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Hirono S, Watanabe J, Miki A, Shiozawa M, Sata N. The Efficacy and Safety of Somatostatin Analog after Axillary Node Dissection in Breast Cancer: A Systematic Review and Meta-analysis. JMA J 2023; 6:274-281. [PMID: 37560373 PMCID: PMC10407358 DOI: 10.31662/jmaj.2022-0219] [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: 12/12/2022] [Accepted: 03/16/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND Somatostatin analogs are expected to reduce lymphatic leakage. However, whether they can be used after axillary lymphadenectomy is unclear. This study aimed to assess the efficacy and safety of somatostatin analogs in axillary lymphadenectomy for breast cancer patients. METHODS We performed a random-effects meta-analysis by searching electronic databases for randomized trials and trial registries until June 2022. The primary outcomes were the volume of drained fluid, the duration of drainage, and seroma incidence. Bias was assessed using the Cochrane Collaboration's tool and the Grading of Recommendations, Assessment, Development, and Evaluations approach. RESULTS Six trials (738 participants) and one protocol without results were included. Somatostatin analogs may reduce the volume of drained fluid (mean difference = -22.07 mL, 95% confidence interval [CI] = -42.09 to -2.05; I2 = 56%) while resulting in a slight-to-no difference in the duration of drainage (mean difference = -0.48 days, 95% CI = -1.43 to 0.46; I2 = 87%) and seroma incidence (risk ratio = 0.91, 95% CI = 0.61-1.34; I2 = 55%). The certainty of the evidence was low. CONCLUSIONS There was limited evidence supporting somatostatin analogs for lymphorrhea after axillary lymphadenectomy. Multicenter randomized controlled trials are needed to confirm the efficacy and safety of somatostatin analogs after axillary lymphadenectomy.
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Affiliation(s)
- Satsuki Hirono
- Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University, Shimotsuke, Japan
| | - Jun Watanabe
- Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University, Shimotsuke, Japan
- Division of Community and Family Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Atsushi Miki
- Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University, Shimotsuke, Japan
| | - Mikio Shiozawa
- Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University, Shimotsuke, Japan
| | - Naohiro Sata
- Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University, Shimotsuke, Japan
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Roman MM, Barbieux R, Eddy C, Karler C, Veys I, Zeltzer A, Adriaenssens N, Leduc O, Bourgeois P. Lymphoscintigraphic Investigations for Axillary Web Syndromes. Lymphat Res Biol 2021; 20:417-424. [PMID: 34813367 PMCID: PMC9422805 DOI: 10.1089/lrb.2021.0015] [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: 11/12/2022] Open
Abstract
Background: Axillary web syndrome (AWS) is a frequent complication after surgery for breast cancer, but its lymphatic involvement is not definitively established. Here we report the results of lymphoscintigraphic investigations in patients with AWS. Methods and Findings: We conducted a retrospective, single-center review of lymphoscintigraphic investigations performed in 46 patients with AWS that was either clinically obvious or suspected. Of this group, 23 patients had two investigations with a mean interval of 19 weeks between them (range, 6-98 weeks). Results of the lymphoscintigraphic investigations, which were performed according to a well-standardized protocol, were classified into four patterns: normal; functional lymphatic insufficiency only (no lymphatic vascular morphologic abnormality); lymphovascular blockade without collateralization; and vascular collateralization and/or dermal backflow. Of the 46 patients, on the first lymphoscintigraphic investigation, four (8.6%) had a normal pattern, seven (15.2%) had functional lymphatic insufficiency only, four (8.6%) had lymphovascular blockade without collateralization, and 31 (67.3%) had vascular collateralization and/or dermal backflow. Among patients who underwent two investigations, four of the five who had only functional lymphatic insufficiency at the first investigation had developed vascular collateralization and/or dermal backflow by the second. The three patients who had lymphovascular blockade without collateralization at the first examination had also progressed to collateralization and/or dermal backflow at the second. None of the 15 patients who initially had vascular collateralization and/or dermal backflow showed any reversal at the second examination. Conclusions: Our analysis confirms the lymphatic nature of AWS and shows the lymphoscintigraphic patterns and evolutions of the lymphatic lesions with potential therapeutic implications. The retrospective review of our database is approved by the institutional ethics committee under number 2048.
