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Mazeaud C, Larose C, Dagry A, Sarfati B, Lagrange F, Lecoanet P, Manuguerra A, Eschwège P, Hubert J. Place de la robotique dans les interventions cœlioscopiques urologiques majeures en france. une évaluation enfin possible grâce à un codage spécifique. Prog Urol 2021. [DOI: 10.1016/j.purol.2021.08.215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Sanson C, Roulot A, Honart JF, Rimareix F, Leymarie N, Sarfati B. Robotic Prophylactic Nipple-Sparing Mastectomy with Immediate Prosthetic Breast Reconstruction: A prospective Study of 138 Procedures. Chirurgia (Bucur) 2021; 116:135-142. [PMID: 33950808 DOI: 10.21614/chirurgia.116.2.135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2021] [Indexed: 11/23/2022]
Abstract
Bachground: Robotic breast surgery is an emergent procedure with encouraging preliminary results. The aim of this study is to assess the feasibility and the safety of robotic nipple sparing mastectomy (RNSM) with immediate prosthetic breast reconstruction (IPBR). Methods: This is a prospective study including from December 2015 to January 2020 all RNSM surgeries with IPBR, in patients with moderate ptosis and A B or C cup. The primary endpoint was the rate of major necrosis. Secondary endpoints were conversion rate, postoperative complications (infections, hematoma, implant exposure), aesthetic results and quality of life. Results: 79 patients underwent 138 RNSM with IPBR. The average follow-up was 28 months. 2 procedures required conversion. Two cases of major necrosis occurred (1.4%). 9 surgical site infections were observed (6.5%), 4 infections could be treated with implant replacement. Unfortunately, 5 others resulted in implant loss. 4 other implant losses occurred: 2 due to major necrosis, and 2 due to periprosthetic capsula. In total, 9 implants were lost (6.5%). Esthetical results were mostly very satisfying and quality of life was not affected by the mastectomy. Conclusions: RSNM with IPBR was associated with low rates of major necrosis. It is a safe and reproducible procedure that allows breast reconstruction without visible scar.
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Asgeirsson KS, Dixon JM, Darrigues L, Sarfati B, Macmillan RD. Multicenter Evaluation of Hydrodissection-Assisted Mastectomy (HAM). Ann Surg Oncol 2021; 28:4780-4781. [PMID: 33861405 DOI: 10.1245/s10434-021-09932-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 03/17/2021] [Indexed: 11/18/2022]
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Pascal G, Salleron J, Sarfati B, Baumard F, Hubert J, Eschwege P. Surgical complications of kidney cancer treatment: Using French database PMSI 2016-2017. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)32647-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Julien L, Genet J, Leymarie N, Honart JF, Rimareix F, Mazouni C, Kolb F, De Frémicourt K, Conversano A, Marchal F, Simon E, Brix M, Sarfati B. [Comparing outcomes of Immediate Breast reconstruction with and without use of radiotherapy]. ANN CHIR PLAST ESTH 2020; 65:181-197. [PMID: 32007227 DOI: 10.1016/j.anplas.2019.12.002] [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: 11/01/2019] [Accepted: 12/05/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Breast cancer and its treatment remains a public health problem. There is still a lack of epidemiological data concerning complications and aesthetic results bound to radiotherapy after an immediate breast reconstruction. The objective of this study was to compare outcomes of immediate breast reconstruction regardless to the use of radiotherapy (history of radiotherapy or adjuvant radiation therapy), in order to determine risk factor of complications and bad aesthetic results. METHODS We conducted a retrospective study between January 2014 and December 2016 at the hospital "Gustave Roussy" in Paris, concerning breast cancer patients who needed immediate breast reconstruction after total mastectomy. The primary endpoint was to assess the failure rate of reconstruction and the aesthetic result, the secondary endpoint assessed the early and late rate of complications. We realized a multivariate analysis in order to identify risks factors that may predict complications. RESULTS Three hundred and thirty three patients have been included: 157 in the "radiotherapy group" compared to 176 in the "no radiotherapy group". Preoperative characteristics were comparable. Average follow-up was between 1 and 3years without missing. Patients who benefited from radiotherapy had an equal risk failure of reconstruction. The subgroup analysis revealed non-significant differences: 12.7% failure rate reconstruction in the "radiotherapy group" vs. 12.5%. We could notify a better rate of "excellent results" in the "no radiotherapy group": 35% vs. 8.2%. Secondary outcomes were comparable. CONCLUSIONS Radiotherapy related to immediate breast reconstruction didn't increase the failure rate of reconstruction or aesthetic results, comparatively to non-irradiated patients. It is therefore permissible to suggest an immediate breast reconstruction to any patients which would benefit from a total mastectomy followed by radiotherapy; in order to prevent them from a secondary breast reconstruction, who could be physically and psychologically more impactful.
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Affiliation(s)
- L Julien
- Department of plastic and maxillofacial surgery, hôpital Cenral, CHRU Nancy, 54000 Nancy, France.
| | - J Genet
- Department of plastic and maxillofacial surgery, hôpital Cenral, CHRU Nancy, 54000 Nancy, France
| | - N Leymarie
- Department of cancer surgery, institut de cancérologie Gustave-Roussy, 75000 Villejuif, France
| | - J-F Honart
- Department of cancer surgery, institut de cancérologie Gustave-Roussy, 75000 Villejuif, France
| | - F Rimareix
- Department of cancer surgery, institut de cancérologie Gustave-Roussy, 75000 Villejuif, France
| | - C Mazouni
- Department of cancer surgery, institut de cancérologie Gustave-Roussy, 75000 Villejuif, France
| | - F Kolb
- Department of cancer surgery, institut de cancérologie Gustave-Roussy, 75000 Villejuif, France
| | - K De Frémicourt
- Department of cancer surgery, institut de cancérologie Gustave-Roussy, 75000 Villejuif, France
| | - A Conversano
- Department of cancer surgery, institut de cancérologie Gustave-Roussy, 75000 Villejuif, France
| | - F Marchal
- Department of cancer surgery, institut de cancérologie de Lorraine, 54000 Vandoeuvre-les-Nancy, France
| | - E Simon
- Department of plastic and maxillofacial surgery, hôpital Cenral, CHRU Nancy, 54000 Nancy, France
| | - M Brix
- Department of plastic and maxillofacial surgery, hôpital Cenral, CHRU Nancy, 54000 Nancy, France
| | - B Sarfati
- Department of cancer surgery, institut de cancérologie Gustave-Roussy, 75000 Villejuif, France
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Arnedos M, Bayar MA, Cheaib B, Scott V, Bouakka I, Valent A, Adam J, Leroux-Kozal V, Marty V, Rapinat A, Mazouni C, Sarfati B, Bieche I, Balleyguier C, Gentien D, Delaloge S, Lacroix-Triki M, Michiels S, Andre F. Modulation of Rb phosphorylation and antiproliferative response to palbociclib: the preoperative-palbociclib (POP) randomized clinical trial. Ann Oncol 2019; 29:1755-1762. [PMID: 29893769 DOI: 10.1093/annonc/mdy202] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background The cyclin-dependent kinase 4 (CDK4)/6 inhibitor Palbociclib is a new standard treatment in hormone-receptor positive breast cancer patients. No predictive biomarkers have been identified and no pharmacodynamics has properly been described so far. Patients and methods Patients with early-breast cancer were randomized 3 : 1 to oral palbociclib 125 mg daily for 14 days until the day before the surgery versus no treatment. Primary objective was antiproliferative response defined as a natural logarithm of Ki67 expression at day 15 below 1. Secondary end points were subgroups analyses and safety. Exploratory analyses included search for predictive biomarkers. Immunostainings (Ki67, RB, pRB, p16, pAKT, pER, pCDK2, CyclinD1), FISH (CCND1) and gene expression (GE) arrays were carried out at baseline and at surgery. In addition, activating PIK3CA and AKT1 mutations were assessed at baseline. Results 74 patients were allocated to palbociclib and 26 to control. Most patients (93%) were hormone-receptor (HR)-positive, whereas 8% were HER2-positive. Palbociclib led to significantly more antiproliferative responses when compared with control (58% versus 12%, P < 0.001), and to a significantly higher Ki67 decrease (P < 0.001). In the HR-positive/HER2-negative subgroup, this antiproliferative effect was even more marked in the palbociclib arm when compared with control (70% versus 9%, P < 0.001). Palbociclib treatment led also to a significantly higher decrease from baseline in phospho-Rb when compared with control (P < 0.001). Among treated patients, changes in Ki67 correlated with changes in phospho-Rb (Spearman rank r = 0.41, P < 0.0001). GE analyses confirmed a major effect on proliferation and cell cycle genes. Among treated patients, CCNE2 expression was significantly more decreased in antiproliferative responders versus nonresponders (P = 0.006). Conclusion Short-term preoperative palbociclib decreases Ki67 in early-breast cancer patients. Early decrease of Rb phosphorylation correlates with drug's effect on cell proliferation and could potentially identify patients with primary resistance. Clinical trial registration NCT02008734.
