Table of Contents
1
UI - 11967684
AU - Tagaya N; Kubota K
TI -
Experience with endoscopic axillary lymphadenectomy using needlescopic
instruments in patients with breast cancer: a preliminary report.
SO - Surg Endosc 2002 Feb;16(2):307-9
AD - Second Department of Surgery, Dokkyo University School of Medicine, 880
Kitakobayshi, Mibu, Tochigi 321-0293, Japan. tagaya@dokkyomed.ac.jp
BACKGROUND: The purpose of this study was to evaluate the safety and
efficacy of endoscopic axillary lymphadenectomy using needlescopic
instruments in patients with breast cancer. METHODS: Five patients with
breast cancer were treated by partial mastectomy and endoscopic axillary
lymphadenectomy. We evaluated the results of the surgical procedure and
the postoperative course. RESULTS: In all the patients, endoscopic
axillary lymphadenectomy was performed successfully. The mean duration
of the operation was 105.4 min, the mean blood loss 19.4 ml, and the
mean number of dissected axillary lymph nodes 13. There were no intra-
or postoperative complications. The mean amount of lymphorrhea was 131.2
ml, and the mean duration of drainage was 3.6 days. No postoperative
analgesics were administered. CONCLUSIONS: Endoscopic axillary
lymphadenectomy can be performed safely with needlescopic instruments,
but further study is needed to establish this technique.
2
UI - 11884042
AU - Ahlgren J; Holmberg L; Bergh J; Liljegren G
TI -
Five-node biopsy of the axilla: an alternative to axillary dissection of
levels I-II in operable breast cancer.
SO - Eur J Surg Oncol 2002 Mar;28(2):97-102
AD - Department of Oncology, University Hospital, Uppsala, S-751 85, Sweden.
BACKGROUND: Axillary clearance of patients with early breast cancer is
accompanied by a high risk of arm morbidity. Less invasive ways to
establish the axillary nodal status are therefore of interest,
especially in women with low risk of nodal metastases. METHODS: Four
hundred and fifteen breast cancer patients (clinical stage T(0-3) N(0-1)
M(0)) were operated in the axilla with a five-node biopsy followed in
the same operation by a further dissection of levels I-II of the axilla
in order to evaluate the accuracy of the five-node node biopsy compared
with level I-II dissection. RESULTS: In all patients the sensitivity of
the five-node biopsy was 97.3% with a negative predictive value of 98.5%
and a negative likelihood ratio of 0.027. Among cases detected by
screening (n=204) and those clinically detected (n=197) the sensitivity
of the five-node biopsy was 95.8% and 97.9% respectively, with negative
predictive values of 98.7% and 98.0% and negative likelihood ratios of
0.042 and 0.021 respectively. CONCLUSION: Five-node biopsy of the axilla
has good accuracy for correctly staging the axilla in both clinically
and screening-detected cases. Five-node biopsy is an alternative to
axillary clearance and sentinel node biopsy in patients with operable
breast cancer. Copyright Harcourt Publishers Limited.
3
UI - 11943114
AU - Allweis TM; Boisvert ME; Otero SE; Perry DJ; Dubin NH; Priebat DA
TI -
Immediate reconstruction after mastectomy for breast cancer does not
prolong the time to starting adjuvant chemotherapy.
SO - Am J Surg 2002 Mar;183(3):218-21
AD - Center for Breast Health and the Department of Surgery, Washington
Cancer Institute, Washington, DC, USA.
BACKGROUND: Immediate breast reconstruction is often performed after
mastectomy for breast cancer. There has been concern that this will
result in a delay in initiating chemotherapy and, as a consequence, may
adversely impact survival. In this study we sought to determine whether
immediate breast reconstruction affects the interval between surgery and
adjuvant chemotherapy. METHODS: A single institution retrospective
analysis was made using the institutional tumor registry and chart
reviews. RESULTS: Forty-nine patients were identified who had undergone
mastectomy with immediate reconstruction followed by adjuvant
chemotherapy. They were compared with 308 patients undergoing mastectomy
without reconstruction. Patients who underwent reconstruction were
overall younger (46 versus 55, P <0.001), and had more advanced disease.
The time to chemotherapy was significantly longer in the group receiving
no reconstruction: 53 versus 41 days (P = 0.039). The type of
reconstruction did not affect the time to chemotherapy. CONCLUSIONS:
Immediate reconstruction after mastectomy does not increase the time to
chemotherapy compared with mastectomy alone.
4
UI - 11906388
AU - Chua B; Ung O; Boyages J
TI -
Treatment of the axilla in early breast cancer: past, present and
future.
SO - ANZ J Surg 2001 Dec;71(12):729-36
AD - Department of Radiation Oncology, Westmead Hospital, New South Wales,
Australia.