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Affiliation(s)
- Mirela Mariana Roman
- Department of Mammo-Pelvic Surgery, Institute Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium.,Multi-disciplinary Clinic of Lymphology, Institute Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Romain Barbieux
- Departement of Physical Therapy, Université Libre de Bruxelles, Brussels, Belgium
| | - Christine Eddy
- Department of Mammo-Pelvic Surgery, Institute Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Clarence Karler
- Department of Anesthesia-Algologia, Hospital Moliere, Université Libre de Bruxells, Brussels, Belgium
| | - Isabelle Veys
- Department of Mammo-Pelvic Surgery, Institute Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Assaf Zeltzer
- European Center for Lymphedema Surgery, Department of Plastic and Reconstructive Surgery, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Nele Adriaenssens
- Medical Oncology Department, Universitair Ziekenhuis Brussel, Brussels, Belgium & Rehabilitation Research, Vrije Universiteit Brussel, Brussels, Belgium
| | - Olivier Leduc
- Departement of Physical Therapy, Université Libre de Bruxelles, Brussels, Belgium
| | - Pierre Bourgeois
- Multi-disciplinary Clinic of Lymphology, Institute Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium.,Service of Dermatology, Hospital Erasme, and Services of Nuclear Medicine, Institut Jules Bordet and HIS-IZZ Hospitals, Université Libre de Bruxelles, Brussels, Belgium
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Salinas-Huertas S, Luzardo-González A, Vázquez-Gallego S, Pernas S, Falo C, Pla MJ, Gil-Gil M, Beranuy-Rodriguez M, Pérez-Montero H, Gomila-Sancho M, Manent-Molina N, Arencibia-Domínguez A, Gonzalez-Pineda B, Tormo-Collado F, Ortí-Asencio M, Terra J, Martinez-Perez E, Mestre-Jane A, Campos-Varela I, Jaraba-Armas M, Benítez-Segura A, Campos-Delgado M, Fernández-Montolí ME, Valverde-Alcántara Y, Rodríguez A, Campos G, Guma A, Ponce-Sebastià J, Planas-Balagué R, Catasús-Clavé M, García-Tejedor A. Risk factors for lymphedema after breast surgery: A prospective cohort study in the era of sentinel lymph node biopsy. Breast Dis 2021; 41:97-108. [PMID: 34542055 DOI: 10.3233/bd-210043] [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] [Indexed: 11/15/2022]
Abstract
INTRODUCTION The Objective was to investigate the incidence of lymphedema after breast cancer treatment and to analyze the risk factors involved in a tertiary level hospital. METHODS Prospective longitudinal observational study over 3 years post-breast surgery. 232 patients undergoing surgery for breast cancer at our institution between September 2013 and February 2018. Sentinel lymph node biopsy (SLNB) or axillary lymphadenectomy (ALND) were mandatory in this cohort. In total, 201 patients met the inclusion criteria and had a median follow-up of 31 months (range, 1-54 months). Lymphedema was diagnosed by circumferential measurements and truncated cone calculations. Patients and tumor characteristics, shoulder range of motion limitation and local and systemic therapies were analyzed as possible risk factors for lymphedema. RESULTS Most cases of lymphedema appeared in the first 2 years. 13.9% of patients developed lymphedema: 31% after ALND and 4.6% after SLNB (p < 0.01), and 46.7% after mastectomy and 11.3% after breast-conserving surgery (p < 0.01). The lymphedema rate increased when axillary radiotherapy (RT) was added to radical surgery: 4.3% for SLNB alone, 6.7% for SLNB + RT, 17.6% for ALND alone, and 35.2% for ALND + RT (p < 0.01). In the multivariate analysis, the only risk factors associated with the development of lymphedema were ALND and mastectomy, which had hazard ratios (95% confidence intervals) of 7.28 (2.92-18.16) and 3.9 (1.60-9.49) respectively. CONCLUSIONS The main risk factors for lymphedema were the more radical surgeries (ALND and mastectomy). The risk associated with these procedures appeared to be worsened by the addition of axillary radiotherapy. A follow-up protocol in patients with ALND lasting at least two years, in which special attention is paid to these risk factors, is necessary to guarantee a comprehensive control of lymphedema that provides early detection and treatment.
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Affiliation(s)
- S Salinas-Huertas
- Department of Rehabilitation, Hospital Universitari Bellvitge, Idibell, Universitat de Barcelona, Barcelona, Spain
| | - A Luzardo-González
- Department of Rehabilitation, Hospital Universitari Bellvitge, Idibell, Universitat de Barcelona, Barcelona, Spain
| | - S Vázquez-Gallego
- Department of Rehabilitation, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
| | - S Pernas
- Department of Oncology, Multidisciplinary Breast Cancer Unit, Institut Català d'Oncología, Barcelona, Spain
| | - C Falo
- Department of Oncology, Multidisciplinary Breast Cancer Unit, Institut Català d'Oncología, Barcelona, Spain
| | - M J Pla
- Department of Gynecology, Multidisciplinary Breast Cancer Unit, Hospital Universitari Bellvitge, Idibell, Universitat de Barcelona, Barcelona, Spain
| | - M Gil-Gil
- Department of Oncology, Multidisciplinary Breast Cancer Unit, Institut Català d'Oncología, Barcelona, Spain
| | - M Beranuy-Rodriguez
- Department of Rehabilitation, Hospital de la Santa Creu i Sant Pau, Universitat de Barcelona, Barcelona, Spain
| | - H Pérez-Montero
- Department of Oncologic Radiotherapy, Multidisciplinary Breast Cancer Unit, Institut Català d'Oncología, Barcelona, Spain
| | - M Gomila-Sancho
