement flap as an oncoplastic technique for breast cancer. Breast J 2019; 26:420-426. [PMID: 31502394 DOI: 10.1111/tbj.13503] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 07/03/2019] [Accepted: 07/03/2019] [Indexed: 11/28/2022]
Abstract
We propose a novel oncoplastic surgical technique, dermoglandular rotation flap with subaxillary advancement flap, as a feasible one-stage operation. Breast conserving surgery, incorporating the dermoglandular rotation flap with subaxillary advancement flap, was performed in 49 female patients with breast cancer, between January and December 2015. After a full-thickness fibroglandular resection including the tumor, an inferior- or a superior-based rotation flap was performed according to the location of the defect. The subaxillary flap consisted of skin, dermis, and subcutaneous fat tissue and was mobilized from the chest wall musculature. Since subaxillary skin has greater redundancy, it can be easily moved to reach the lateral aspect of the breast. Approximation of the subaxillary flap to the lateral side of rotated dermoglandular flap served to relieve skin tension and avoid displacement of the nipple-areola complex (NAC). Consequently, there was wider dermoglandular tissue rotation and efficient filling of defect without any significant postoperative deformity. The mean follow-up period was 46.5 ± 3.1 months (range, 42.4-52.1 months). Mean tumor size, on pathology, was 2.1 cm (range, 0.4-6.0). Mean excised breast tissue weight was 78.4 g (range, 28.6-195.0). More than half of the patients (51%) studied had excised breast tissue weighing more than 80 g. None of the included patients had positive surgical margins in final pathologic reports. Most patients answered excellent or good for self-estimated cosmetic outcomes including symmetry of the breast and NAC, breast shape, scarring, and overall satisfaction. A modified dermoglandular rotation flap technique along with subaxillary advancement flap is a feasible and effective oncoplastic technique for breast cancers.
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Affiliation(s)
- Seokwon Lee
- Department of Surgery, Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Younglae Jung
- Department of Surgery, Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Youngtae Bae
- Department of Surgery, Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
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Refaat M, Abouelnagah G, Awad AT, Fayed HM, Abdelhady DA. Modified round block technique for peripherally located early cancer breast, a technique that fits for all quadrants. Breast J 2019; 26:414-419. [PMID: 31448485 DOI: 10.1111/tbj.13485] [Citation(s) in RCA: 5] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Revised: 04/04/2019] [Accepted: 04/09/2019] [Indexed: 11/28/2022]
Abstract
Round block technique (RBT) is an oncoplastic technique used in periareolar lesions, particularly in breasts with moderate ptosis or hypertrophy. However, it has some drawbacks including the possibility of late-onset scar widening, change in areolar shape, and asymmetry of the breasts. Moreover, it is hard to be performed with tumors located in periphery of breast. Modified round block technique (MRBT) is a new technique described to overcome these problems. A circumferential periareolar incision was made around the areola followed by subcutaneous dissection to the entire breast. Wide local excision (WLE) could then easily be performed with a good field of view, the breast tumor was excised with an acceptable macroscopic safety margin, and specimens were marked with orienting sutures for intraoperative frozen section. Remodeling of the breast was done, a close suction drain was placed, and the wound was narrowed with a nonabsorbable purse-string suture and attached to the NAC with continuous subcuticular absorbable suture. This study was conducted on 144 female patients diagnosed with breast cancer. The median size of the tumor was 2 cm, the majority of the patients (66.7%) had moderate breast size (cup B) and the median distance of the tumor from NAC was 7 cm. Patients' satisfaction was assessed according to Harvard scale and good to excellent results were found in 88.8% of the patients. There were no postoperative changes in areolar shape or position. Complications in the form of hematoma, wound dehiscence, and infection were encountered in 25% of the patients. Modified round block technique is an oncoplastic technique that permits excision of peripherally located breast cancer without excision of periareolar skin and it is suitable for all quadrant tumors. It also avoids the scar which occurs after ordinary breast-conserving surgery.