BACKGROUND: The optimal treatment of the axilla in early breast cancer
is controversial. The present study reviews the pattern and predictors
of regional recurrence (RR) and prognosis after RR in patients with
early breast cancer treated by conservative surgery and radiotherapy (CS
+ RT). Implications of the results on current practice and future
directions are explored. METHODS: Between 1979 and 1994, 1158 patients
with stage I or II breast cancer were treated with CS + RT at Westmead
Hospital. Two groups of patients were compared: 782 patients who
underwent axillary dissection (axillary surgery group) and 229 patients
who received radiotherapy (axillary RT group) as the only axillary
treatment. At least 10 lymph nodes were dissected in 82% of the axillary
surgery group. Of the women in the RT group, 90% received RT to the
axilla and supraclavicular fossa (SCF) only and 10% also received RT to
the internal mammary chain (IMC). RESULTS: With a median follow-up
period of 79 months for the axillary surgery group and 111 months for
the axillary RT group, 27 patients developed a RR (2.8% and 2.2%,
respectively). Seven patients (0.9%) in the axillary surgery group and
three patients (1.3%) in the axillary RT group developed a RR in the
axilla (P, not significant). Of the patients with SCF recurrences, 14
(1.8%) were in the axillary surgery group and one (0.4%) in the axillary
RT group (P, not significant). One patient in the axillary surgery group
developed concurrent axillary and SCF recurrences, while a patient in
the axillary RT group developed an IMC recurrence. Twenty (74%) of the
27 patients with a RR developed a concurrent or subsequent distant
relapse (30% and 44%, respectively). In the pathologically node-positive
patients, the axillary recurrence rate was higher in those who had less
than five nodes removed (17%) than those who had 10 or more nodes
removed (0%; P = 0.01). The SCF recurrence rate was higher in patients
with four or more positive axillary nodes (9.5%) than in those with 0-3
positive nodes (1.5%; P = 0.003). CONCLUSION: Adequate treatment of the
axilla by surgery or RT alone is associated with a low rate of RR. The
incidence of distant relapse was substantial in patients who developed a
RR, which gives emphasis to the importance of optimizing local-regional
control.
5
UI - 11987942
AU - DeBono R; Thompson A; Stevenson JH
TI -
Immediate versus delayed free TRAM breast reconstruction: an analysis of
perioperative factors and complications.
SO - Br J Plast Surg 2002 Mar;55(2):111-6
AD - Department of Plastic Surgery, Ninewells Hospital and Medical School,
Dundee, UK.
Immediate breast reconstruction provides superior psychological benefit
to the patient compared with delayed reconstruction, and has a financial
advantage. Smokers undergoing immediate free TRAM breast reconstruction
have a higher incidence of flap necrosis than smokers undergoing delayed
free TRAM reconstruction. Whereas the differences in psychological
benefit, effects of smoking and cost are well addressed in the
literature, the differences in morbidity between immediate and delayed
free TRAM breast reconstruction are still unknown. Knowledge of any
differences would help to determine the best timing for reconstruction,
and would support surgical decision making and preoperative patient
advice. We present a retrospective review of 105 consecutive free TRAM
breast reconstructions performed in 97 patients (89 unilateral and eight
bilateral reconstructions). There were 48 immediate reconstructions and
57 delayed reconstructions. In the immediate-reconstruction group six
flaps required revision of the anastomosis, and three flaps (6%) were
lost. In the delayed-reconstruction group five flaps required revision
of the anastomosis, and only one flap (2%) could not be salvaged.
Delayed healing of the chest-wall skin flaps only occurred in immediate
reconstructions (16%, P = 0.017). Copyright 2002 The British Association
of Plastic Surgeons.
6
UI - 11884818
AU - Losken A; Elwood ET; Styblo TM; Bostwick J 3rd
TI -
The role of reduction mammaplasty in reconstructing partial mastectomy
defects.
SO - Plast Reconstr Surg 2002 Mar;109(3):968-75; discussion 976-7
AD - Division of Plastic and Reconstructive Surgery, Surgical Oncology
Department, Emory University School of Medicine, 1365B Clifton Road NE,
Atlanta, GA 30322, USA. alosken@emory.edu
The management of breast tumors in women with macromastia can be
challenging. Reconstructive options are limited and breast conservation
therapy is often not indicated or results in poor cosmetic outcomes. The
purpose of this report was to present a series of women with macromastia
who underwent simultaneous reconstruction of a partial mastectomy defect
with bilateral reduction mammaplasty. A retrospective review was
performed and included all women who underwent partial mastectomy with
simultaneous reduction mammaplasty. Data points included patient
demographics, preoperative assessment, operative intervention, adjuvant
treatment, and outcomes. Twenty women were included in the series (mean
age, 43 years; range, 11 to 72 years) with an average body mass index of
32.6 (range, 24.9 to 44.1). Tissue diagnosis was ductal carcinoma (n =
8), ductal carcinoma in situ (n = 6), fibroadenoma (n = 4), and benign
breast tissue (n = 2). The various reduction mammaplasty techniques were
documented with regard to tumor size and location. The superior medial
and inferior pedicles seemed to be the most versatile techniques. One
patient required completion mastectomy with autologous tissue
reconstruction given positive margins. All patients were disease-free at
follow-up (mean, 23 months) and postoperative cancer surveillance was
not impaired by the combined procedures. The versatility of reduction
mammaplasty allows this procedure to be performed in conjunction with
partial mastectomy for any tumor location. Combining these procedures in
patients with macromastia provides numerous therapeutic benefits at low
cost, while reducing breast distortion and preserving symmetry.