- Department of Rehabilitation, Hospital Universitari Bellvitge, Idibell, Universitat de Barcelona, Barcelona, Spain
| | - N Manent-Molina
- Department of Rehabilitation, Hospital Universitari Bellvitge, Idibell, Universitat de Barcelona, Barcelona, Spain
| | - A Arencibia-Domínguez
- Department of Rehabilitation, Hospital Universitari Bellvitge, Idibell, Universitat de Barcelona, Barcelona, Spain
| | - B Gonzalez-Pineda
- Department of Rehabilitation, Hospital Universitari Bellvitge, Idibell, Universitat de Barcelona, Barcelona, Spain
| | - F Tormo-Collado
- Department of Rehabilitation, Hospital Universitari Bellvitge, Idibell, Universitat de Barcelona, Barcelona, Spain
| | - M Ortí-Asencio
- Department of Rehabilitation, Hospital Universitari Bellvitge, Idibell, Universitat de Barcelona, Barcelona, Spain
| | - J Terra
- Department of Rehabilitation, Hospital Universitari Bellvitge, Idibell, Universitat de Barcelona, Barcelona, Spain
| | - E Martinez-Perez
- Department of Oncologic Radiotherapy, Multidisciplinary Breast Cancer Unit, Institut Català d'Oncología, Barcelona, Spain
| | - A Mestre-Jane
- Department of Rehabilitation, Hospital Universitari Bellvitge, Idibell, Universitat de Barcelona, Barcelona, Spain
| | - I Campos-Varela
- Department of Rehabilitation, Hospital Universitari Bellvitge, Idibell, Universitat de Barcelona, Barcelona, Spain
| | - M Jaraba-Armas
- Department of Rehabilitation, Hospital Universitari Bellvitge, Idibell, Universitat de Barcelona, Barcelona, Spain
| | - A Benítez-Segura
- Department of Nuclear Medicine, Multidisciplinary Breast Cancer Unit, Hospital Universitari Bellvitge, Idibell, Barcelona, Spain
| | - M Campos-Delgado
- Department of Gynecology, Multidisciplinary Breast Cancer Unit, Hospital Universitari Bellvitge, Idibell, Universitat de Barcelona, Barcelona, Spain
| | - M E Fernández-Montolí
- Department of Gynecology, Multidisciplinary Breast Cancer Unit, Hospital Universitari Bellvitge, Idibell, Universitat de Barcelona, Barcelona, Spain
| | - Y Valverde-Alcántara
- Department of Cancer Prevencion and Control, Institut Català d'Oncología, Barcelona, Spain
| | - A Rodríguez
- Breast Functional Unit, Institut Català d'Oncología, Barcelona, Spain
| | - G Campos
- Breast Functional Unit, Institut Català d'Oncología, Barcelona, Spain
| | - A Guma
- Department of Radiology, Hospital Universitari Bellvitge, Idibell, Universitat de Barcelona, Barcelona, Spain
| | - J Ponce-Sebastià
- Department of Gynecology, Multidisciplinary Breast Cancer Unit, Hospital Universitari Bellvitge, Idibell, Universitat de Barcelona, Barcelona, Spain
| | - R Planas-Balagué
- Department of Rehabilitation, Hospital Universitari Bellvitge, Idibell, Universitat de Barcelona, Barcelona, Spain
| | - M Catasús-Clavé
- Department of Rehabilitation, Hospital Universitari Bellvitge, Idibell, Universitat de Barcelona, Barcelona, Spain
| | - A García-Tejedor
- Department of Gynecology, Multidisciplinary Breast Cancer Unit, Hospital Universitari Bellvitge, Idibell, Universitat de Barcelona, Barcelona, Spain
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Gasparri ML, Kuehn T, Ruscito I, Zuber V, Di Micco R, Galiano I, Navarro Quinones SC, Santurro L, Di Vittorio F, Meani F, Bassi V, Ditsch N, Mueller MD, Bellati F, Caserta D, Papadia A, Gentilini OD. Fibrin Sealants and Axillary Lymphatic Morbidity: A Systematic Review and Meta-Analysis of 23 Clinical Randomized Trials. Cancers (Basel) 2021; 13:cancers13092056. [PMID: 33923153 PMCID: PMC8123055 DOI: 10.3390/cancers13092056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 04/11/2021] [Accepted: 04/21/2021] [Indexed: 11/18/2022] Open
Abstract
Simple Summary Axillary dissection is a highly mobile procedure with severe lymphatic consequences. The off-label application of fibrin sealants in the axilla, with the sole aim to eliminate dead space and to provoke sealing of the disrupted lymphatic vessels at the end of axillary dissection, is an experimental procedure to reduce lymphatic morbidity. The aim of our systematic review and meta-analysis is to investigate the effects of fibrin sealants on lymphatic morbidity after axillary dissection. Our results show that this experimental procedure is able to decrease the total axillary drainage output, the number of days before the axillary drainage is removed, and the length of hospital stay. However, no effects on the occurrence rate of axillary lymphocele or on the surgical site complications rate were demonstrated Abstract Background: use of fibrin sealants following pelvic, paraaortic, and inguinal lymphadenectomy may reduce lymphatic morbidity. The aim of this meta-analysis is to evaluate if this finding applies to the axillary lymphadenectomy. Methods: randomized trials evaluating the efficacy of fibrin sealants in reducing axillary lymphatic complications were included. Lymphocele, drainage output, surgical-site complications, and hospital stay were considered as outcomes. Results: twenty-three randomized studies, including patients undergoing axillary lymphadenectomy for breast cancer, melanoma, and Hodgkin’s disease, were included. Fibrin sealants did not affect axillary lymphocele incidence nor the surgical site complications. Drainage output, days with drainage, and hospital stay were reduced when fibrin sealants were applied (p < 0.0001, p < 0.005, p = 0.008). Conclusion: fibrin sealants after axillary dissection reduce the total axillary drainage output, the duration of drainage, and the hospital stay. No effects on the incidence of postoperative lymphocele and surgical site complications rate are found.