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Affiliation(s)
- M Arnedos
- Department of Cancer Medicine, Breast Cancer Committee, Gustave Roussy, Villejuif, France; INSERM Unit 981, Gustave Roussy, Villejuif, France.
| | - M A Bayar
- Statistics and Epidemiology Unit, Gustave Roussy, Villejuif, France; CESP, Medical School, INSERM, Université Paris Saclay, Villejuif, France
| | - B Cheaib
- Department of Cancer Medicine, Breast Cancer Committee, Gustave Roussy, Villejuif, France
| | - V Scott
- INSERM Unit 981, Gustave Roussy, Villejuif, France
| | - I Bouakka
- INSERM Unit 981, Gustave Roussy, Villejuif, France
| | - A Valent
- Department of Biology and Pathology, Gustave Roussy, Villejuif, France
| | - J Adam
- INSERM Unit 981, Gustave Roussy, Villejuif, France; Department of Biology and Pathology, Gustave Roussy, Villejuif, France
| | - V Leroux-Kozal
- Department of Biology and Pathology, Gustave Roussy, Villejuif, France
| | - V Marty
- Hystopathology and Translational Research Department, Gustave Roussy, Villejuif, France
| | - A Rapinat
- Translational Research Department, Genomics Platform, Institut Curie, PSL Research University, Paris, France
| | - C Mazouni
- Department of Surgery, Gustave Roussy, Villejuif, France
| | - B Sarfati
- Department of Surgery, Gustave Roussy, Villejuif, France
| | - I Bieche
- Department of Genetics, Institut Curie, Paris, France
| | - C Balleyguier
- Department of Radiology, Gustave Roussy, Villejuif, France
| | - D Gentien
- Translational Research Department, Genomics Platform, Institut Curie, PSL Research University, Paris, France
| | - S Delaloge
- Department of Cancer Medicine, Breast Cancer Committee, Gustave Roussy, Villejuif, France
| | - M Lacroix-Triki
- Department of Biology and Pathology, Gustave Roussy, Villejuif, France
| | - S Michiels
- Statistics and Epidemiology Unit, Gustave Roussy, Villejuif, France; CESP, Medical School, INSERM, Université Paris Saclay, Villejuif, France
| | - F Andre
- Department of Cancer Medicine, Breast Cancer Committee, Gustave Roussy, Villejuif, France; INSERM Unit 981, Gustave Roussy, Villejuif, France
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Moya-Plana A, Veyrat M, Honart JF, de Fremicourt K, Alkhashnam H, Sarfati B, Janot F, Leymarie N, Temam S, Kolb F. Reconstruction of maxillectomy and midfacial defects using latissimus dorsi-scapular free flaps in a comprehensive cancer center. Oral Oncol 2019; 99:104468. [PMID: 31678764 DOI: 10.1016/j.oraloncology.2019.104468] [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: 07/15/2019] [Revised: 09/04/2019] [Accepted: 10/22/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND The standard of care for sinonasal malignancies is a large surgical resection followed by radiotherapy. Midfacial defects resulting from maxillectomy require a complex reconstruction procedure. Given their adaptability, chimeric flaps such as latissimus dorsi-scapular (LDS) free flaps appear to be a good option. MATERIAL & METHODS We performed a single-center retrospective study of consecutive patients with sinonasal cancers where a LDS free flap was used for reconstruction. We assessed the postoperative complications and the functional, aesthetic and oncologic outcomes. RESULTS Eighty-four patients were included. Primary tumors were staged as T4a in 68% of cases; 38.3% of the patients received induction chemotherapy and 82.7% received adjuvant radiotherapy. Based on our classification of midfacial and palatal defects, the majority of the patients (69%) had a type IIa with interruption of the three facial pillars. The orbital floor was removed in 55.9% of cases. The median follow-up was 45 months. Total flap necrosis with no possible revascularization occurred in 5.9% of cases. For the orbital reconstruction, a revision procedure was needed for necrosis and/or infection of the costal cartilage graft in eight cases (17%). More than 90% of the patients had no functional disorders regarding speaking, swallowing and chewing. Soft palate involvement was a prognostic factor of speech (p < 10-4) and swallowing (p = .005) disorders. Dental rehabilitation was realized in 70.2% of the patients. No severe complications were observed in the donor site, except for one seroma. CONCLUSION A LDS free flap is a reliable technique for the reconstruction of complex midfacial defects.
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Affiliation(s)
- A Moya-Plana
- Head and Neck Oncology Department, Gustave Roussy Cancer Campus, Villejuif, France.
| | - M Veyrat
- Head and Neck Oncology Department, Gustave Roussy Cancer Campus, Villejuif, France
| | - J F Honart
- Plastic and Reconstructive Surgery Department, Gustave Roussy Cancer Campus, Villejuif, France
| | - K de Fremicourt
- Plastic and Reconstructive Surgery Department, Gustave Roussy Cancer Campus, Villejuif, France
| | - H Alkhashnam
- Plastic and Reconstructive Surgery Department, Gustave Roussy Cancer Campus, Villejuif, France
| | - B Sarfati
- Plastic and Reconstructive Surgery Department, Gustave Roussy Cancer Campus, Villejuif, France
| | - F Janot
- Head and Neck Oncology Department, Gustave Roussy Cancer Campus, Villejuif, France
| | - N Leymarie
- Plastic and Reconstructive Surgery Department, Gustave Roussy Cancer Campus, Villejuif, France
| | - S Temam
- Head and Neck Oncology Department, Gustave Roussy Cancer Campus, Villejuif, France
| | - F Kolb
- Plastic and Reconstructive Surgery Department, Gustave Roussy Cancer Campus, Villejuif, France
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Klausner G, Honart JF, Leymarie N, Auzac G, Rimareix F, Sarfati B, Rivera S. Radiothérapie externe adjuvante après mastectomie et reconstruction mammaire immédiate par expandeur chez des patientes prises en charge pour un cancer du sein localisé. Cancer Radiother 2018. [DOI: 10.1016/j.canrad.2018.07.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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9
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Rimareix F, Sarfati B, Leymarie N, Alkhashnam H, Honart JF, Tran De Frémicourt K, Conversano A, Struk S, Schaff JB, Bennis Y, Mazouni C, Delaloge S, Rivera S, Kolb F. [Mastectomy and immediate reconstruction: Indications, techniques and decision algorithm]. ANN CHIR PLAST ESTH 2018; 63:542-544. [PMID: 30144962 DOI: 10.1016/j.anplas.2018.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 07/12/2018] [Indexed: 01/22/2023]
Abstract
Immediate breast reconstruction indications extend to infiltrating carcinomas, due to new matrix implant coverage techniques and the development of perforator flaps. These techniques allow adjuvant treatments. However, the decision of immediate reconstruction must be discussed with the oncological multidisciplinary team and the benefits/risks must also be evaluated in relation to the morphology of the patients and their co-morbidities. The chosen type of mastectomy: conventional or skin sparing and/or nipple sparing depends on the shape and volume of the breast, the localization of the tumor in the breast and the distance from the nipple areola complex (NAC). We describe an algorithm to allow, in the case of therapeutic mastectomy with or without adjuvant radiotherapy, an immediate reconstruction with implants or free or pedicled flaps.