7
UI - 11959734
AU - Morris EA; Liberman L; Dershaw DD; Kaplan JB; LaTrenta LR; Abramson AF;
TI -
Ballon DJ
Preoperative MR imaging-guided needle localization of breast lesions.
SO - AJR Am J Roentgenol 2002 May;178(5):1211-20
AD - Breast Imaging Section, Department of Radiology, Memorial
Sloan-Kettering Cancer Center, 1275 York Ave., New York, NY 10021, USA.
OBJECTIVE: MR imaging of the breast can depict cancer that is occult on
mammography and at physical examination. Our study was undertaken to
determine the ease of performance and the outcome of MR imaging-guided
needle localization and surgical excision of breast lesions. MATERIALS
AND METHODS: Retrospective review revealed 101 consecutive breast
lesions that had preoperative MR imaging-guided needle localization with
commercially available equipment, including a 1.5-T magnet with a breast
surface coil, a dedicated biopsy compression device, and MR
imaging-compatible hookwires. Imaging studies and medical records were
reviewed. RESULTS: Histologic findings in these 101 lesions were
carcinoma in 31 (30.7%), high-risk lesions (atypical ductal hyperplasia
or lobular carcinoma in situ) in nine (8.9%), and benign lesions in 61
(60.4%). Fifteen (48.4%) of 31 carcinomas were ductal carcinoma in situ,
and 16 (51.6%) were infiltrating carcinoma (size range, 0.1-2.0 cm;
median, 1.2 cm). Carcinoma was found in 16 (45.7%) of 35 lesions
detected in women with synchronous cancer, 10 (32.3%) of 31 lesions
detected on MR imaging for problem solving, and five (14.3%) of 35
lesions detected on MR screening. The time range to perform MR
imaging-guided localization was 15-59 min (median time, 31 min).
Complications encountered in three cases were retained wire fragments in
two and breakage of the wire tip in one. CONCLUSION: MR imaging-guided
needle localization can be performed quickly and safely with
commercially available equipment. The positive predictive value of MR
imaging-guided needle localization (30.7%) was comparable to that
reported for mammographically guided needle localization and was highest
in women with synchronous breast cancer.
8
UI - 11959735
AU - Wunderbaldinger P; Wolf G; Turetschek K; Helbich TH
TI -
Comparison of sitting versus prone position for stereotactic large-core
breast biopsy in surgically proven lesions.
SO - AJR Am J Roentgenol 2002 May;178(5):1221-5
AD - Department of Radiology, University of Vienna, Austria, Waehringer
Guertel 18-20, A-1090 Vienna, Austria.
OBJECTIVE: Our purpose was to compare the two different body positions
for stereotactic large-core breast biopsy with regard to sensitivity,
specificity, and accuracy, as well as complication rate. SUBJECTS AND
METHODS: Two hundred patients had large-core breast biopsy performed
either in the prone (n = 100) or in the sitting (n = 100) position and
subsequently underwent surgical resection. The histopathologic findings
of large-core breast biopsy and surgery of all 200 patients were
compared; sensitivity, specificity, and accuracy were calculated for
both groups. Biopsy-associated complications were prospectively recorded
for immediate and delayed events and for technical failures in both
groups. RESULTS: Sensitivity (96%), specificity (100%), and accuracy
(98%) were the same for both groups with two false-negative findings in
each group. The two false-negative results in the sitting group were
caused by vasovagal reactions, whereas those in the prone group were
caused by technical failure and uncomfortable biopsy position. More
statistically significant complications (seven vs four, p < 0.001) and
vasovagal reactions (seven vs two, p < 0.0001) were seen in the sitting
group. CONCLUSION: For performance of large-core breast biopsy, both the
prone and sitting positions are reliable and accurate methods. However,
vasovagal reactions that could potentially complicate biopsy were seen
significantly more often in the sitting position.