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Affiliation(s)
- Maria Luisa Gasparri
- Department of Gynecology and Obstetrics, Ospedale Regionale di Lugano EOC, via Tesserete 46, 6900 Lugano, Switzerland; (M.L.G.); (F.M.); (V.B.)
- Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), via Giuseppe Buffi 13, 6900 Lugano, Switzerland
| | - Thorsten Kuehn
- Interdisciplinary Breast Center, Department of Gynecology and Obstetrics, Klinikum Esslingen, 73730 Neckar, Germany;
| | - Ilary Ruscito
- Gynecology Division, Department of Medical and Surgical Sciences and Translational Medicine, Sant’Andrea University Hospital, Sapienza University of Rome, via di Grottarossa 1035, 00189 Rome, Italy; (I.R.); (F.B.); (D.C.)
| | - Veronica Zuber
- Breast Surgery Unit, Department of Surgery, San Raffaele University Hospital, via Olgettina 60, 20132 Milan, Italy; (V.Z.); (R.D.M.); (I.G.); (L.S.); (F.D.V.); (O.D.G.)
| | - Rosa Di Micco
- Breast Surgery Unit, Department of Surgery, San Raffaele University Hospital, via Olgettina 60, 20132 Milan, Italy; (V.Z.); (R.D.M.); (I.G.); (L.S.); (F.D.V.); (O.D.G.)
- Department of Clinical Medicine and Surgery, University of Naples Federico II, 80138 Naples, Italy
| | - Ilaria Galiano
- Breast Surgery Unit, Department of Surgery, San Raffaele University Hospital, via Olgettina 60, 20132 Milan, Italy; (V.Z.); (R.D.M.); (I.G.); (L.S.); (F.D.V.); (O.D.G.)
| | | | - Letizia Santurro
- Breast Surgery Unit, Department of Surgery, San Raffaele University Hospital, via Olgettina 60, 20132 Milan, Italy; (V.Z.); (R.D.M.); (I.G.); (L.S.); (F.D.V.); (O.D.G.)
| | - Francesca Di Vittorio
- Breast Surgery Unit, Department of Surgery, San Raffaele University Hospital, via Olgettina 60, 20132 Milan, Italy; (V.Z.); (R.D.M.); (I.G.); (L.S.); (F.D.V.); (O.D.G.)
| | - Francesco Meani
- Department of Gynecology and Obstetrics, Ospedale Regionale di Lugano EOC, via Tesserete 46, 6900 Lugano, Switzerland; (M.L.G.); (F.M.); (V.B.)
| | - Valerio Bassi
- Department of Gynecology and Obstetrics, Ospedale Regionale di Lugano EOC, via Tesserete 46, 6900 Lugano, Switzerland; (M.L.G.); (F.M.); (V.B.)
| | - Nina Ditsch
- Department of Gynecology and Obstetrics, University Hospital of Augsburg, Stenglinstraße 2, 86156 Augsburg, Germany;
| | - Michael D. Mueller
- Department of Obstetrics and Gynecology, University Hospital of Bern, Friedbühlstrasse 19, 3010 Bern, Switzerland;
| | - Filippo Bellati
- Gynecology Division, Department of Medical and Surgical Sciences and Translational Medicine, Sant’Andrea University Hospital, Sapienza University of Rome, via di Grottarossa 1035, 00189 Rome, Italy; (I.R.); (F.B.); (D.C.)
| | - Donatella Caserta
- Gynecology Division, Department of Medical and Surgical Sciences and Translational Medicine, Sant’Andrea University Hospital, Sapienza University of Rome, via di Grottarossa 1035, 00189 Rome, Italy; (I.R.); (F.B.); (D.C.)
| | - Andrea Papadia
- Department of Gynecology and Obstetrics, Ospedale Regionale di Lugano EOC, via Tesserete 46, 6900 Lugano, Switzerland; (M.L.G.); (F.M.); (V.B.)
- Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), via Giuseppe Buffi 13, 6900 Lugano, Switzerland
- Correspondence:
| | - Oreste D. Gentilini
- Breast Surgery Unit, Department of Surgery, San Raffaele University Hospital, via Olgettina 60, 20132 Milan, Italy; (V.Z.); (R.D.M.); (I.G.); (L.S.); (F.D.V.); (O.D.G.)