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Affiliation(s)
- F Rimareix
- Département de chirurgie plastique, Gustave-Roussy, 114, rue Edouard-Vaillant, 94800 Villejuif, France.
| | - B Sarfati
- Département de chirurgie plastique, Gustave-Roussy, 114, rue Edouard-Vaillant, 94800 Villejuif, France.
| | - N Leymarie
- Département de chirurgie plastique, Gustave-Roussy, 114, rue Edouard-Vaillant, 94800 Villejuif, France.
| | - H Alkhashnam
- Département de chirurgie plastique, Gustave-Roussy, 114, rue Edouard-Vaillant, 94800 Villejuif, France.
| | - J F Honart
- Département de chirurgie plastique, Gustave-Roussy, 114, rue Edouard-Vaillant, 94800 Villejuif, France.
| | - K Tran De Frémicourt
- Département de chirurgie plastique, Gustave-Roussy, 114, rue Edouard-Vaillant, 94800 Villejuif, France.
| | - A Conversano
- Département de chirurgie plastique, Gustave-Roussy, 114, rue Edouard-Vaillant, 94800 Villejuif, France.
| | - S Struk
- Département de chirurgie plastique, Gustave-Roussy, 114, rue Edouard-Vaillant, 94800 Villejuif, France.
| | - J-B Schaff
- Département de chirurgie plastique, Gustave-Roussy, 114, rue Edouard-Vaillant, 94800 Villejuif, France.
| | - Y Bennis
- Département de chirurgie plastique, Gustave-Roussy, 114, rue Edouard-Vaillant, 94800 Villejuif, France.
| | - C Mazouni
- Département de chirurgie plastique, Gustave-Roussy, 114, rue Edouard-Vaillant, 94800 Villejuif, France.
| | - S Delaloge
- Département d'oncologie médicale, Gustave-Roussy, 114, rue Edouard-Vaillant, 94800 Villejuif, France.
| | - S Rivera
- Département de radiothérapie, Gustave-Roussy, 114, rue Edouard-Vaillant, 94800 Villejuif, France.
| | - F Kolb
- Département de chirurgie plastique, Gustave-Roussy, 114, rue Edouard-Vaillant, 94800 Villejuif, France.
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Sarfati B, Rimareix F, Honart JF, Alkhashnam H, De Frémicourt KT, Conversano A, Struk S, Schaff JB, Bennis Y, Mazouni C, Kolb F, Leymarie N. [Decision algorithm in immediate breast reconstruction]. ANN CHIR PLAST ESTH 2018; 63:585-588. [PMID: 30143370 DOI: 10.1016/j.anplas.2018.07.002] [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: 07/11/2018] [Accepted: 07/12/2018] [Indexed: 11/29/2022]
Abstract
Immediate breast reconstruction showed many advantages in terms of aesthetic and functional results and improvement of quality of life when compared to delayed breast reconstruction. Previous radiotherapy or the use of adjuvant treatments such as radiation therapy, or chemotherapy are no longer a contraindication for immediate breast reconstruction. However, it is important to respect certain rules in order to decrease the risk of complications: the choice of reconstruction technique, the management of the skin envelope according to the breast shape you want to create, the time delay between the first and the second stage of reconstruction depending on a possible adjuvant treatment.
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Affiliation(s)
- B Sarfati
- Service de chirurgie plastique, Gustave-Roussy, 114, rue Édouard-Vaillant, 94800 Villejuif, France.
| | - F Rimareix
- Service de chirurgie plastique, Gustave-Roussy, 114, rue Édouard-Vaillant, 94800 Villejuif, France.
| | - J F Honart
- Service de chirurgie plastique, Gustave-Roussy, 114, rue Édouard-Vaillant, 94800 Villejuif, France.
| | - H Alkhashnam
- Service de chirurgie plastique, Gustave-Roussy, 114, rue Édouard-Vaillant, 94800 Villejuif, France.
| | - K T De Frémicourt
- Service de chirurgie plastique, Gustave-Roussy, 114, rue Édouard-Vaillant, 94800 Villejuif, France.
| | - A Conversano
- Service de chirurgie plastique, Gustave-Roussy, 114, rue Édouard-Vaillant, 94800 Villejuif, France.
| | - S Struk
- Service de chirurgie plastique, Gustave-Roussy, 114, rue Édouard-Vaillant, 94800 Villejuif, France.
| | - J-B Schaff
- Service de chirurgie plastique, Gustave-Roussy, 114, rue Édouard-Vaillant, 94800 Villejuif, France.
| | - Y Bennis
- Service de chirurgie plastique, Gustave-Roussy, 114, rue Édouard-Vaillant, 94800 Villejuif, France.
| | - C Mazouni
- Service de chirurgie plastique, Gustave-Roussy, 114, rue Édouard-Vaillant, 94800 Villejuif, France.
| | - F Kolb
- Service de chirurgie plastique, Gustave-Roussy, 114, rue Édouard-Vaillant, 94800 Villejuif, France.
| | - N Leymarie
- Service de chirurgie plastique, Gustave-Roussy, 114, rue Édouard-Vaillant, 94800 Villejuif, France.