9
UI - 11162038
AU - Kosir MA; Rymal C; Koppolu P; Hryniuk L; Darga L; Du W; Rice V; Mood D;
TI -
Shakoor S; Wang W; Bedoyan J; Aref A; Biernat L; Northouse L
Surgical outcomes after breast cancer surgery: measuring acute
lymphedema.
SO - J Surg Res 2001 Feb;95(2):147-51
AD - Surgical Section, John D. Dingell VA Medical Center, Detroit, Michigan,
USA. Mary.kosir@med.va.gov
BACKGROUND: Studies of lymphedema have used inconsistent measures and
criteria. The purpose of this pilot study was to measure the onset and
incidence of acute lymphedema in breast cancer survivors using strict
criteria for limb evaluation. MATERIALS AND METHODS: Eligible women were
those undergoing breast cancer surgery that included axillary staging
and/or radiation therapy of the breast. Arm volume, strength, and
flexibility were measured preoperatively and quarterly. Lymphedema was
defined as a greater than 10% increase in limb volume. Additional
strength and flexibility assessments were done at these times. RESULTS:
In 30 evaluable patients, half underwent modified radical mastectomy and
half lumpectomy, with half of the lumpectomy patients undergoing
axillary node staging. Of the 30 patients 27% were Stage 0; the rest
were Stage I (27%), IIA (13%), IIB (23%), and IIIA (7%). One subject was
IIIB postoperatively. There were 2 women with a 10% or greater change in
limb volume; the change was detected in one woman at 3 months (5%
incidence) and in the second woman at 6 months (11% incidence). Both had
undergone mastectomy and axillary dissection and one of these two women
had symptoms of tingling and numbness in the affected arm that began at
3 months. Overall, 35% of the sample experienced symptoms by 3 months,
which included numbness, aching, and tingling of the entire upper
extremity, but without volume changes. The relationship between
undergoing modified radical mastectomy and experiencing symptoms in the
affected limb at 3 months was significant (P = 0.05). CONCLUSIONS: In
this interim report strict methods of measurement and limb volume
comparisons detected acute lymphedema at 3 months in 5% of the sample,
and at 6 months in 11% of the sample. Furthermore, symptoms were
detected in 35% without volume changes at 3 months postoperatively,
which may warn of lymphedema occurrence within the next 3 months. This
may assist clinical evaluation of symptoms in the postoperative period
and support early referral to lymphedema experts. Copyright 2000
Academic Press.
10
UI - 11757297
AU - Khoronenko VE; Osipova NA; Petrova VV; Sergeeva IE; Donskova IuS;
TI -
Zhelezkina NV; Ivanova LM
[General intravenous anesthesia with spontaneous respiration for
noncavitary interventions in cancer]
SO - Anesteziol Reanimatol 2001 Sep-Oct;(5):36-40
Two new variants of total intravenous anesthesia with spontaneous
respiration were used in 307 female patients subjected to noncavitary
interventions for cancer and gynecological cancer. The patients were
divided into 2 groups: 1) total anesthesia with midasolam, fentanyl, and
calipsol and 2) the same + propofol. Preventive analgesia by
preoperative injections of peripheral analgesics was carried out in both
groups. Both methods proved to be effective, ensuring good protection
from traumatic noncavitary oncological operations. Balanced anesthesia
with two hypnotics midasolam and propofol should be preferred, as they
mutually potentiate their effects and therefore can be used in the
minimum doses, thus preventing the probable side effects, minimizing the
use of central analgesics, and ruling out the probability of respiration
depression.
11
UI - 11994589
AU - Kronowitz SJ; Chang DW; Robb GL; Hunt KK; Ames FC; Ross MI; Singletary
TI -
SE; Symmans WF; Kroll SS; Kuerer HM
Implications of axillary sentinel lymph node biopsy in immediate
autologous breast reconstruction.
SO - Plast Reconstr Surg 2002 May;109(6):1888-96
AD - Department of Plastic and Reconstructive Surgery, The University of
Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA.
skronowi@mdanderson.org
For patients with invasive breast cancer, if the results of an axillary
sentinel node biopsy are determined to be positive after permanent
pathologic examination, the current recommendation is to perform a
complete axillary node dissection. Subsequent axillary surgery may
compromise the blood supply to an immediate autologous breast
reconstruction. The purpose of this study was to determine which
clinicopathologic factors in clinically node-negative breast cancer
patients may be associated with an increased risk of positive axillary
nodes. Identification of these factors will allow surgeons to modify
their approach to immediate autologous breast reconstruction in these
high-risk patients. The relationship between presenting
clinicopathologic characteristics and the incidence of axillary
metastases was analyzed by chi-square test and multivariate analysis in
167 patients with invasive breast cancer and a clinically negative
axilla who underwent modified radical mastectomy with an immediate free
transverse rectus abdominis musculocutaneous (TRAM) flap reconstruction.