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Affiliation(s)
| | - Galal Abouelnagah
- Surgical Oncology Unit, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Ahmed Tarek Awad
- Surgical Oncology Unit, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Haytham Mahmoud Fayed
- Surgical Oncology Unit, Faculty of Medicine, Alexandria University, Alexandria, Egypt
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Lombardi A, Pastore E, Maggi S, Stanzani G, Vitale V, Romano C, Bersigotti L, Vecchione A, Amanti C. Positive margins (R1) risk factors in breast cancer conservative surgery. Breast Cancer (Dove Med Press) 2019; 11:243-248. [PMID: 31440079 PMCID: PMC6668245 DOI: 10.2147/bctt.s210788] [Citation(s) in RCA: 9] [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] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Accepted: 06/12/2019] [Indexed: 12/02/2022]
Abstract
Background The primary goal in conservative breast cancer surgery is the complete excision of the tumor, but at the same time attempting to obtain a satisfactory postoperative esthetic result. The notion of “No Ink on Tumor” that indicates exclusively the presence of tumor cells on the inked surface of the surgical specimen is now the gold standard; however, the problem of the free margin is still a fundamental topic of debate that has not yet found a definitive solution. Methods Our retrospective analysis takes into account 1440 patients undergoing breast conservative surgery, from October 2004 to November 2018, all treated at the breast unit of our institution. Results Positive margins (R1) rate was 10.2% (147 cases out of 1440). Overall survival was 95% at 5 years and 89% at 10 years. No differences in mortality and local recurrence rate between R0 and R1 patients were found. Half of the R1 patients underwent secondary surgery with enlargement of margins, while in the other half we performed direct mastectomy. Among the analyzed variables, age, histological size, histological type, grading, multifocality, lympho-vascular invasion and lymph node status were significantly correlated with the R1 status. The multivariate analysis shows the association of age and surgical technique (oncoplastic) with R1 status. Conclusion Further studies will allow the creation of a statistical model, for better pre-operative prediction of patients with higher risk of R1 and better selection of patients to be candidates for conservative surgery.
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Affiliation(s)
- Augusto Lombardi
- Breast Surgery, Università La Sapienza, Ospedale Sant'Andrea, Rome, Italy
| | - Elena Pastore
- Breast Surgery, Università La Sapienza, Ospedale Sant'Andrea, Rome, Italy
| | - Stefano Maggi
- Breast Surgery, Università La Sapienza, Ospedale Sant'Andrea, Rome, Italy
| | | | | | - Camilla Romano
- Breast Surgery, Università La Sapienza, Ospedale Sant'Andrea, Rome, Italy
| | - Laura Bersigotti
- Breast Surgery, Università La Sapienza, Ospedale Sant'Andrea, Rome, Italy
| | - Andrea Vecchione
- Department of Pathology, Università La Sapienza, Ospedale Sant'Andrea, Rome, Italy
| | - Claudio Amanti
- Breast Surgery, Università La Sapienza, Ospedale Sant'Andrea, Rome, Italy
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Vella Baldacchino R, Bellizzi A, Madada-Nyakauru RN, Kazzazi F, Oni G, Forouhi P, Malata CM. Assessment of breast symmetry in breast cancer patients undergoing therapeutic mammaplasty using the Breast Cancer Conservation Therapy cosmetic results software (BCCT.core). Gland Surg 2019; 8:218-225. [PMID: 31328100 DOI: 10.21037/gs.2018.09.06] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 11/06/2022]
Abstract
Background Therapeutic mammaplasty (TM) is a standard oncoplastic technique utilising aesthetic breast reduction principles to facilitate tumour resection and breast reshaping. Simultaneous contralateral mammaplasties are often performed to maintain symmetry. BCCT.core software, which principally assesses breast symmetry, has been previously employed for evaluating cosmetic results after standard breast conservation therapy and latterly TMs for upper pole tumours. The purpose of this study was to validate this novel tool for TMs in all breast zones. Methods Standardised photographs of 20 consecutive patients who underwent TM were evaluated for symmetry using BCCT.core versus a plastic surgical panel completing a visual analogue scale. Results were rated as (excellent/good/fair/poor). Outcomes between the two methods were compared. Results Twenty patients aged 37 to 63 years with a median 36G bra size had 22 TMs (18 unilateral, 2 bilateral). Indications were invasive breast cancer (87%) and ductal carcinoma in situ (DCIS) (13%). The median (range) tumour size was 22.5 mm (6-90 mm) with a resection weight of 245.8 g (16-1,079 g). Primary nipple pedicles were superomedial (63%), inferior (21%) and superolateral (16%). Five patients required a secondary glandular pedicle for volume redistribution to maintain breast shape. The BCCT.core software vs. panel symmetry assessments were 37% vs. 39% (excellent), 63% vs. 50% (good) and 0% vs. 11% (fair). Wilcoxon matched-pairs sign rank tests and Spearman rank correlations found the pairings to be statistically significant (P<0.05). Conclusions Despite small patient numbers, BCCT.core gave comparable findings with the panel and is thus useful for objectively assessing cosmesis of TMs in all breast zones.