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Sarfati B, Struk S, Leymarie N, Honart JF, Alkhashnam H, Tran de Fremicourt K, Conversano A, Rimareix F, Simon M, Michiels S, Kolb F. Robotic Prophylactic Nipple-Sparing Mastectomy with Immediate Prosthetic Breast Reconstruction: A Prospective Study. Ann Surg Oncol 2018; 25:2579-2586. [DOI: 10.1245/s10434-018-6555-x] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Indexed: 12/23/2022]
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12
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Struk S, Qassemyar Q, Leymarie N, Honart JF, Alkhashnam H, De Fremicourt K, Conversano A, Schaff JB, Rimareix F, Kolb F, Sarfati B. The ongoing emergence of robotics in plastic and reconstructive surgery. ANN CHIR PLAST ESTH 2018; 63:105-112. [DOI: 10.1016/j.anplas.2018.01.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Accepted: 01/02/2018] [Indexed: 12/25/2022]
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13
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Struk S, Sarfati B, Leymarie N, Missistrano A, Alkhashnam H, Rimareix F, Kolb F, Honart JF. Robotic-assisted DIEP flap harvest: A feasibility study on cadaveric model. J Plast Reconstr Aesthet Surg 2018; 71:259-261. [DOI: 10.1016/j.bjps.2017.10.028] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Accepted: 10/13/2017] [Indexed: 10/18/2022]
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Struk S, Honart JF, Qassemyar Q, Leymarie N, Sarfati B, Alkhashnam H, Mazouni C, Rimareix F, Kolb F. Utilisation du vert d’indocyanine en chirurgie sénologique et reconstruction mammaire. ANN CHIR PLAST ESTH 2018; 63:54-61. [DOI: 10.1016/j.anplas.2017.09.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 09/25/2017] [Indexed: 12/21/2022]
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15
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Sarfati B, Honart JF, Leymarie N, Rimareix F, Al Khashnam H, Kolb F. Robotic da Vinci Xi-assisted nipple-sparing mastectomy: First clinical report. Breast J 2017; 24:373-376. [DOI: 10.1111/tbj.12937] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2016] [Revised: 01/02/2017] [Accepted: 01/04/2017] [Indexed: 12/22/2022]
Affiliation(s)
- Benjamin Sarfati
- Department of Plastic and Reconstructive Surgery; Gustave Roussy; Villejuif France
| | - Jean-Francois Honart
- Department of Plastic and Reconstructive Surgery; Gustave Roussy; Villejuif France
| | - Nicolas Leymarie
- Department of Plastic and Reconstructive Surgery; Gustave Roussy; Villejuif France
| | - Francoise Rimareix
- Department of Plastic and Reconstructive Surgery; Gustave Roussy; Villejuif France
| | - Heba Al Khashnam
- Department of Plastic and Reconstructive Surgery; Gustave Roussy; Villejuif France
| | - Frederic Kolb
- Department of Plastic and Reconstructive Surgery; Gustave Roussy; Villejuif France
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Struk S, Leymarie N, Honart JF, Missistrano A, Kolb F, Rimareix F, Sarfati B. Robotic nipple-sparing mastectomy with immediate reconstruction by robotically harvested latissimus dorsi muscle in a single position: Cadaveric study. J Plast Reconstr Aesthet Surg 2017; 71:764-766. [PMID: 29233511 DOI: 10.1016/j.bjps.2017.11.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 11/09/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Samuel Struk
- Department of Plastic Surgery, Gustave Roussy, Villejuif, France.
| | - Nicolas Leymarie
- Department of Plastic Surgery, Gustave Roussy, Villejuif, France
| | | | | | - Frédéric Kolb
- Department of Plastic Surgery, Gustave Roussy, Villejuif, France
| | | | - Benjamin Sarfati
- Department of Plastic Surgery, Gustave Roussy, Villejuif, France
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Honart JF, Reguesse AS, Struk S, Sarfati B, Rimareix F, Alkhashnam H, Kolb F, Rem K, Leymarie N. Indications and Controversies in Partial Mastectomy Defect Reconstruction. Clin Plast Surg 2017; 45:33-45. [PMID: 29080658 DOI: 10.1016/j.cps.2017.08.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Breast cancer surgical treatment nowadays includes oncoplastic surgery. It is a reliable oncologic surgical treatment, which also prevents functional and aesthetic sequelae, thus improving the patient's quality of life and satisfaction. Numerous techniques have been described, with different levels of complexity and technicality. Their indications differ depending on the global breast volume and the degree of ptosis, on the tumor volume compared with the breast volume, and on the tumor location. This article describes the authors' many years of experience of breast cancer treatment using oncoplastic surgery. They also established a decision-making guide, whose implementation enables treatment of every patient.
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Affiliation(s)
- Jean-François Honart
- Plastic and Reconstructive Surgery Department, Gustave Roussy, 114, Rue Edouard Vaillant, Villejuif 94800, France.
| | - Anne-Sophie Reguesse
- Plastic and Reconstructive Surgery Department, Gustave Roussy, 114, Rue Edouard Vaillant, Villejuif 94800, France
| | - Samuel Struk
- Plastic and Reconstructive Surgery Department, Gustave Roussy, 114, Rue Edouard Vaillant, Villejuif 94800, France
| | - Benjamin Sarfati
- Plastic and Reconstructive Surgery Department, Gustave Roussy, 114, Rue Edouard Vaillant, Villejuif 94800, France
| | - Françoise Rimareix
- Plastic and Reconstructive Surgery Department, Gustave Roussy, 114, Rue Edouard Vaillant, Villejuif 94800, France
| | - Heba Alkhashnam
- Plastic and Reconstructive Surgery Department, Gustave Roussy, 114, Rue Edouard Vaillant, Villejuif 94800, France
| | - Frédéric Kolb
- Plastic and Reconstructive Surgery Department, Gustave Roussy, 114, Rue Edouard Vaillant, Villejuif 94800, France
| | - Kessara Rem
- Plastic and Reconstructive Surgery Department, Gustave Roussy, 114, Rue Edouard Vaillant, Villejuif 94800, France
| | - Nicolas Leymarie
- Plastic and Reconstructive Surgery Department, Gustave Roussy, 114, Rue Edouard Vaillant, Villejuif 94800, France
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Honart JF, Leymarie N, Sarfati B. Response to the reply to the letter to the editor "Robotic-assisted Nipple Sparing Mastectomy: A feasibility study on cadaveric models". J Plast Reconstr Aesthet Surg 2017; 70:560-561. [PMID: 28237519 DOI: 10.1016/j.bjps.2017.01.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 01/31/2017] [Indexed: 10/20/2022]
Affiliation(s)
| | - Nicolas Leymarie
- Plastic and Reconstructive Surgery Unit, Gustave Roussy, Villejuif, France
| | - Benjamin Sarfati
- Plastic and Reconstructive Surgery Unit, Gustave Roussy, Villejuif, France
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Lefèvre M, Sarfati B, Honart JF, Alkashnam H, Rimareix F, Leymarie N, Kolb F. Le lambeau perforant de fascia lata en reconstruction mammaire : une option intéressante en cas de contre-indication au DIEP. ANN CHIR PLAST ESTH 2017; 62:97-103. [DOI: 10.1016/j.anplas.2016.05.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Accepted: 05/29/2016] [Indexed: 10/21/2022]
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Sarfati B, Honart J, Leymarie N, Kolb F, Rimareix F. Robotic-assisted Nipple Sparing Mastectomy: A feasibility study on cadaveric models. J Plast Reconstr Aesthet Surg 2016; 69:1571-1572. [DOI: 10.1016/j.bjps.2016.08.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Revised: 07/04/2016] [Accepted: 08/22/2016] [Indexed: 11/30/2022]
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Delaloge S, Bonastre J, Borget I, Garbay JR, Fontenay R, Boinon D, Saghatchian M, Mathieu MC, Mazouni C, Rivera S, Uzan C, André F, Dromain C, Boyer B, Pistilli B, Azoulay S, Rimareix F, Bayou EH, Sarfati B, Caron H, Ghouadni A, Leymarie N, Canale S, Mons M, Arfi-Rouche J, Arnedos M, Suciu V, Vielh P, Balleyguier C. The challenge of rapid diagnosis in oncology: Diagnostic accuracy and cost analysis of a large-scale one-stop breast clinic. Eur J Cancer 2016; 66:131-7. [PMID: 27569041 DOI: 10.1016/j.ejca.2016.06.021] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [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: 04/20/2016] [Revised: 05/30/2016] [Accepted: 06/25/2016] [Indexed: 12/16/2022]
Abstract
PURPOSE Rapid diagnosis is a key issue in modern oncology, for which one-stop breast clinics are a model. We aimed to assess the diagnosis accuracy and procedure costs of a large-scale one-stop breast clinic. PATIENTS AND METHODS A total of 10,602 individuals with suspect breast lesions attended the Gustave Roussy's regional one-stop breast clinic between 2004 and 2012. The multidisciplinary clinic uses multimodal imaging together with ultrasonography-guided fine needle aspiration for masses and ultrasonography-guided and stereotactic biopsies as needed. Diagnostic accuracy was assessed by comparing one-stop diagnosis to the consolidated diagnosis obtained after surgery or biopsy or long-term monitoring. The medical cost per patient of the care pathway was assessed from patient-level data collected prospectively. RESULTS Sixty-nine percent of the patients had masses, while 31% had micro-calcifications or other non-mass lesions. In 75% of the cases (87% of masses), an exact diagnosis could be given on the same day. In the base-case analysis (i.e. considering only benign and malignant lesions at one-stop and at consolidated diagnoses), the sensitivity of the one-stop clinic was 98.4%, specificity 99.8%, positive and negative predictive values 99.7% and 99.0%. In the sensitivity analysis (reclassification of suspect, atypical and undetermined lesions), diagnostic sensitivity varied from 90.3% to 98.5% and specificity varied from 94.3% to 99.8%. The mean medical cost per patient of one-stop diagnostic procedure was €420. CONCLUSIONS One-stop breast clinic can provide timely and cost-efficient delivery of highly accurate diagnoses and serve as models of care for multiple settings, including rapid screening-linked diagnosis.
