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Abramson Cancer CenterNCI CANCERLIT® Search: Surgery for Breast Cancer - March 2002
National Cancer Institute®
Last Modified: March 1, 2002
Table of Contents
1
UI - 11733225
AU - Singletary SE
TI -
New approaches to surgery for breast cancer.
SO - Endocr Relat Cancer 2001 Dec;8(4):265-86
AD - The University of Texas M D Anderson Cancer Center, Department of
Surgical Oncology, Houston, Texas 77030, USA.
The surgical management of breast cancer is rapidly evolving towards
less invasive procedures. Alternative biopsy techniques, including
fine-needle aspiration and core needle biopsy, are replacing excisional
biopsy as the treatment standard. Breast conservation therapy is now
widely used in place of mastectomy, both for small tumors and for larger
tumors that have been downstaged through induction chemotherapy. Less
invasive procedures for axillary treatment such as lymphatic mapping and
sentinel lymph-node biopsy are being explored in an effort to avoid the
morbidity associated with axillary lymph-node dissection. For women who
still prefer or need to receive a mastectomy, immediate breast
reconstruction with autologous tissue provides an excellent cosmetic
outcome that is oncologically sound. This is especially appealing to
high-risk women who opt to have a prophylactic mastectomy. High-risk
women are also being offered the option of receiving chemopreventive
treatment that may reduce their lifetime risk of cancer by almost 50%.
These new, less invasive approaches require the close cooperation of a
team of physicians,including surgeons, pathologists, radiologists, and
medical and radiation oncologists.
2
UI - 11078501
AU - Krag D; Ashikaga T; Abrams J
TI -
Sentinel nodes: clinical trial data needed.
SO - J Clin Oncol 2000 Nov 15;18(22):3873-4
3
UI - 11544837
AU - Istagilov AKh; Sigal EI; Khamidullin RG; Nagumanov EV; Gubaidullin KhM
TI -
[Diagnosis and treatment of breast cancer with central and medial
localization using video-assisted thoracoscopic parasternal
lymphadenectomy]
SO - Vopr Onkol 2001;47(3):348-55
AD - Clinical Oncological Center, Ministry of Health of the Republic of
Tatarstan, Kazan.
Since extended mastectomy after Urban involves an unjustifiably high
level of trauma, this method has limited application. We have evolved a
procedure of video-assisted thoracoscopic parasternal lymphadenectomy
(VATPL). On completion of the experimental part using cadavers to work
out the rationale for extent of surgery, clinical trials started. A
total of 120 operations in patients aged 27-73 were performed
(left-sided--64, right-sided--56), with the number of lymph nodes
removed in each case ranging 1-10. Metastases were detected in 23
(19.2%), isolated lesions (metastases to parasternal lymph nodes
alone)--6 (5.0%). With volume of removed tissue being identical, the
findings on level of pain, amount of narcotic analgetics, hospital stay
duration, intra- and postoperative complication incidence and
cardiointervalography and pneumotachometry for VATPL patients were
significantly better than for those treated by traditional (open-chest)
procedure. It is concluded that VATPL is a highly effective and
low-traumatizing diagnostic method. It may be recommended as an
operation of choice for parasternal lymph collector involvement of
central or medial localization.
4
UI - 11821832
AU - Kitamura K; Ishida M; Inoue H; Kinoshita J; Hashizume M; Sugimachi K
TI -
Early results of an endoscope-assisted subcutaneous mastectomy and
reconstruction for breast cancer.
SO - Surgery 2002 Jan;131(1 Suppl):S324-9
AD - Department of Surgery and Science, Graduate School of Medical Sciences,
Kyushu University, Fukuoka, Japan.
BACKGROUND: Subcutaneous mastectomy and reconstruction (SMR) is well
established; however, most incisions are made directly on the breast,
and the majority of patients care about visible scars even if they are
breast cancer underwent SMR using a saline-filled prosthesis by lateral
axillary incision. There were 25 patients who received previous SMR
without endoscopic assistance (group A) and 21 patients who underwent an
endoscope-assisted SMR (E-SMR) (group B). These 2 groups were compared
for curability, morbidity, and cosmesis. RESULTS: The median follow-up
period was 19.2 + 9.8 months (range, 5.8 - 35.2 months). No significant
difference was found in clinicopathologic data between the 2 groups. The
operation time was 176 minutes in group A and 237 minutes in group B,
and the estimated blood loss was 189 mL vs 356 mL, respectively. No
critical complications were seen in either group. The average length of
incision was 10 cm in group A and 5.7 cm in group B. As for the
patients' satisfaction, the incidence of "excellent" plus "good" ratings
was 76% in group A and 90.4% in group B. CONCLUSIONS: E-SMR is a new
option that can provide an improved operative view and better cosmetic
results for the treatment of breast cancer than with SMR. The operation
time is longer than for SMR, but the incision is drastically shorter,
resulting in better cosmesis and increased patient satisfaction.