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Affiliation(s)
| | - Annalise Bellizzi
- Mater Dei Hospital, Malta Medical School, University of Malta, Msida, Malta
| | - Rudo N Madada-Nyakauru
- Department of Plastic and Reconstructive Surgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Fawz Kazzazi
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Georgette Oni
- Department of Plastic and Reconstructive Surgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Parto Forouhi
- Cambridge Breast Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Charles M Malata
- Department of Plastic and Reconstructive Surgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.,Cambridge Breast Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.,Anglia Ruskin School of Medicine, Anglia Ruskin University, Chelmsford and Cambridge, UK
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Jonczyk MM, Jean J, Graham R, Chatterjee A. Trending Towards Safer Breast Cancer Surgeries? Examining Acute Complication Rates from A 13-Year NSQIP Analysis. Cancers (Basel) 2019; 11:cancers11020253. [PMID: 30795637 PMCID: PMC6407023 DOI: 10.3390/cancers11020253] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [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] [Received: 12/24/2018] [Revised: 01/29/2019] [Accepted: 02/18/2019] [Indexed: 02/06/2023] Open
Abstract
As breast cancer surgery continues to evolve, this study highlights the acute complication rates and predisposing risks following partial mastectomy (PM), mastectomy(M), mastectomy with muscular flap reconstruction (M + MF), mastectomy with implant reconstruction (M + I), and oncoplastic surgery (OPS). Data was collected from the American College of Surgeons NSQIP database (2005⁻2017). Complication rate and trend analyses were performed along with an assessment of odds ratios for predisposing risk factors using adjusted linear regression. 226,899 patients met the inclusion criteria. Complication rates have steadily increased in all mastectomy groups (p < 0.05). Cumulative complication rates between surgical categories were significantly different in each complication cluster (all p < 0.0001). Overall complication rates were: PM: 2.25%, OPS: 3.2%, M: 6.56%, M + MF: 13.04% and M + I: 5.68%. The most common predictive risk factors were mastectomy, increasing operative time, ASA class, BMI, smoking, recent weight loss, history of CHF, COPD and bleeding disorders (all p < 0.001). Patients who were non-diabetic, younger (age < 60) and treated as an outpatient all had protective OR for an acute complication (p < 0.0001). This study provides data comparing nationwide acute complication rates following different breast cancer surgeries. These can be used to inform patients during surgical decision making.
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Affiliation(s)
- Michael M Jonczyk
- Department of Surgery, Tufts Medical Center, 800 Washington Street, South Building, 4th Floor, Boston, MA 02111, USA.
- Department of Clinical and Translational Science, Tufts University Sackler Graduate School, 136 Harrison Ave #813, Boston, MA 02111, USA.
| | - Jolie Jean
- Tufts University School of Medicine, 145 Harrison Ave, Boston, MA 02111, USA.
| | - Roger Graham
- Department of Surgery, Tufts Medical Center, 800 Washington Street, South Building, 4th Floor, Boston, MA 02111, USA.
| | - Abhishek Chatterjee
- Department of Surgery, Tufts Medical Center, 800 Washington Street, South Building, 4th Floor, Boston, MA 02111, USA.
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Abstract
The use of biological and synthetic meshes to aid implant coverage in implant-based breast reconstruction is well established. This technique allows single stage implant-based reconstruction compared to the traditional technique which required tissue expansion before permanent implant placement and therefore involved two operations for the patient. They can further be used for pre-pectoral implant reconstructions in a similar direct-to-implant strategy. This retrospective observational study by Pompei et al has evaluated the use of TIGR Matrix, a long-term resorbable mesh, in 49 patients with 60 operated breasts for both reconstructive and aesthetic cases. They have reported their operative method and followed up their cases for a mean of 12 months. They have reported a cumulative mesh complication rate of 5.4% and one implant was explanted due to infection. They identified a significant correlation between obesity and mesh-related complications. This study is significant as there remains little data regarding the long term outcomes of resorbable synthetic mesh for breast reconstruction. Their reported complication rates are consistent with those in other studies for synthetic meshes. As synthetic meshes can be significantly cheaper than their biological counterparts, this work could promote more widespread use.