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Affiliation(s)
- Suzette Delaloge
- Gustave Roussy, Université Paris-Saclay, Department of Medical Oncology, Villejuif, F-94805, France.
| | - Julia Bonastre
- Gustave Roussy, Université Paris-Saclay, Department of Biostatistics, Epidemiology and Health Economics, Villejuif, F-94805, France; INSERM U1018, CESP Centre for Research in Epidemiology and Population Health, Université Paris-Sud, Université Paris-Saclay, Villejuif, France
| | - Isabelle Borget
- Gustave Roussy, Université Paris-Saclay, Department of Biostatistics, Epidemiology and Health Economics, Villejuif, F-94805, France; INSERM U1018, CESP Centre for Research in Epidemiology and Population Health, Université Paris-Sud, Université Paris-Saclay, Villejuif, France
| | - Jean-Rémi Garbay
- Gustave Roussy, Université Paris-Saclay, Department of Surgery, Villejuif, F-94805, France
| | - Rachel Fontenay
- Gustave Roussy, Université Paris-Saclay, Department of Biostatistics, Epidemiology and Health Economics, Villejuif, F-94805, France; INSERM U1018, CESP Centre for Research in Epidemiology and Population Health, Université Paris-Sud, Université Paris-Saclay, Villejuif, France
| | - Diane Boinon
- Gustave Roussy, Université Paris-Saclay, Department of Supportive Care, Villejuif, F-94805, France
| | - Mahasti Saghatchian
- Gustave Roussy, Université Paris-Saclay, Department of Medical Oncology, Villejuif, F-94805, France
| | - Marie-Christine Mathieu
- Gustave Roussy, Université Paris-Saclay, Department of Pathology, Villejuif, F-94805, France
| | - Chafika Mazouni
- Gustave Roussy, Université Paris-Saclay, Department of Surgery, Villejuif, F-94805, France
| | - Sofia Rivera
- Gustave Roussy, Université Paris-Saclay, Department of Radiation Therapy, Villejuif, F-94805, France
| | - Catherine Uzan
- Gustave Roussy, Université Paris-Saclay, Department of Surgery, Villejuif, F-94805, France
| | - Fabrice André
- Gustave Roussy, Université Paris-Saclay, Department of Medical Oncology, Villejuif, F-94805, France
| | - Clarisse Dromain
- Gustave Roussy, Université Paris-Saclay, Department of Radiology, Villejuif, F-94805, France
| | - Bruno Boyer
- Gustave Roussy, Université Paris-Saclay, Department of Radiology, Villejuif, F-94805, France
| | - Barbara Pistilli
- Gustave Roussy, Université Paris-Saclay, Department of Medical Oncology, Villejuif, F-94805, France
| | - Sandy Azoulay
- Gustave Roussy, Université Paris-Saclay, Department of Pathology, Villejuif, F-94805, France
| | - Françoise Rimareix
- Gustave Roussy, Université Paris-Saclay, Department of Surgery, Villejuif, F-94805, France
| | - El-Hadi Bayou
- Gustave Roussy, Université Paris-Saclay, Department of Radiology, Villejuif, F-94805, France
| | - Benjamin Sarfati
- Gustave Roussy, Université Paris-Saclay, Department of Surgery, Villejuif, F-94805, France
| | - Hélène Caron
- Gustave Roussy, Université Paris-Saclay, Department of Medical Oncology, Villejuif, F-94805, France
| | - Amal Ghouadni
- Gustave Roussy, Université Paris-Saclay, Department of Medical Oncology, Villejuif, F-94805, France
| | - Nicolas Leymarie
- Gustave Roussy, Université Paris-Saclay, Department of Surgery, Villejuif, F-94805, France
| | - Sandra Canale
- Gustave Roussy, Université Paris-Saclay, Department of Radiology, Villejuif, F-94805, France
| | - Muriel Mons
- Gustave Roussy, Université Paris-Saclay, Department of Medical Information, Villejuif, F-94805, France
| | - Julia Arfi-Rouche
- Gustave Roussy, Université Paris-Saclay, Department of Radiology, Villejuif, F-94805, France
| | - Monica Arnedos
- Gustave Roussy, Université Paris-Saclay, Department of Medical Oncology, Villejuif, F-94805, France
| | - Voichita Suciu
- Gustave Roussy, Université Paris-Saclay, Department of Pathology, Villejuif, F-94805, France
| | - Philippe Vielh
- Gustave Roussy, Université Paris-Saclay, Department of Pathology, Villejuif, F-94805, France
| | - Corinne Balleyguier
- Gustave Roussy, Université Paris-Saclay, Department of Radiology, Villejuif, F-94805, France
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Arnedos M, Cheaib B, Bayar MA, Michiels S, Scott V, Adam J, Leroux-Kozal V, Marty V, Mazouni C, Sarfati B, Bieche I, Gentien D, Delaloge S, Lacroix-Triki M, Andre F. Abstract CT041: Anti-proliferative response and predictive biomarkers to palbociclib in early breast cancer: The Preoperative Palbociclib (POP) randomized trial. Clin Trials 2016. [DOI: 10.1158/1538-7445.am2016-ct041] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Scherer D, Miran I, Mazouni C, Sarfati B, Bernard M, Adam J, Louvet E, Drusch F, Vielh P, Alhazmi K, Ulrich CM, Delaloge S, Feunteun J. Abstract 4286: Gene expression profiles in adipose tissue of cancer-bearing breasts differ from that of tumor-free breasts. Cancer Res 2016. [DOI: 10.1158/1538-7445.am2016-4286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction
Adipose tissue - long believed to be no more than an energy storage organ - is metabolically active and consists of a variety of cell types. Adipocytes, fibroblasts and macrophages reside in adipose tissue and may have tumor-promoting properties through the release of cytokines and other growth stimulating molecules. Further, adipose tissue has the capacity of storing pollutants and carcinogens. Breast tumors are embedded in adipose tissue and the direct interface between tumor and adipose tissue in the breast defines a micro-environment potentially fostering tumor initiation and/or progression. The aim of this study was to investigate the transcriptome of adipose tissue from cancer-bearing breasts, localized either close to or distant from the tumor, in addition to comparing it to adipose tissue from tumor-free breasts.