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Peña KB, Kepa A, Cochs A, Riu F, Parada D, Gumà J. Total Tumor Load of mRNA Cytokeratin 19 in the Sentinel Lymph Node as a Predictive Value of Axillary Lymphadenectomy in Patients with Neoadjuvant Breast Cancer. Genes (Basel) 2021; 12:genes12010077. [PMID: 33435629 PMCID: PMC7826715 DOI: 10.3390/genes12010077] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 01/06/2021] [Accepted: 01/06/2021] [Indexed: 02/07/2023] Open
Abstract
Although sentinel lymph node biopsy (SLNB) has proved to be able to diagnose axillary lymph node status safely and reliably, there is still not enough evidence to suggest that it can be used in patients who have undergone neoadjuvant chemotherapy (NAC) for lymph node-sparing surgery. The present study used molecular approaches to determine whether SLNB can be reliably used in patients who have been treated with NAC before SLN surgery, and whether the total tumor load of the SLN can be used as a predictive factor in axillary lymphadenectomy (ALD). We used one-step nucleic acid amplification (OSNA) to analyze a total of 111 consecutive patients who presented operable invasive breast carcinomas and who had been treated with NAC. SLN was positive in 55 patients and the identification rate was 100%. In 9 of these 55 patients, ALD showed that other lymph nodes were also involved. In all of the other 46 patients, the only lymph node to be identified as positive was SLN. Metastasis was not found in any of the axillary lymph nodes in the isolated tumor cell group. The total tumor load, defined as the amount of cytokeratin 19 mRNA copy numbers in all positives SLN (copies/µL), showed three risk groups related to the possibility of positive non-sentinel nodes. OSNA is a diagnostic technique that is highly sensitive, specific, and reproducible and it can be used to analyze sentinel lymph nodes after NAC. Total tumor load may be able to help predict additional metastases in axillary lymphadenectomy.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Axilla
- Biomarkers, Tumor/analysis
- Biomarkers, Tumor/genetics
- Breast/pathology
- Breast/surgery
- Breast Neoplasms/pathology
- Breast Neoplasms/therapy
- Carcinoma, Ductal, Breast/diagnosis
- Carcinoma, Ductal, Breast/secondary
- Carcinoma, Ductal, Breast/therapy
- Female
- Humans
- Keratin-19/analysis
- Keratin-19/genetics
- Lymph Node Excision/statistics & numerical data
- Lymphatic Metastasis/diagnosis
- Lymphatic Metastasis/pathology
- Lymphatic Metastasis/therapy
- Mastectomy
- Middle Aged
- Neoadjuvant Therapy
- Predictive Value of Tests
- Prospective Studies
- RNA, Messenger/analysis
- Sentinel Lymph Node/pathology
- Sentinel Lymph Node/surgery
- Sentinel Lymph Node Biopsy
- Tumor Burden/genetics
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Affiliation(s)
- Karla B. Peña
- Department of Pathology, Hospital Universitari de Sant Joan, Institut d’Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, 43204 Reus, Spain; (K.B.P.); (F.R.)
| | - Amillano Kepa
- Department of Oncology, Hospital Universitari de Sant Joan, Institut d’Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, 43204 Reus, Spain; (A.K.); (A.C.)
| | - Alba Cochs
- Department of Oncology, Hospital Universitari de Sant Joan, Institut d’Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, 43204 Reus, Spain; (A.K.); (A.C.)
| | - Francesc Riu
- Department of Pathology, Hospital Universitari de Sant Joan, Institut d’Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, 43204 Reus, Spain; (K.B.P.); (F.R.)
| | - David Parada
- Department of Pathology, Hospital Universitari de Sant Joan, Institut d’Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, 43204 Reus, Spain; (K.B.P.); (F.R.)
- Correspondence: (D.P.); (J.G.)
| | - Josep Gumà
- Department of Oncology, Hospital Universitari de Sant Joan, Institut d’Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, 43204 Reus, Spain; (A.K.); (A.C.)
- Correspondence: (D.P.); (J.G.)
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Navarro AS, Ciurcur E, Gangloff D, Jouve E, Lusque A, Meresse T. Axillary node dissection in outpatient procedure, is it feasible and safe? J Gynecol Obstet Hum Reprod 2020; 50:101931. [PMID: 33022447 DOI: 10.1016/j.jogoh.2020.101931] [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: 04/26/2020] [Revised: 07/30/2020] [Accepted: 09/30/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Outpatient procedure in cancer surgery is one of the tracks to guarantee the quality of care respecting the delay of support. The aim of this study was to assess the feasibility and safety of outpatients with axillary lymphadenectomy and the postoperative morbidity after outpatient's procedures compared to patients with classic hospitalization. METHODS Patients who underwent axillary lymphadenectomy for breast cancer or melanoma were analyzed. We selected patients having axillary lymphadenectomy only or associated with another operative act compatible with outpatient's procedure (partial mastectomy, lumpectomy or skin excisions). RESULTS Three hundred and forty-nine patients were included. Outpatient procedures were performed in 142 patients (40.7%) and inpatient procedures were performed in 207 patients (59.3%). All time complications combined, we found 148 patients with at least one complication: 77 patients (52.0%) and 71 patients (48.0%) in outpatient and inpatient group, respectively (p=0.0002). The main complication was seroma formation, it concerned 104 patients Among them, Seroma formation was more frequent in ambulatory group, 60 patients (57.7%) and 44 patients (42.3%) in traditional hospitalization (p<0.0001) but 58.7% (61/104) needed only one aspiration and all complications were managed in outpatient. CONCLUSION Complications (mostly seroma) appeared usually after hospitalization discharge and they were known and simple to take in charge. A precise preoperative information concerning post-operative morbidity, specially seroma allows a better comprehension and acceptation of this side effect. We believe that this surgery is feasible and safe in outpatient procedure.
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Affiliation(s)
| | | | | | - Eva Jouve
- Institut Claudius Regaud, IUCT-Oncopole, Toulouse, France.
| | - Amélie Lusque
- Institut Claudius Regaud, IUCT-Oncopole, Toulouse, France.
| | - Thomas Meresse
- Institut Claudius Regaud, IUCT-Oncopole, Toulouse, France.