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Affiliation(s)
- Giulio Cuffolo
- a Frimley Health NHS Foundation Trust , Wexham Park Hospital , Slough , UK
| | - Nicholas C Holford
- a Frimley Health NHS Foundation Trust , Wexham Park Hospital , Slough , UK
| | | | - Alexandra Tenovici
- a Frimley Health NHS Foundation Trust , Wexham Park Hospital , Slough , UK
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Biasio FD, Bertozzi S, Londero AP, Almesberger D, Zanin C, Marchesi A, Cedolini C, Risaliti A, Parodi PC. Surgical and oncological outcomes of free dermal fat graft for breast reconstruction after breast-conserving surgery. ADV CLIN EXP MED 2018; 27:773-780. [PMID: 29790683 DOI: 10.17219/acem/68977] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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] [Indexed: 11/24/2022]
Abstract
BACKGROUND Oncoplastic breast surgery originated in order to improve the esthetic result of breast-conserving surgery (BCS). Autologous free dermal fat graft (FDFG) is an emerging oncoplastic technique to improve the cosmetic outcome of breast-conserving surgery. OBJECTIVES The aim of this study was to analyze our experience with FDFGs in breast reconstruction after breast-conserving surgery. Oncological outcomes, surgical complications and cosmetic results were considered. MATERIAL AND METHODS This retrospective chart review study considered all consecutive oncoplastic breast treatment by means of FDFG reconstruction during the period between September 2011 and September 2012 in our Clinic of Surgery (University of Udine, Italy). The data collected included patient and tumor characteristics and outcomes (cosmetic and oncological). RESULTS During the study period, 37 women were treated by breast cancer surgery and immediate breast reconstruction by FDFG. At a 3-year follow-up, we found no cases of recurrence among breast cancer patients treated by FDFG; at a 18-month follow-up, we found a prevalence of 75.0% of women extremely satisfied with their oncoplastic surgery and a high prevalence of excellent or good cosmetic outcomes (70.3%) according to objective and subjective cosmetic assessment. CONCLUSIONS Immediate breast reconstruction by FDFG after BCS in a population selected for a low risk of breast cancer recurrence seems to be an oncologically safe option, with a good cosmetic outcome and a high prevalence of women satisfied with the treatment.
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Affiliation(s)
- Fabrizio De Biasio
- Clinic of Plastic and Reconstructive Surgery, Department of Medical Area, University of Udine, Italy
| | - Serena Bertozzi
- Clinic of Surgery, Department of Medical Area, University of Udine, Italy
| | | | - Daria Almesberger
- Clinic of Plastic and Reconstructive Surgery, Department of Medical Area, University of Udine, Italy
| | - Chiara Zanin
- Clinic of Plastic and Reconstructive Surgery, Department of Medical Area, University of Udine, Italy
| | - Andrea Marchesi
- Department of Plastic and Reconstructive Surgery, IRCCS Policlinico San Donato, University of Milan, Italy
| | - Carla Cedolini
- Clinic of Surgery, Department of Medical Area, University of Udine, Italy
| | - Andrea Risaliti
- Clinic of Surgery, Department of Medical Area, University of Udine, Italy
| | - Pier C Parodi
- Clinic of Plastic and Reconstructive Surgery, Department of Medical Area, University of Udine, Italy
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45
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Rodriguez GJZ, Chavez MD, Valencia GGC, Concha JMC, Castre MRG, Mantilla R. Oncoplastic surgery for the conservative treatment of breast cancer in Perú's National Cancer Institute. Ecancermedicalscience 2018; 12:815. [PMID: 29662528 PMCID: PMC5880228 DOI: 10.3332/ecancer.2018.815] [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: 10/30/2017] [Indexed: 11/24/2022] Open
Abstract
Background Oncoplastic surgery for breast cancer (OPS) has been a surgical trend for the past 25 years. In 2012, OPS has been introduced as the standard treatment for a selected group of patients at the National Cancer Institute of Peru (INEN). The aim of this study is to describe our findings. Methods This is a retrospective and descriptive study that identified demographics, tumour-pathologic features and includes patients solely treated since diagnosis until late follow-up at INEN. These OPS patients were identified from the conservative treatment patients group by review of medical charts and creation of a database for periods December 2005 through December 2015. Results A total of 146 patients were ruled in by the inclusion criteria. All patients were Peruvian females, 56.2% being 51 or older. 93.8% had core biopsy diagnosis of breast cancer and 52.1% located at the upper outer quadrant. 79.5% patients had upfront OPS and the round block (43.2%) and reduction/mastopexy (23.3%) were the most used techniques. pT2 was the most frequent size (54.7%). We achieved negative margins in 134 patients (93.2%) in a single procedure. Of 29 patients, who had neoadjuvant treatment, 11 achieved pCR. Only 5.5% had pN2 or higher. 95.2% received complimentary external beam radiotherapy. Conclusions OPS has proven to be a reliable surgical option, both for aesthetic and oncologic outcomes. Important points for achieving these results are breast surgeons having properly trained under the OPS philosophy and knowing the patients’ characteristics for correct technique selection.