Axillary nodal metastases were found in 35 percent of clinically
node-negative breast cancer patients. Multivariate analysis showed that
patient age of 50 years or younger (p = 0.019), T2 tumor stage or
greater (p = 0.031), and presence of lymphovascular invasion on the
initial biopsy specimen (p < 0.001) were independent predictors of
axillary metastases in clinically node-negative patients. Based on these
results, the authors propose an algorithm for decision making in
clinically node-negative breast cancer patients who desire autologous
breast reconstruction and sentinel lymph node biopsy. Options for
immediate autologous breast reconstruction in patients undergoing
mastectomy and axillary sentinel lymph node biopsy that may minimize the
risk of vascular damage on reoperation include the use of the internal
mammary artery and vein as recipient vessels for a free TRAM flap or a
pedicled TRAM flap. If an axillary-based blood supply is used, the
authors are considering the use of cadaveric dermis to isolate the
pedicle of the flap away from the remaining axillary contents. New
developments in breast cancer diagnosis and treatment necessitate a team
approach, with increased communication between the breast surgeon and
the plastic surgeon in planning surgery for these patients.
12
UI - 11769957
AU - Singletary SE
TI -
Minimally invasive surgery in breast cancer treatment.
SO - Biomed Pharmacother 2001 Nov;55(9-10):510-4
AD - Department of Surgical Oncology, The University of Texas M. D. Anderson
Cancer Center, Houston 77030-4095, USA. esinglet@mdanderson.org
As genetic and biological treatment modalities are developed that can be
custom-designed for individual patients, the possibility that breast
cancer can be managed as a chronic long-term disease becomes more real,
and the requirement for minimally invasive surgical intervention used as
part of a multidisciplinary treatment approach becomes more pressing.
Rather than fearing that they will be replaced, surgeons should
enthusiastically move into this dynamic phase in the development of new
surgical techniques for the treatment of breast cancer. This article
will discuss such techniques in three evolving areas: 1) management of
the axilla after neoadjuvant chemotherapy; 2) sentinel node dissection;
and 3) radiofrequency ablation of primary tumors of the breast.
13
UI - 11769959
AU - McNeese MD
TI -
Post-mastectomy irradiation: the continuing controversy.
SO - Biomed Pharmacother 2001 Nov;55(9-10):519-23
AD - Breast Radiotherapy Services, M.D. Anderson Cancer Center, Houston, TX
77030, USA. mmcneese@mail.mdanderson.org
14
UI - 11983746
AU - Hortobagyi GN
TI -
The influence of menstrual cycle phase on surgical treatment of primary
breast cancer: have we made any progress over the past 13 years?
SO - J Natl Cancer Inst 2002 May 1;94(9):641-3
15
UI - 11983754
AU - Love RR; Duc NB; Dinh NV; Shen TZ; Havighurst TC; Allred DC; DeMets DL
TI -
Mastectomy and oophorectomy by menstrual cycle phase in women with
operable breast cancer.
SO - J Natl Cancer Inst 2002 May 1;94(9):662-9
AD - Department of Medicine, Section of Medical Oncology, University of
Wisconsin School of Medicine, Madison, 53705, USA.
rrlove@facstaff.wisc.edu
BACKGROUND: It is unclear whether the phase of the menstrual cycle in
which primary surgical treatment occurs influences disease-free survival
(DFS) and overall survival (OS) in premenopausal women with breast
cancer. We investigated this question in the context of a clinical trial
comparing mastectomy alone with mastectomy plus adjuvant oophorectomy
and tamoxifen in premenopausal women with operable breast cancer.
METHODS: The date of the first day of the last menstrual period (LMP)
was used to estimate the phase of the menstrual cycle when the surgeries
were done. Follicular phase was defined as day 1-14 from LMP. Luteal
phase was defined as day 15-42 from LMP. DFS and OS statistics were
determined and analyzed by Cox proportional hazards ratios and
Kaplan-Meier methods. All statistical tests were two-sided. RESULTS: We
analyzed results for 565 women who reported an LMP within 42 days before
surgery. For women in the mastectomy only arm (n = 289), there were no
differences in DFS or OS by menstrual cycle phase. For women in the
adjuvant treatment arm (n = 276), those whose surgery occurred during
the luteal phase (n = 158) had better DFS (relative risk [RR] = 0.54;
95% confidence interval [CI] = 0.32 to 0.96; P =.02) and OS (RR = 0.53;
95% CI = 0.30 to 0.95; P =.03) than those whose surgery occurred during
the follicular phase (n = 118). Moreover, women whose surgery occurred
during the luteal phase and who received adjuvant therapy had better
5-year DFS than did women whose surgery occurred during the follicular
phase (84%; 95% CI = 78% to 90% versus 67%; 95% CI = 58% to 78%; P
=.02); they also had better OS (85%; 95% CI = 78% to 92% versus 75%; 95%
CI = 66% to 84%; P =.03). CONCLUSIONS: The phase of the menstrual cycle
at which surgery was done had no impact on survival for women who
received mastectomy only. However, women who received a mastectomy and
surgical oophorectomy and tamoxifen during the luteal phase had better
outcomes than women who received surgery during the follicular phase.