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7
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Głowacka-Mrotek I, Tarkowska M, Nowikiewicz T, Siedlecki Z, Zegarski W, Hagner W. Evaluation of distant sequelae of breast cancer treatment among patients after breast-conserving surgery depending on the type of intervention in the axillary fossa. Contemp Oncol (Pozn) 2018; 22:240-6. [PMID: 30783388 DOI: 10.5114/wo.2018.82643] [Citation(s) in RCA: 3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 11/15/2018] [Indexed: 11/17/2022] Open
Abstract
Aim of the study The goal of this work was to assess upper-limb sequelae among patients undergoing breast-conserving therapy (BCT) for breast cancer 5-6 years after the surgical procedure. Material and methods A controlled clinical study was conducted on 128 patients who had undergone surgery 5-6 years prior. BCT + ALND (axillary lymph node dissection) was performed in 58 patients and 69 underwent BCT + SLND (sentinel lymph node dissection). Patients declared active participation in physiotherapy. The following parameters were assessed in studied subjects: range of motion in the shoulder joint, superficial sensation, upper limb circumference, skin sensation, and presence of winged scapula sign. Results Five to six years after BCT, patients who had undergone BCT + ALND presented with significantly poorer outcomes concerning upper limb range of motion on the operated side compared to the BCT + SLND group with regard to the following features: flexion (p = 0.00004), external rotation (p = 0.0292), and internal rotation (p = 0.0448). However, no statistically significant differences were noted between compared groups with regard to upper limb circumference and sensation disturbances. Statistically significant differences between limb on the operated side (operated limb - OL) vs. contralateral limb (healthy limb - HL) were noted in the BCT + SLND group with regard to the range of motion in extension (p = 0.0004), external rotation (p = 0.0055), and internal rotation (p < 0.0001), as well as the occurrence of winged scapula sign (p < 0.0001) and sensation disturbances (p < 0.0001). Conclusions Our study demonstrated that both procedures are not free of distant sequelae, although the BCT + ALND group is more frequently affected.
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Koehler LA, Haddad TC, Hunter DW, Tuttle TM. Axillary web syndrome following breast cancer surgery: symptoms, complications, and management strategies. Breast Cancer (Dove Med Press) 2018; 11:13-19. [PMID: 30588087 PMCID: PMC6304256 DOI: 10.2147/bctt.s146635] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [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] [Indexed: 11/23/2022]
Abstract
Axillary web syndrome (AWS) is a common condition occurring in up to 86% of patients following breast cancer surgery with ipsilateral lymphadenectomy of one or more nodes. AWS presents as a single cord or multiple thin cords in the subcutaneous tissues of the ipsilateral axilla. The cords may extend variable distances "down" the ipsilateral arm and/or chest wall. The cords frequently result in painful shoulder abduction and limited shoulder range of motion. AWS most frequently becomes symptomatic between 2 and 8 weeks postoperatively but can also develop and recur months to years after surgery. Education about and increased awareness of AWS should be promoted for patients and caregivers. Assessments for AWS should be performed on a regular basis following breast cancer surgery especially if there has been associated lymphadenectomy. Physical therapy, which consists of manual therapy, exercise, education, and other rehabilitation modalities to improve range of motion and decrease pain, is recommended in the treatment of AWS.
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Affiliation(s)
- L A Koehler
- Division of Physical Therapy,
- Division of Rehabilitation Medicine, Department of Rehabilitation Medicine, Medical School, University of Minnesota, Minneapolis, MN, USA,
- University of Minnesota, Masonic Cancer Center, Minneapolis, MN, USA,
| | - T C Haddad
- Mayo Clinic, Division of Medical Oncology, Department of Oncology, Rochester, MN, USA
| | - D W Hunter
- Department of Radiology, Medical School, University of Minnesota, Minneapolis, MN, USA
| | - T M Tuttle
- University of Minnesota, Masonic Cancer Center, Minneapolis, MN, USA,
- Department of Surgery, Medical School, University of Minnesota, Minneapolis, MN, USA
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Piñero-Madrona A, Castellanos-Escrig G, Abrisqueta-Carrión J, Canteras-Jordana M. Prospective randomized controlled study to assess the value of a hemostatic and sealing agent for preventing seroma after axillary lymphadenectomy. J Surg Oncol 2016; 114:423-7. [PMID: 27338717 DOI: 10.1002/jso.24344] [Citation(s) in RCA: 7] [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] [Received: 05/12/2016] [Accepted: 06/14/2016] [Indexed: 11/10/2022]
Abstract
BACKGROUND AND OBJECTIVES Postoperative seroma after axillary lymphadenectomy leads to an increased use of resources and an impaired quality of life of patients. This randomized clinical trial was designed to assess the value of a hemostatic and sealing agent for decreasing seroma occurrence after axillary lymphadenectomy. METHODS A prospective, randomized, blind study was conducted on 91 axillary lymphadenectomies distributed into a control group (n = 47) and a test group in which a collagen sponge coated with human coagulation factors was used (n = 44). Primary end-points were number of days before removal of axillary drainage, axillary drainage output, and occurrence of seroma, wound infection, haematoma, or wound dehiscence, within 8 weeks of surgery. Bivariate and multivariate analyses on seroma occurrence were performed. RESULTS Seroma occurred in 29 patients (31.86%). A significant direct relationship (P = 0.002) was only noted between use of the hemostatic and sealing agent and nonoccurrence of seroma. In the multivariate study, the only variable found to be significantly related to seroma occurrence was use of the above agent (P = 0.046; odds ratio: 3.365 [95%CI: 1.024-11.060]). CONCLUSIONS Use of a collagen sponge coated with human coagulation factors following axillary lymphadenectomy was associated to a lower incidence of postoperative seroma. J. Surg. Oncol. 2016;114:423-427. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Antonio Piñero-Madrona