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Affiliation(s)
- Gonzalo Javier Ziegler Rodriguez
- Clínica Ricardo Palma, Av Javier Prado 1066, San Isidro 15036, Lima, Peru.,Clinica Ziegler, Av Guardia Civil 990, San Isidro 15036, Lima, Peru
| | - Marcelo Diaz Chavez
- Clinica Ziegler, Av Guardia Civil 990, San Isidro 15036, Lima, Peru.,Hospital Nivel IV Guillermo Almenara Irigoyen
| | | | | | | | - Raul Mantilla
- Breast Surgical Oncology Department, National Cancer Institute of Perú (INEN)
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46
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Yazar SK, Altınel D, Serin M, Aksoy Ş, Yazar M. Oncoplastic Breast Conserving Surgery: Aesthetic Satisfaction and Oncological Outcomes. Eur J Breast Health 2018; 14:35-38. [PMID: 29322117 DOI: 10.5152/ejbh.2017.3512] [Citation(s) in RCA: 4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 07/03/2017] [Indexed: 11/22/2022]
Abstract
Objective Oncoplastic breast conserving surgery (BCS) involves radical excision of tumors while maintaining the natural breast contours. In this study, we present the results of the oncoplastic BCS surgeries performed in our clinic. Material and Methods 13 breast cancer patients who had undergone oncoplastic BCS were included in this retrospective study. Postoperative photographs and retrospective chart reviews were used to evaluate the results. Aesthetic satisfaction level was verbally obtained from the patients. Results Oncoplastic BCS was performed using superomedial, superolateral, superior and inferior pedicles. All the patients were highly satisfied with the final aesthetic results and tumor free at the postoperative 12 months. Conclusion Oncoplastic BCS can achieve favorable results regarding the final aesthetic appearance and tumor control.
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Affiliation(s)
- Sevgi Kurt Yazar
- Department of Plastic Surgery, İstanbul Training and Research Hospital, İstanbul, Turkey
| | - Dinçer Altınel
- Department of Plastic Surgery, İstanbul Training and Research Hospital, İstanbul, Turkey
| | - Merdan Serin
- Department of Plastic Surgery, İstanbul Training and Research Hospital, İstanbul, Turkey
| | - Şefika Aksoy
- Department of General Surgery, İstanbul Training and Research Hospital, İstanbul, Turkey
| | - Memet Yazar
- Department of Plastic Surgery, Şisli Etfal Training and Research Hospital, İstanbul, Turkey
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47
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Noguchi M, Ohno Y, Morioka E, Noguchi M, Nakano Y, Kosaka T, Shimada KI. A novel oncoplastic technique for breast cancer localized in the lower pole of the breast. J Surg Oncol 2017; 117:137-141. [PMID: 28940202 DOI: 10.1002/jso.24824] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2017] [Accepted: 08/10/2017] [Indexed: 11/08/2022]
Affiliation(s)
- Masakuni Noguchi
- Breast Center, Kanazawa Medical University Hospital, Uchinada-Daigaku, Ishikawa, Japan.,Department of Breast and Endocrine Surgery, Kanazawa Medical University Hospital, Uchinada-Daigaku, Ishikawa, Japan
| | - Yukako Ohno
- Breast Center, Kanazawa Medical University Hospital, Uchinada-Daigaku, Ishikawa, Japan.,Department of Breast and Endocrine Surgery, Kanazawa Medical University Hospital, Uchinada-Daigaku, Ishikawa, Japan
| | - Emi Morioka
- Breast Center, Kanazawa Medical University Hospital, Uchinada-Daigaku, Ishikawa, Japan.,Department of Breast and Endocrine Surgery, Kanazawa Medical University Hospital, Uchinada-Daigaku, Ishikawa, Japan
| | - Miki Noguchi
- Breast Center, Kanazawa Medical University Hospital, Uchinada-Daigaku, Ishikawa, Japan.,Department of Breast and Endocrine Surgery, Kanazawa Medical University Hospital, Uchinada-Daigaku, Ishikawa, Japan
| | - Yasuharu Nakano