16
UI - 11981150
AU - Oddby-Muhrbeck E; Eksborg S; Bergendahl HT; Muhrbeck O; Lonnqvist PA
TI -
Effects of clonidine on postoperative nausea and vomiting in breast
cancer surgery.
SO - Anesthesiology 2002 May;96(5):1109-14
AD - Department of Anesthesia and Intensive Care, Karolinska Institutet
Danderyd Hospital, Stockholm, Sweden. eva.oddby@ane.ds.sll.se
BACKGROUND: Postoperative nausea and vomiting (PONV) is still common,
especially among female patients. Our hypothesis is that coinduction
with clonidine reduces the incidence of PONV in adult patients
undergoing breast cancer surgery. METHODS: Sixty-eight women
premedicated with midazolam were randomly allocated to coinduction with
intravenous clonidine (group C) or placebo (group P) in this
prospective, double-blind study. Anesthesia was standardized (laryngeal
mask airway, fentanyl, propofol, sevoflurane, nitrous oxide, and
oxygen). Hemodynamic parameters and the requirements for propofol,
sevoflurane, and the postoperative need for ketobemidone were noted. The
primary endpoints studied were the number of PONV-free patients and
patient satisfaction with respect to PONV. RESULTS: Patients in group C
had a significantly reduced need for propofol (P < 0.04) and sevoflurane
(P < 0.01) and a reduced early need for ketobemidone (P < 0.04). There
were significantly more PONV-free patients in group C compared with
group P (20 and 11 of 30, respectively; P < 0.04). The number needed to
treat was 3.3 (95% confidence interval, 1.8, 16.9). Intraoperative blood
pressure, postoperative heart rate, and postoperative blood pressure
were all significantly lower in group C compared with group P, but were
not considered to be of clinical importance. No negative side effects
were recorded. CONCLUSION: Coinduction with clonidine significantly
increased the number of PONV-free patients after breast cancer surgery
with general anesthesia.
17
UI - 12011912
AU - Baron RH; Fey JV; Raboy S; Thaler HT; Borgen PI; Temple LK; Van Zee KJ
TI -
Eighteen sensations after breast cancer surgery: a comparison of
sentinel lymph node biopsy and axillary lymph node dissection.
SO - Oncol Nurs Forum 2002 May;29(4):651-9
AD - Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York,
NY, USA. baronr@mskcc.org
PURPOSE/OBJECTIVES: To evaluate prevalence, severity, and level of
distress of 18 sensations at 3-15 days (baseline), 3 months, and 6
months after breast cancer surgery; to compare sentinel lymph node
biopsy (SLNB) to SLNB with immediate or delayed axillary lymph node
dissection; to evaluate the Breast Sensation Assessment Scale(c)
(BSAS(c)) for reliability and validity. DESIGN: Prospective,
descriptive. SETTING: Evelyn H. Lauder Ambulatory Breast Center at
Memorial Sloan-Kettering Cancer Center in New York City. SAMPLE: 283
women with breast cancer; 187 had SLNB, and 96 had SLNB and axillary
lymph node dissection. METHODS: Patients completed the BSAS(c) at
baseline, three months, and six months after surgery. MAIN RESEARCH
VARIABLES: Prevalence, severity, and level of distress of sensations in
patients who had breast cancer surgery. FINDINGS: Sensations were less
prevalent, severe, and distressing following SLNB compared with axillary
lymph node dissection at all three time points. Tenderness and soreness
remained highly prevalent following SLNB at the three time points.
Tenderness, soreness, tightness, and numbness were among the most severe
and distressing symptoms in both groups. The BSAS(c) demonstrated good
reliability and validity. CONCLUSIONS: Overall prevalence, severity, and
level of distress were lower following SLNB compared with axillary lymph
node dissection at baseline, three months, and six months after surgery.
Certain sensations remained prevalent, severe, and distressing in both
groups. The BSAS(c) is a reliable and valid instrument. IMPLICATIONS FOR
NURSING: Nurses should be familiar with prevalent sensations patients
experience after SLNB and axillary lymph node dissection so they can
provide education and support.
18
UI - 10787363
AU - Bickell NA; Chassin MR
TI -
Determining the quality of breast cancer care: do tumor registries
measure up?