- Department of General Surgery, "Virgen de la Arrixaca" University Hospital, Murcia, Spain
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Plesca M, Bordea C, El Houcheimi B, Ichim E, Blidaru A. Modulating the extension of axillary lymphadenectomy for early stage breast cancer. J Med Life 2016; 9:52-55. [PMID: 27974914 PMCID: PMC5152599] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Axillary lymph node evaluation remains essential in breast cancer surgery, first as a prognostic factor, because it indicates the degree of dissemination of the disease to the main lymphatic drainage basin of the breast, and, on the other hand, as an element of preventing the local relapse. In the era of the sentinel lymph node, complete axillary lymphadenectomy, considered valuable until recently, but as therapeutic and diagnostic, has become an intervention performed increasingly rare in selected cases. Axillary lymphatic tissue resections are accompanied by morbidity (lymphedema, paresthesia, limitations of arm movement) and symptom magnitude is proportional to the extension of the intervention. For this reason, a solution to avoid these kinds of complications was looked for. Since Gould, in 1960, who mentioned cancer parotid and continuing with Cabanas, Morton, or Veronesi, many surgeons have contributed to the development of safe techniques with which the multidisciplinary team involved in the surgical treatment for breast cancer could perform a safe oncological intervention and at the same time could conserve the healthy tissue, thus limiting morbidity. To achieve this standard, axillary lymphadenectomy has passed through several stages, from over radical interventions that followed the Halsted era, in which, besides axillary lymph nodes, the internal mammary and jugulo-carotidian lymph nodes were excised, to the absence of axillary surgery and replacing it with radiation therapy.
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Affiliation(s)
- M Plesca
- 2nd Department Surgical Oncology, “Prof. Dr. Alexandru Trestioreanu” Oncology Institute, Bucharest, Romania
| | - C Bordea
- 2nd Department Surgical Oncology, “Prof. Dr. Alexandru Trestioreanu” Oncology Institute, Bucharest, Romania
| | - B El Houcheimi
- 2nd Department Surgical Oncology, “Prof. Dr. Alexandru Trestioreanu” Oncology Institute, Bucharest, Romania
| | - E Ichim
- 2nd Department Surgical Oncology, “Prof. Dr. Alexandru Trestioreanu” Oncology Institute, Bucharest, Romania
| | - A Blidaru
- 2nd Department Surgical Oncology, “Prof. Dr. Alexandru Trestioreanu” Oncology Institute, Bucharest, Romania
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Abstract
The presence of axillary nodal metastases has a significant impact on locoregional and systemic treatment decisions. Historically, all node-positive patients underwent complete axillary lymph node dissection; however, this paradigm has changed over the last 10 years. The use of sentinel lymph node dissection has expanded from its initial role as a surgical staging procedure in clinically node-negative patients. Clinically node-negative patients with small volume disease found on sentinel lymph node dissection now commonly avoid more extensive axillary surgery. There is interest in expanding this role to node-positive patients who receive neoadjuvant chemotherapy as a way to restage the axilla in hopes of sparing women who convert to node-negative status from the morbidity of complete nodal clearance. While sentinel lymph node dissection alone may not accomplish this goal, there are novel techniques, such as targeted axillary dissection, that may now allow for reliable nodal staging after chemotherapy.
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Affiliation(s)
- Abigail S Caudle
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit1484, Houston, TX, 77230-1402, USA.
| | - Henry M Kuerer
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit1484, Houston, TX, 77230-1402, USA.
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12
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Mastrella ADS, Freitas-Junior R, Paulinelli RR, Soares LR. Incidence and risk factors for winged scapula after surgical treatment for breast cancer. J Clin Nurs 2013; 23:2525-31. [PMID: 24372657 DOI: 10.1111/jocn.12443] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2013] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To evaluate the incidence of winged scapula following surgical breast cancer treatment, determine its evolution over time and correlate factors that might influence this incidence. BACKGROUND Winged scapula is a complication that may occur as a result of exposing the long thoracic nerve during axillary lymphadenectomy for the treatment for breast cancer. There is no consensus in the literature about the incidence of this complication after surgical treatment for breast cancer, and complication rates range from 1·5-74%. DESIGN This is a prospective cohort study. METHODS A prospective cohort study was conducted including 57 patients with breast cancer who underwent surgical treatment. Each patient was assessed before and after the surgery, by means of Hoppenfeld manoeuvre. The incidence rate of winged scapula was calculated at four different times. RESULTS At the preoperative assessment, none of the patients presented with winged scapula, while 16 patients (28·1%) were shown to have this complication after the procedure. The incidence of winged scapula decreased over time. Factors associated with winged scapula were as follows: patients younger than 50 years, clinical stage I and II and no neoadjuvant chemotherapy. Other factors that were evaluated, such as type of surgery, number of lymph nodes compromised and removed, as well as body mass index, were not associated with the risk of winged scapula. CONCLUSIONS This study demonstrated that the incidence of winged scapula is low and decreased over time. Furthermore, a greater incidence of winged scapula was noted in young women at an initial stage of the disease who had not been treated with neoadjuvant chemotherapy. RELEVANCE TO CLINICAL PRACTICE The result of this work may have great impact, for demonstrating what risk factors are significantly associated with winged scapula after surgical treatment for breast cancer.