Methods
We collected adipose tissue from n = 33 tumor-bearing breasts (a) close to (< 2cm) and (b) distant from (>5cm) the tumor and from n = 5 tumor-free breasts to investigate gene expression profiles in these three series of tissues. Gene expression was measured from RNA isolated from fresh frozen adipose tissue using Illumina HT12 bead arrays. Quantile normalized expression values were analyzed between (a) and (b) as well as between (a)+(b) and (c) using t-test. Data was filtered by standard variation of 0.95. P-values ≤0.001 were considered significant.
Results
We did not observe any significant differences in gene expression when comparing adipose tissue close to or distant from the tumor. By contrast, expression profiles in adipose tissue of tumor-free breasts clearly differed from that of cancer-bearing breasts. We observed 81 genes significantly differentially expressed between the two groups. Among the overexpressed genes were the previously identified genes MARCO and VSIG4, which were 1.5-fold upregulated in adipose tissue from diseased patients (both p-value = 0.001). Both genes are involved in processes of immunity and inflammation, promoting immune-tolerance in macrophages and T-cells. Other differentially expressed genes also relate to these pathways including CD163, CCL13 and C3. This striking role of inflammatory and immune-modulatory processes was further supported by pathway analyses.
Conclusions
Breast adipose tissues of cancer-bearing breasts show distinct gene expression profiles from that of tumor-free breasts, whereas tumor-distant and tumor-close adipose tissues are similar. However the selected distance of ≤2cm from the tumor may by insufficient to capture the tumor micro-environment. Nevertheless, this rather provocative result raises issues related to the status of breast adipose tissue that may define individually determined cancer fields. Differentially expressed genes are, to a large proportion, involved in immunity-related and inflammatory processes, emphasizing that adipose tissue is an important contributor to one of the hallmarks of cancer.
Citation Format: Dominique Scherer, Isabelle Miran, Chafika Mazouni, Benjamin Sarfati, Marine Bernard, Julien Adam, Emilie Louvet, Francoise Drusch, Philippe Vielh, Khalid Alhazmi, Cornelia M. Ulrich, Suzette Delaloge, Jean Feunteun. Gene expression profiles in adipose tissue of cancer-bearing breasts differ from that of tumor-free breasts. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 4286.
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Garbay JR, Skalli-Chrisostome D, Leymarie N, Sarfati B, Rimareix F, Mazouni C. The Role of Blue Dye in Sentinel Node Detection for Breast Cancer: A Retrospective Study of 203 Patients. Breast Care (Basel) 2016; 11:128-32. [PMID: 27239175 DOI: 10.1159/000445368] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE We aimed at examining the potential benefits of blue dye in sentinel node biopsy (SNB) in comparison with its proven drawbacks. PATIENTS AND METHODS In 2007, 203 T1 primary breast carcinomas had been operated on in our institute. The patients had undergone a lumpectomy and SNB. Sentinel node (SN) detection was exclusively isotopic (ISO) in 77 patients and performed with blue dye combined with a radioactive isotope (COMBI) in 126 patients. We compared the number of SNs and the rate of SN positivity in both groups. RESULTS The detection rate was 99% in both groups: 76/77 in the ISO group and 125/126 in the COMBI group. The mean number of SNs was 2.14 and 1.91 in the ISO group and the COMBI group, respectively (difference not significant (NS)). SN positivity was found in 26.1% and 24.6% in the ISO group and the COMBI group, respectively (NS). Only 1 SN had been removed in 26% of the patients in the ISO group versus 45.2% of the patients in the COMBI group (p = 0.004). No significant differences were observed in the tumor characteristics. CONCLUSION The systematic use of patent blue dye combined with isotopic detection does not appear to increase the overall performance of the SNB technique in this retrospective study.
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Amabile MI, Mazouni C, Guimond C, Sarfati B, Leymarie N, Cloutier AS, Bentivegna E, Garbay JR, Kolb F, Rimareix F. Factors Predictive of Re-excision After Oncoplastic Breast-conserving Surgery. Anticancer Res 2015; 35:4229-4234. [PMID: 26124383] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND Oncoplastic surgery (OPS) consists of breast-conserving surgery (BCS) that allows for oncologically safe breast conservation and breast remodeling, thus reducing postoperative deformities. The purpose of the present study was to identify factors determining the risk of re-excision and complications after OPS. PATIENTS AND METHODS A retrospective analysis was conducted on patients who underwent OPS between 2009 and 2013, regardless of whether neoadjuvant chemotherapy was administered. Clinical and pathological factors were evaluated. Recursive partitioning analysis (RPA) was used to build regression trees for the prediction of re-excision. RESULTS Amongst the 129 patients treated by OPS procedures, 30.3% required re-excision. Predictive factors for re-excision were: being overweight (p=0.02), the presence of microcalcifications on mammography (p=0.003), and tumor multifocality (p=0.03). The RPA identified five terminal nodes based on microcalcifications on mammography, being overweight and the presence of ductal carcinoma in situ. Another model included minimal invasive margins (p<0.001), being overweight (p=0.02) and the presence of microcalcifications (p=0.01) on mammography yielded a model with an area under the receiver operating characteristic curve of 0.875. CONCLUSION Microcalcifications, tumor multifocality and being overweight were the factors identified as predictors of re-excision after OPS. These factors can serve as decisional tools before surgery.
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Affiliation(s)
- Maria-Ida Amabile
- Division of Breast Surgery, Plastic and Reconstructive Surgery, Department of Surgery, Gustave Roussy Institute, Villejuif, France
| | - Chafika Mazouni
- Division of Breast Surgery, Plastic and Reconstructive Surgery, Department of Surgery, Gustave Roussy Institute, Villejuif, France
| | - Cathie Guimond
- Division of Breast Surgery, Plastic and Reconstructive Surgery, Department of Surgery, Gustave Roussy Institute, Villejuif, France
| | - Benjamin Sarfati
- Division of Breast Surgery, Plastic and Reconstructive Surgery, Department of Surgery, Gustave Roussy Institute, Villejuif, France
| | - Nicolas Leymarie
- Division of Breast Surgery, Plastic and Reconstructive Surgery, Department of Surgery, Gustave Roussy Institute, Villejuif, France
| | - Alexis-Simon Cloutier
- Division of Breast Surgery, Plastic and Reconstructive Surgery, Department of Surgery, Gustave Roussy Institute, Villejuif, France
| | - Enrica Bentivegna
- Division of Breast Surgery, Plastic and Reconstructive Surgery, Department of Surgery, Gustave Roussy Institute, Villejuif, France
| | - Jean-Rémi Garbay
- Division of Breast Surgery, Plastic and Reconstructive Surgery, Department of Surgery, Gustave Roussy Institute, Villejuif, France
| | - Frédéric Kolb
- Division of Breast Surgery, Plastic and Reconstructive Surgery, Department of Surgery, Gustave Roussy Institute, Villejuif, France
| | - Françoise Rimareix
- Division of Breast Surgery, Plastic and Reconstructive Surgery, Department of Surgery, Gustave Roussy Institute, Villejuif, France
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Mazouni C, Mesnard C, Cloutier AS, Amabile MI, Bentivegna E, Garbay JR, Sarfati B, Leymarie N, Kolb F, Rimareix F. Quilting Sutures Reduces Seroma in Mastectomy. Clin Breast Cancer 2015; 15:289-93. [PMID: 25661806 DOI: 10.1016/j.clbc.2014.12.014] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Accepted: 12/31/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Drainage duration and seroma formation occurring after mastectomy with or without axillary surgery lengthens hospitalization and delays adjuvant treatment. The aim of the study was to evaluate the effect of quilting in the prevention of seroma after mastectomy for breast cancer. PATIENTS AND METHODS Eighty-two breast cancer patients about to undergo mastectomy with or without axillary surgery lymphadenectomy were enrolled in the study. We conducted an observational comparison between 41 patients in whom quilting with closed suction drainage was used and 41 patients in whom drainage only was used. RESULTS The mean drained volume was significantly lower in the quilting group compared with the control group on days 1 and 2 (day 1: 107.1 mL vs. 156.5 mL; P = .02; day 2: 108.4 mL vs. 162.8 mL; P = .01). The mean drainage period was shorter in the quilting group (4.6 vs. 5.3 days; P = .046). There were fewer needle aspirations for seroma in the padding group (n = 14, 34.1% vs. n = 24, 58.5%; P = .03). CONCLUSION The use of padding after mastectomy seems to reduce seroma formation, volume drained, and length of drainage time.