- Breast Center, Kanazawa Medical University Hospital, Uchinada-Daigaku, Ishikawa, Japan.,Department of Breast and Endocrine Surgery, Kanazawa Medical University Hospital, Uchinada-Daigaku, Ishikawa, Japan
| | - Takeo Kosaka
- Department of Surgical Oncology, Kanazawa Medical University Hospital, Uchinada-Daigaku, Ishikawa, Japan
| | - Ken-Ichi Shimada
- Department of Plastic Surgery, Kanazawa Medical University Hospital, Uchinada-Daigaku, Ishikawa, Japan
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48
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Schwartz JCD, Skowronksi PP. Extending the Indications for Autologous Breast Reconstruction Using a Two-Stage Modified Goldilocks Procedure: A Case Report. Breast J 2016; 23:344-347. [PMID: 27914123 DOI: 10.1111/tbj.12737] [Citation(s) in RCA: 14] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Post-mastectomy reconstruction is performed using implant-based or autologous techniques. Many women refuse or are poor candidates for implant-based reconstruction. We previously described a single-stage autologous technique that was most applicable in obese women with significant ptosis that made use of the mastectomy skin flap and subcutaneous tissue to reconstruct a breast mound. Here, we extend this technique to smaller breasted women by incorporating a second stage of skin tailoring and fat grafting. This technique does not require donor site surgery nor extended operative and recovery times. It extends the indications for autologous reconstruction to nonideal candidates and to developing countries where cost limits access.
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49
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Alço G, Igdem S, Okkan S, Dincer M, Sarsenov D, Ilgun AS, Agacayak F, Elbüken F, Ercan T, Selamoglu D, Ozmen V. Replacement of the tumor bed following oncoplastic breast-conserving surgery with immediate latissimus dorsi mini-flap. Mol Clin Oncol 2016; 5:365-371. [PMID: 27699027 PMCID: PMC5038510 DOI: 10.3892/mco.2016.984] [Citation(s) in RCA: 14] [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: 11/24/2015] [Accepted: 04/25/2016] [Indexed: 11/06/2022] Open
Abstract
The aim of the present study was to evaluate the geographic variability of the tumor bed following oncoplastic breast-conserving surgery (OP-BCS), and to assess its relevance for radiotherapy planning. In this prospective study, pre- and postoperative computerized tomography (CT) scans of 22 patients with early-stage breast cancer were fused. The preoperative gross tumor volume or excisional biopsy cavity were contoured under the guidance of preoperative radiological images. Postoperative lumpectomy cavities were contoured under the guidance of surgical clips. The conformity index (CI) was calculated and defined on a scale between 0 and 1, where 0 indicated no overlap and 1 indicated 100% concordance. Associations between CI and the number of clips, time interval between surgery and CT scans, pathological tumor size and age were assessed using independent sample testing. The median CI was 0.07 (in five cases, 1, and in eight cases, 0). The lumpectomy cavity shifted from the primary location in 36.4% of the cases. Median shifts between the isocenters of pre- and postoperative volumes were measured as 1.02 cm (range, 0.4-4.43 cm) in the x, 1.07 cm (range, 0.05-5.67 cm) in the y, and 1.12 cm (range, 0-3.75 cm) in the z directions. Only the clip number was determined to be significantly associated with CI (P=0.017). Pre- and postoperative tumor bed volumes were fully superposed in five of the 22 cases. The present study has shown that the tumor bed is markedly replaced following OP-BCS with latissimus dorsi mini-flap (LDMF) reconstruction. Special care should therefore be taken when defining the lumpectomy cavity following OP-BCS with LDMF reconstruction.