SO - Ann Intern Med 2000 May 2;132(9):705-10
AD - Mount Sinai School of Medicine, Department of Health Policy, New York,
New York 10029, USA.
BACKGROUND: Hospital tumor registries, which provide data that inform
health services research and cancer control policies, may be a source of
information about quality of cancer care. However, the accuracy of data
from such registries is unknown. OBJECTIVE: To determine the accuracy of
tumor registry data by comparing it with data collected from numerous
sources for a breast cancer quality improvement project. DESIGN:
Retrospective cohort study. SETTING: Three teaching hospitals with tumor
registries in the New York metropolitan area that had participated in
the quality improvement project. PATIENTS: All women with newly
diagnosed primary breast cancer (stage I or stage II) who were
and data from the quality improvement project were used as the gold
standard. RESULTS: The tumor registries and the quality improvement
project had similar information on tumor stage and surgery type.
Sensitivity ranged from 0.91 to 0.96, and specificity ranged from 0.93
to 0.97. When both sources were used to calculate quality measures, the
overall rate of radiation therapy after breast-conserving surgery was
80% in the quality improvement project and 48% in the tumor registries
(sensitivity, 0.58; specificity, 0.94). For receipt of adjuvant systemic
treatment, the rate was 78% in the quality improvement project and 22%
in the tumor registries (sensitivity, 0.27; specificity, 0.97).
CONCLUSIONS: Data from tumor registries provide accurate measures for
hospital-based surgical treatments but not for outpatient treatments.
Unverified tumor registry data should not be used to measure quality of
care.
19
UI - 11767790
AU - Rollins G
TI -
Amid controversy, panel recommends postmastectomy radiation therapy for
breast cancer patients with limited lymph node involvement.
SO - Rep Med Guidel Outcomes Res 2001 Feb 8;12(3):1-2, 5
20
UI - 11905711
AU - Smith I E; Lipton L
TI -
Preoperative/neoadjuvant medical therapy for early breast cancer.
SO - Lancet Oncol 2001 Sep;2(9):561-70
AD - Breast Unit, Royal Marsden NHS Trust, London, UK.
ian.smith@rmh.nthames.nhs.uk
Preoperative (neoadjuvant) medical therapy has emerged over the past
decade as a new approach for the treatment of early breast cancer.
Results show it has high activity, but survival is no better than with
conventional adjuvant treatment. The need for mastectomy is reduced but
not abolished; in some studies this effect is associated with a small
increase in risk of local recurrence, but without any detriment to
survival. Predictive factors for improved outcome include clinical
response, and especially pathological complete remissions. However,
persisting pathological axillary node involvement is associated with
poor outcome. Biological changes in apoptosis or proliferation pathways
may prove to be more sensitive surrogate markers than clinical or
pathological responses for assessing treatment outcome. The main
long-term aim of preoperative medical treatment must be to establish
such surrogate predictive markers. This would lead to individualised
treatment for each patient, and would allow much more rapid assessment
of new drugs than is currently possible with adjuvant therapy trials.
21
UI - 11957585
AU - Rayner C
TI -
Whatever happened to amenity beds?
SO - Nurs Times 2001 Aug 30-Sep 5;97(35):18
22
UI - 11957606
AU - Anonymous
TI -
Cancer services. Breast drain pilot success.
SO - Nurs Times 2001 Aug 30-Sep 5;97(35):7
23
UI - 12004849
AU - Petit JY; Garusi C; Greuse M; Rietiens M; Youssef O; Luini A; De Lorenzi
TI -
F
One hundred and eleven cases of breast conservation treatment with
simultaneous reconstruction at the European Institute of Oncology
(Milan).
SO - Tumori 2002 Jan-Feb;88(1):41-7
AD - Department of Plastic Surgery, European Institute of Oncology, Milan,
Italy. jean.petit@ieo.it
AIMS AND BACKGROUND: Breast conserving treatment (BCT) should provide
similar quality of local control as mastectomy and avoid psychological
distress due to mutilation. Randomized trials have demonstrated the
value of conservative surgery for small tumors. Several publications
have indicated the possibility of improving the cosmetic result when
quadrantectomy is combined with plastic surgery. These papers focused on
two techniques involving reduction mammaplasty and latissimus dorsi flap
procedures. At the European Institute of Oncology (EIO) we use various
plastic procedures to reshape the breast and to improve symmetry. The
choice of these techniques depends on tumor size and location, as well
as on breast volume. METHODS AND STUDY DESIGN: In two years (1995 and
1996) 111 patients were treated at the EIO with quadrantectomy and
concomitant plastic surgery. Preoperative tumor staging was as follows:
T1 57.5%, T2 29%, T3 4.5%, Tis 8%, and sarcoma 1%. The tumor locations
were upper quadrant 50%, lower quadrant 40%, and central quadrant 10%.