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Affiliation(s)
- Chafika Mazouni
- Gustave Roussy, Cancer Campus, Division of Breast and Plastic Surgery, Department of Surgery, Villejuif, France.
| | - Chrystelle Mesnard
- Gustave Roussy, Cancer Campus, Division of Breast and Plastic Surgery, Department of Surgery, Villejuif, France
| | - Alexis-Simon Cloutier
- Gustave Roussy, Cancer Campus, Division of Breast and Plastic Surgery, Department of Surgery, Villejuif, France
| | - Maria-Ida Amabile
- Gustave Roussy, Cancer Campus, Division of Breast and Plastic Surgery, Department of Surgery, Villejuif, France
| | - Enrica Bentivegna
- Gustave Roussy, Cancer Campus, Division of Breast and Plastic Surgery, Department of Surgery, Villejuif, France
| | - Jean-Rémi Garbay
- Gustave Roussy, Cancer Campus, Division of Breast and Plastic Surgery, Department of Surgery, Villejuif, France
| | - Benjamin Sarfati
- Gustave Roussy, Cancer Campus, Division of Breast and Plastic Surgery, Department of Surgery, Villejuif, France
| | - Nicolas Leymarie
- Gustave Roussy, Cancer Campus, Division of Breast and Plastic Surgery, Department of Surgery, Villejuif, France
| | - Frédéric Kolb
- Gustave Roussy, Cancer Campus, Division of Breast and Plastic Surgery, Department of Surgery, Villejuif, France
| | - Françoise Rimareix
- Gustave Roussy, Cancer Campus, Division of Breast and Plastic Surgery, Department of Surgery, Villejuif, France
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Qassemyar Q, Gianfermi M, Sarfati B, Leymarie N, Kolb F. Super-microdissected local flaps for the coverage of temporal defects. Microsurgery 2014; 34:554-7. [PMID: 24895327 DOI: 10.1002/micr.22284] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Revised: 05/18/2014] [Accepted: 05/21/2014] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Skin graft is still a method of choice for the coverage of temporal defects. But there are some disadvantages like a "patch" appearance, the need of dressing or longer healing time. Numbers of local flaps have been described for closing skin defects on temporal region. Yet, they may cause distortion of the surrounding tissues, especially in the temporal hairline and eyebrow. We present a series of seven local flaps based on small branches (SB) of the superficial temporal artery (STA) for the coverage of temporal defects, and discuss their advantages. PATIENTS AND METHODS Supermicrodissection of SB of the STA was performed to obtain local flaps for reconstruction of temporal defects after skin cancer excisions in seven patients. Patient's age ranged from 70 to 88 years old and the diameter of defects ranged from 4 to 6 cm. All procedures were performed under local anesthesia except one. In all cases, defects were obtained after skin cancer excisions. RESULTS The operative time ranged from 55 to 75 min. All flaps survived with an average follow-up of 8 months, reconstructions have maintained a cosmetically pleasing result. CONCLUSION We believe that SB flaps may be a new option for reconstruction of temporal defects with the advantages of local flaps, without the inconvenience of a skin pedicle. Moreover, these flaps raise the question of the use of SB based flaps for the coverage of moderate-sized skin defects anywhere in the body, and open new fields in reconstructive surgery.
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Affiliation(s)
- Q Qassemyar
- Department of Plastic and Reconstructive Surgery, Gustave Roussy Cancer Campus, Grand Paris, 114 Rue Edouard Vaillant, F-94805, Villejuif, France; Department of Anatomy, University of Picardie, rue des Louvels, 80000, Amiens, France; Department of Plastic Surgery, Amiens Hospital, place Victor Pauchet, 80000, Amiens, France
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Gorphe P, Sarfati B, Janot F, Bourgain JL, Motamed C, Blot F, Temam S. Airway fire during tracheostomy. Eur Ann Otorhinolaryngol Head Neck Dis 2014; 131:197-9. [PMID: 24703002 DOI: 10.1016/j.anorl.2013.07.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [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: 02/19/2013] [Revised: 04/17/2013] [Accepted: 07/16/2013] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Twenty-five cases of airway fire during tracheostomy have been reported in the literature. The authors describe a case observed in their centre 3 years ago, discuss the causes and preventive management and propose guidelines for prevention of this complication. CASE REPORT A 66-year-old woman was intubated and ventilated with 100% oxygen during general anaesthesia for tracheostomy. On opening the trachea by monopolar diathermy, the oxygen present in the endotracheal tube caught fire, inducing combustion of the tube spreading to the lower airways. This airway fire was responsible for severe acute respiratory failure and the formation of multiple laryngotracheal stenoses. DISCUSSION Combustion of the endotracheal tube due to ignition of anaesthetic gases induced by the heat generated by diathermy is responsible for airway fire. These various phenomena are discussed. Prevention is based on safety measures and coordination of surgical and anaesthetic teams.
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Affiliation(s)
- P Gorphe
- Département de cancérologie cervico-faciale, institut de cancérologie Gustave-Roussy, 114, rue Edouard-Vaillant, 94800 Villejuif, France.
| | - B Sarfati
- Département de cancérologie cervico-faciale, institut de cancérologie Gustave-Roussy, 114, rue Edouard-Vaillant, 94800 Villejuif, France
| | - F Janot
- Département de cancérologie cervico-faciale, institut de cancérologie Gustave-Roussy, 114, rue Edouard-Vaillant, 94800 Villejuif, France
| | - J L Bourgain
- Service d'anesthésie, institut de cancérologie Gustave-Roussy, 94800 Villejuif, France
| | - C Motamed
- Service d'anesthésie, institut de cancérologie Gustave-Roussy, 94800 Villejuif, France
| | - F Blot
- Service d'anesthésie, institut de cancérologie Gustave-Roussy, 94800 Villejuif, France
| | - S Temam
- Département de cancérologie cervico-faciale, institut de cancérologie Gustave-Roussy, 114, rue Edouard-Vaillant, 94800 Villejuif, France
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Robert C, Cavalcanti A, Kolb F, Sarfati B, Moya-Plana A, Tomasic G, Mateus C. [Management of patients with melanoma]. Rev Prat 2014; 64:75-80. [PMID: 24649552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Management of patients with metastatic melanoma has been revolutionized over the last few years with targeted anti-BRAF therapies for BRAF-mutant melanomas (in about 50% of the cases) and immunotherapy with anti-CTLA-4. Several new drugs are now authorized and available. Because of their new mechanisms of action, they also have new adverse events and guidelines concerning their safety are of critical importance. New innovative strategies using combination of targeted therapies and immunotherapies with anti-PD-1 are in accelerated development. The quality of patient-physician relationship is central to this promising but complex new paradigm of treatment.