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Affiliation(s)
- Gül Alço
- Department of Radiation Oncology, Florence Nightingale Gayrettepe Hospital, Istanbul 34349, Turkey
| | - Sefik Igdem
- Department of Radiation Oncology, Florence Nightingale Gayrettepe Hospital, Istanbul 34349, Turkey
| | - Sait Okkan
- Department of Radiation Oncology, Florence Nightingale Gayrettepe Hospital, Istanbul 34349, Turkey
| | - Maktav Dincer
- Department of Radiation Oncology, Florence Nightingale Gayrettepe Hospital, Istanbul 34349, Turkey
| | - Dauren Sarsenov
- Department of Breast Surgery, Florence Nightingale Istanbul Hospital, Istanbul 34387, Turkey
| | - Ahmet Serkan Ilgun
- Department of Breast Surgery, Florence Nightingale Istanbul Hospital, Istanbul 34387, Turkey
| | - Filiz Agacayak
- Department of Radiodiagnostics, Florence Nightingale Istanbul Hospital, Istanbul 34387, Turkey
| | - Filiz Elbüken
- Department of Radiodiagnostics, Florence Nightingale Istanbul Hospital, Istanbul 34387, Turkey
| | - Tulay Ercan
- Department of Radiation Oncology, Florence Nightingale Gayrettepe Hospital, Istanbul 34349, Turkey
| | - Derya Selamoglu
- Department of Breast Surgery, Florence Nightingale Istanbul Hospital, Istanbul 34387, Turkey
| | - Vahit Ozmen
- Department of Breast Surgery, Florence Nightingale Istanbul Hospital, Istanbul 34387, Turkey
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50
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Haraldsdóttir KH, Jónsson Þ, Halldórsdóttir AB, Tranberg KG, Ásgeirsson KS. Tumor Size of Invasive Breast Cancer on Magnetic Resonance Imaging and Conventional Imaging (Mammogram/Ultrasound): Comparison with Pathological Size and Clinical Implications. Scand J Surg 2016; 106:68-73. [PMID: 26929290 DOI: 10.1177/1457496916631855] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND AIM In Landspitali University Hospital, magnetic resonance imaging is used non-selectively in addition to mammogram and ultrasound in the preoperative assessment of breast cancer patients. The aim of this study was to assess invasive tumor size on imaging, compare with pathological size and evaluate the impact of magnetic resonance imaging on the type of surgery performed. MATERIAL AND METHODS All women with invasive breast cancer, diagnosed in Iceland, between 2007 and 2009 were reviewed retrospectively. In all, 438 of 641 (68%) patients diagnosed had preoperative magnetic resonance imaging. Twelve patients treated with neoadjuvant chemotherapy were excluded and 65 patients with multifocal or contralateral disease were assessed separately. RESULTS Correlations between microscopic and radiologic tumor sizes were relatively weak. All imaging methods were inaccurate especially for large tumors, resulting in an overall underestimation of tumor size for these tumors. Magnetic resonance imaging under- and overestimated pathological tumor size by more than 10 mm in 16/348 (4.6%) and 26/348 patients (7.5%), respectively. In 19 patients (73%), overestimation of size was seen exclusively on magnetic resonance imaging. For tumors under- or overestimated by magnetic resonance imaging, the mastectomy rates were 56% and 65%, respectively, compared to an overall mastectomy rate of 43%. Of 51 patients diagnosed with multifocal disease on pathology, 19 (37%) were diagnosed by mammogram or ultrasound and 40 (78%) by magnetic resonance imaging resulting in a total detection rate of 84% (43 patients). Fourteen (3%) patients were diagnosed preoperatively with contralateral disease. Of those tumors, all were detected on magnetic resonance imaging but seven (50%) were also detected on mammogram or ultrasound or both. CONCLUSION Our results suggest that routine use of magnetic resonance imaging may result in both under- and overestimation of tumor size and increase mastectomy rates in a small proportion of patients. Magnetic resonance imaging aids in the diagnosis of contralateral and multifocal disease.
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Affiliation(s)
- K H Haraldsdóttir
- 1 Department of Surgery, Landspitali University Hospital, Reykjavik, Iceland.,2 Department of Surgery, Lund University Hospital, Lund, Sweden
| | - Þ Jónsson
- 1 Department of Surgery, Landspitali University Hospital, Reykjavik, Iceland
| | | | - K-G Tranberg
- 2 Department of Surgery, Lund University Hospital, Lund, Sweden
| | - K S Ásgeirsson
- 1 Department of Surgery, Landspitali University Hospital, Reykjavik, Iceland
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