The plastic surgery techniques used included local glandular flaps,
areola transposition, mastopexy or classical reduction mastoplasty
procedures, the round block technique, prosthesis insertion, and distal
musculocutaneous flaps. Cosmetic evaluation on the basis of predefined
cosmetic criteria was carried out on photographs after a mean follow-up
of 21 months. In 48 cases the patients' own rating of breast cosmesis
was asked. RESULTS: The global results were good in 77.5%, fair in 17%,
and poor in 5.5% of the patients. No statistical difference was observed
between different tumor locations, although the percentage of good
cosmetic results, which was similar in the upper and lower
quadrantectomy groups, was slightly lower for centrally located tumors.
With regard to the different techniques, we obtained 100% good results
with the round block technique and the Grisotti flap, 87% good results
with the inferior pedicle, 74% good results with the Lejour and superior
pedicle techniques, 67% good results with the latissimus dorsi flap, and
58% good results with prosthetic implants. The outcome was less
satisfactory when no contralateral mastoplasty was performed (14 of the
111 cases): 72% good, 14% fair, and 14% poor results. These differences
were not statistically significant. The median weight of the specimens
was 157 g, which is almost three-fold the usual weight in regular
tumorectomies. Six carcinomas were found in contralateral breasts (4
DCIS and 2 infiltrating). CONCLUSIONS: The double-team approach (plastic
surgeons and oncologists) to BCT may improve the final cosmetic result
following large tumor excisions. It can also extend the indications for
breast preserving surgery. Moreover, it allows surgical and histological
exploration of the contralateral breast when a surgical procedure for
symmetry is required.
24
UI - 11972541
AU - Baildam AD
TI -
Oncoplastic surgery of the breast.
SO - Br J Surg 2002 May;89(5):532-3
AD - Specialist Breast Unit, Withington Hospital, Nell Lane, West Didsbury,
Manchester M20 2LR, UK. aetab@btinternet.com
25
UI - 12007955
AU - Polednak AP
TI -
Trends in, and predictors of, breast-conserving surgery and radiotherapy
for breast cancer in Connecticut, 1988-1997.
SO - Int J Radiat Oncol Biol Phys 2002 May 1;53(1):157-63
AD - Connecticut Tumor Registry, Connecticut Department of Public Health, 410
Capitol Avenue, Hartford, CT 06134-0308, USA.
anthony.polednak@po.state.ct.us
PURPOSE: To describe the trends in, and predictors of, use of
breast-conserving surgery (BCS) vs. mastectomy and use of post-BCS
radiotherapy (RT), from 1988 through 1997 among residents of
Connecticut. METHODS AND MATERIALS: Data on surgical and RT procedures
for 16,676 women diagnosed with early-stage (localized to the breast or
with regional lymph node involvement) invasive breast cancer in
1988-1997 were obtained from the population-based Connecticut Tumor
Registry. RESULTS: Use of BCS (vs. mastectomy) increased over time and
was lower for patients with nodal involvement or larger tumors. The
absence of RT facilities at the hospital of first admission was
negatively associated with BCS but not with post-BCS RT. Post-BCS RT was
low among patients diagnosed at age 80+ years but increased over time
only in this age group. CONCLUSION: Absence of RT at the hospital may be
a deterrent to BCS. The temporal increase in post-BCS RT among patients
diagnosed at age > or =80 years suggests changes in physicians'
attitudes and/or patient preferences that require further study.
26
UI - 11763811
AU - Ismagilov AKh; Sigal EI; Gimranov AM
TI -
[Parasternal lymph node excision in breast cancer]
SO - Khirurgiia (Mosk) 2001;(10):11-6
Comparative analysis of the results of videothoracoscopic parasternal
lymphadenectomy and standard mastectomy by Urban--Holdin is presented.
lymphadenectomies were performed (96--on the left, 104--on the right).
Central and medial location of breast cancer was indication for this
operation. Age of the patients ranged from 23 to 73 years. Surgery was
performed under intravenous anesthesia in the conditions of artificial
lung ventilation with separate lung intubation. Mastectomy was performed
as the first stage. Further, thoracoports were introduced into pleural
cavity in the 5th intercostal space along medioclavicular and
mediaxillar lines and in the 4th intercostal space along anterior
axillar line. Parietal pleurotemy was performed parallely to internal
thoracic vessels, parasternal fat and lymph nodes were removed en-block.
Parasternal lymph nodes were involved in 40 (19.5%) patients. The
spirometry, cardiomonitoring which were used pre-, intra-,
postoperatively demonstrated that parasternal thoracoscopic
lymphadenectomy is less traumatic and effective as diagnostic method
than mastectomy by Urban--Holdin. Parasternal thoracoscopic
lymphadenectomy can be recommended as a method of choice in medial and
central breast cancer.
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