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Affiliation(s)
- Adriana de S Mastrella
- Mastology Program, Hospital das Clinicas of the Federal University of Goiás, Goiânia, Brazil
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Classe JM, Baffert S, Sigal-Zafrani B, Fall M, Rousseau C, Alran S, Rouanet P, Belichard C, Mignotte H, Ferron G, Marchal F, Giard S, Tunon de Lara C, Le Bouedec G, Cuisenier J, Werner R, Raoust I, Rodier JF, Laki F, Colombo PE, Lasry S, Faure C, Charitansky H, Olivier JB, Chauvet MP, Bussières E, Gimbergues P, Flipo B, Houvenaeghel G, Dravet F, Livartowski A. Cost comparison of axillary sentinel lymph node detection and axillary lymphadenectomy in early breast cancer. A national study based on a prospective multi-institutional series of 985 patients 'on behalf of the Group of Surgeons from the French Unicancer Federation'. Ann Oncol 2012; 23:1170-1177. [PMID: 21896543 PMCID: PMC3335244 DOI: 10.1093/annonc/mdr355] [Citation(s) in RCA: 18] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2011] [Revised: 05/11/2011] [Accepted: 06/20/2011] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Our objective was to assess the global cost of the sentinel lymph node detection [axillary sentinel lymph node detection (ASLND)] compared with standard axillary lymphadenectomy [axillary lymph node dissection (ALND)] for early breast cancer patients. PATIENTS AND METHODS We conducted a prospective, multi-institutional, observational, cost comparative analysis. Cost calculations were realized with the micro-costing method from the diagnosis until 1 month after the last surgery. RESULTS Eight hundred and thirty nine patients were included in the ASLND group and 146 in the ALND group. The cost generated for a patient with an ASLND, with one preoperative scintigraphy, a combined method for sentinel node detection, an intraoperative pathological analysis without lymphadenectomy, was lower than the cost generated for a patient with lymphadenectomy [€ 2947 (σ = 580) versus € 3331 (σ = 902); P = 0.0001]. CONCLUSION ASLND, involving expensive techniques, was finally less expensive than ALND. The length of hospital stay was the cost driver of these procedures. The current observational study points the heterogeneous practices for this validated and largely diffused technique. Several technical choices have an impact on the cost of ASLND, as intraoperative analysis allowing to reduce rehospitalization rate for secondary lymphadenectomy or preoperative scintigraphy, suggesting possible savings on hospital resources.
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Affiliation(s)
- J M Classe
- Surgical Department, Institut de Cancérologie de l'Ouest-Center Gauducheau, Nantes.
| | - S Baffert
- Medico economic unit, Institut Curie, Paris
| | | | - M Fall
- Medico economic unit, Institut Curie, Paris
| | - C Rousseau
- Nuclear medicine Department, Institut de Cancérologie de l'Ouest-Center Gauducheau, Nantes
| | - S Alran
- Surgical Department, Institut Curie, Paris
| | - P Rouanet
- Surgical Department, Center Val d'Aurel Montpellier
| | - C Belichard
- Surgical Department, Center René Huguenin, Saint Cloud
| | - H Mignotte
- Surgical Department, Center Léon Bérard, Lyon
| | - G Ferron
- Surgical Department, Institut Claudius Regaud, Toulouse
| | - F Marchal
- Surgical Department, Center Alexis Vautrin, Nancy
| | - S Giard
- Surgical Department, Center Oscar Lambret, Lille
| | | | - G Le Bouedec
- Surgical Department, Center Jean Perrin, Clermont Ferrand
| | - J Cuisenier
- Surgical Department, Center Georges François Leclerc, Dijon
| | - R Werner
- Surgical Department, Center Jean Godinot, Reims
| | - I Raoust
- Surgical Department, Center Georges Lacassagne, Nice
| | - J-F Rodier
- Surgical Department, Center Paul Strauss, Strasbourg
| | - F Laki
- Medico economic unit, Institut Curie, Paris; Surgical Department, Institut Curie, Paris
| | - P-E Colombo
- Surgical Department, Center Val d'Aurel Montpellier
| | - S Lasry
- Surgical Department, Center René Huguenin, Saint Cloud
| | - C Faure
- Surgical Department, Center Léon Bérard, Lyon
| | - H Charitansky
- Surgical Department, Institut Claudius Regaud, Toulouse
| | - J-B Olivier
- Surgical Department, Center Alexis Vautrin, Nancy
| | - M-P Chauvet
- Surgical Department, Center Oscar Lambret, Lille
| | - E Bussières
- Surgical Department, Center Bergonié, Bordeaux
| | - P Gimbergues
- Surgical Department, Center Jean Perrin, Clermont Ferrand
| | - B Flipo
- Surgical Department, Center Georges Lacassagne, Nice
| | - G Houvenaeghel
- Surgical Department, Institut Paoli Calmette Marseille, France
| | - F Dravet
- Surgical Department, Institut de Cancérologie de l'Ouest-Center Gauducheau, Nantes
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