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Leclère FM, Bosc R, Temam S, Leymarie N, Mirghani H, Sarfati B, Kolb F. Reconstruction of large mandibulofacial defects with the composed double skin paddle fibula free flap: A review of 32 procedures. Laryngoscope 2013; 124:1336-43. [DOI: 10.1002/lary.24452] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Revised: 09/03/2013] [Accepted: 09/23/2013] [Indexed: 11/09/2022]
Affiliation(s)
- Franck M. Leclère
- Department of Plastic and Reconstructive Surgery; Institut Gustave Roussy; 94805 Villejuif Cedex France
| | - Romain Bosc
- Department of Plastic and Reconstructive Surgery; Institut Gustave Roussy; 94805 Villejuif Cedex France
| | - Stéphane Temam
- Department of ENT Surgery; Gustave Roussy Cancer Campus Grand Paris; 94805 Villejuif Cedex France
| | - Nicolas Leymarie
- Department of Plastic and Reconstructive Surgery; Institut Gustave Roussy; 94805 Villejuif Cedex France
| | - Haitham Mirghani
- Department of ENT Surgery; Gustave Roussy Cancer Campus Grand Paris; 94805 Villejuif Cedex France
| | - Benjamin Sarfati
- Department of Plastic and Reconstructive Surgery; Institut Gustave Roussy; 94805 Villejuif Cedex France
| | - Frédéric Kolb
- Department of Plastic and Reconstructive Surgery; Institut Gustave Roussy; 94805 Villejuif Cedex France
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Naoura I, Mazouni C, Ghanimeh J, Leymarie N, Garbay JR, Karsenti G, Sarfati B, Leduey A, Kolb F, Delaloge S, Rimareix F. Factors influencing the decision to offer immediate breast reconstruction after mastectomy for ductal carcinoma in situ (DCIS): The Institut Gustave Roussy Breast Cancer Study Group experience. Breast 2013; 22:673-5. [DOI: 10.1016/j.breast.2013.01.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Revised: 11/21/2012] [Accepted: 01/06/2013] [Indexed: 11/16/2022] Open
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Mazouni C, Naveau A, Kane A, Dunant A, Garbay JR, Leymarie N, Sarfati B, Delaloge S, Rimareix F. The role of oncoplastic breast surgery in the management of breast cancer treated with primary chemotherapy. Breast 2013; 22:1189-93. [PMID: 24054903 DOI: 10.1016/j.breast.2013.07.055] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Revised: 07/04/2013] [Accepted: 07/20/2013] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE The purpose of this study was to evaluate the benefit of Oncoplastic Breast Conserving Surgery (BCS) compared to standard BCS after primary CT, in terms of oncologic safety and cosmetic outcomes. BACKGROUND The development of new drugs has led to greater use of primary chemotherapy (CT) for bulky breast cancer (BC) and has allowed wider indications for conservative surgery. PATIENTS AND METHODS We identified 259 patients consecutively treated with BCS for primary BC from January 2002 to November 2010. All patients had undergone Oncoplastic Breast Surgery (OBS) or standard BCS after primary CT. Mastectomy rates, and oncological and cosmetic outcomes were compared. RESULTS A total of 45 OBS and 214 standard BCS were analyzed. The median tumor size was 40 mm in the two groups (p = 0.66). The median operative specimen volumes were larger in the OBS group than in the standard group (respectively, 180 cm3 and 98 cm3, p < 0.0001). Re-excision (9% vs. 2%) and mastectomy (24% vs. 18%) rates were similar (p = 0.22 and p = 0.30) in the standard BCS group and in the OBS group respectively. At a median follow-up of 46 months, local relapse (p = 0.23) and distant relapse (p = 0.35) rates were similar. CONCLUSION OBS allows excision of larger volumes of residual tumor after primary CT. OBS outcomes results were similar to those of standard BCS. Oncoplastic Breast Conserving Surgery (BCS) after primary chemotherapy allows wider breast resection than standard BCS. Survival and relapse probabilities are similar in both groups.
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Affiliation(s)
- Chafika Mazouni
- Department of Breast and Plastic Surgery, Institut Gustave Roussy, Villejuif, France.
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Leymarie N, Karsenti G, Sarfati B, Rimareix F, Kolb F. Modification of flap design for total mobile tongue reconstruction using a sensitive antero-lateral thigh flap. J Plast Reconstr Aesthet Surg 2012; 65:e169-74. [DOI: 10.1016/j.bjps.2011.11.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2011] [Revised: 09/25/2011] [Accepted: 11/07/2011] [Indexed: 10/14/2022]
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Garbay JR, Thoury A, Moinon E, Cavalcanti A, Palma MD, Karsenti G, Leymarie N, Sarfati B, Rimareix F, Mazouni C. Axillary Padding without Drainage after Axillary Lymphadenectomy - a Prospective Study of 299 Patients with Early Breast Cancer. ACTA ACUST UNITED AC 2012; 7:231-235. [PMID: 22872798 DOI: 10.1159/000341102] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND: After lymphadenectomy for early breast cancer, seroma formation is a constant event requiring a suction drainage. This drainage is the strongest obstacle to reducing the hospital stay. Axillary padding without drainage appears to be a valuable option amid the various solutions for reducing the hospital stay. METHODS: We conducted a comparison between 114 patients with padding and 185 patients with drainage. Data were obtained from 2 successive prospective studies. RESULTS: The mean hospital stay was 2.4 days (range 1-4) in the padding group and 4.2 days (range 2-9) in the drainage group (p < 0.05). There were fewer needle aspirations for seroma in the padding group (8.8 vs. 23%, p < 0.05). At 6 weeks, only 28% (32/114) of the patients in the padding group reported pain versus 51% (94/185) in the drainage group. The mean pain intensity at 6 weeks was 3 and 4.3 respectively (p < 0.0001). CONCLUSION: Axillary padding without drainage was associated with a better post-operative course than suction drainage in this historical comparison, and the hospital stay was significantly shortened. There are only few series published on this new technique but they all indicate good feasibility and good tolerance. A large randomised multicentric evaluation is now warranted.
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Affiliation(s)
- Jean-Rémi Garbay
- Department of Breast Surgical Oncology, Institut Gustave Roussy, Villejuif, France
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Sarfati B, Zwillinger N, Lazar CC, Sarfati A, Lorenceau B. [The internal breast flap: a new technique of reconstruction]. ANN CHIR PLAST ESTH 2009; 54:379-83. [PMID: 19342144 DOI: 10.1016/j.anplas.2009.01.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2008] [Accepted: 01/16/2009] [Indexed: 11/17/2022]
Abstract
AIM The internal breast pedicle flap is not a well-known technique yet. Anyway, it is effective for some of breast reconstructions and partial thoracic defects. This technique is applied to patients presenting breast hypertrophy. In this article, we present the experience of our department in this technique, considering its indications, surgery details, complications that may occur and subsisting interrogations about this surgical approach. MATERIAL AND METHODS Two patients were treated with internal breast pedicle flap, one for controlateral breast reconstruction and one for coverage of partial thoracic defect. RESULTS Patients were followed; flap survival and aesthetic results were analyzed during consultations. Results were good and similar to other well-spread reconstruction techniques. CONCLUSION The internal breast pedicle flap is a relevant, reproducible and easy technique. Overall results are satisfying and allow the possibility of applying other techniques in case of failure. You have to keep in mind the risk of making a transfer of a potentially carcinogenic tissue for a patient having already presented a breast cancer.
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Affiliation(s)
- B Sarfati
- Département de chirurgie plastique, reconstructrice et esthétique, centre hospitalier René-Dubos, 6, avenue de l'Ile-de-France, 95301 Pontoise, France.
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