5
UI - 11750836
AU - Petit JY; Greco M; EUSOMA
TI -
Quality control in prophylactic mastectomy for women at high risk of
breast cancer.
SO - Eur J Cancer 2002 Jan;38(1):23-6
AD - Division of Plastic Surgery, European Institute of Oncology, via
Ripamonti 435, Milan, Italy. jean.petit@ieo.it
6
UI - 11856156
AU - Chua B; Ung O; Boyages J
TI -
Competing considerations in regional nodal treatment for early breast
cancer.
SO - Breast J 2002 Jan-Feb;8(1):15-22
AD - Department of Radiation Oncology, Westmead Hospital, Westmead, New South
Wales, Australia.
The purpose of this article was to review the patterns and morbidity of
regional recurrence (RR) in patients with early breast cancer, efficacy
of salvage therapy for RR, and complications of regional nodal
treatment. A retrospective evaluation of 1,158 patients with stage I or
stage II breast cancer treated with conservative surgery and
radiotherapy (RT) between 1979 and 1994 was performed. Seven hundred
fifty patients underwent axillary surgery, and 229 patients received RT
as their only treatment of the regional lymphatics. Regional nodal RT
was given to 168 patients who also had axillary surgery. The regional
lymphatics of 11 patients were not treated. The patterns and morbidity
of RR, relapse management, and complications related to regional nodal
treatment were reviewed from the patients' records. With a median
follow-up of 88 months, a total of 31 patients (2.7%) developed a RR.
Nine of 31 patients (29%) with an RR experienced significant morbidity,
including pain, fungating tumor, dysphagia, dyspnoea, and/or sensory
motor changes at diagnosis. Nineteen patients (61%) had symptomatic
residual or progressive regional disease after salvage therapy at last
follow-up or death. Six of nine patients (67%) who developed an isolated
axillary recurrence and underwent salvage surgery had no further
axillary recurrence. The addition of regional nodal RT to breast
irradiation significantly increased the incidence of symptomatic
pneumonitis (1% without regional nodal RT and 4% with regional nodal RT,
p < 0.001). Combined axillary dissection and nodal irradiation resulted
in a significantly higher incidence of arm edema compared with either
alone (9.5% with axillary dissection, 6.1% with RT to the axilla and
supraclavicular fossa, and 31% with combined modality therapy, p <
0.001). Five of 380 patients (1%) who received RT to the axilla and/or
supraclavicular fossa developed a transient brachial plexus neuropathy.
Although RR was uncommon in patients treated with axillary surgery
and/or regional nodal irradiation, salvage therapy failed to eradicate
the recurrence in approximately two thirds of the patients with a RR.
Ongoing research is essential to optimize regional control with an
acceptable level of risk of treatment complications. Sentinel lymph node
biopsy, if validated as an accurate method of staging the axilla in
patients with breast cancer, would allow selective avoidance of regional
nodal treatment and hence the associated morbidity.
7
UI - 11856158
AU - Lash TL; Silliman RA
TI -
Long-term follow-up of upper-body function among breast cancer
survivors.
SO - Breast J 2002 Jan-Feb;8(1):28-33
AD - Department of Epidemiology and Biostatistics, Boston University School
of Public Health, Geriatrics Section, Boston Medical Center, Boston,
Massachusetts, USA.
We enrolled a cohort of 303 stage I or stage II breast cancer patients
followed the patients by interview and medical record abstract for 5
years (a) to characterize the incidence and predictors of upper-body
function decline and (b) to characterize the incidence and predictors of
recovery of upper-body function. The incidence of decline in the first
year after therapy (17.7/100 person years) was substantially higher than
in the subsequent 4 years of follow-up (11.0/100 person-years, p value
for test of homogeneity equal 0.028). With only one exception, no
patient characteristic, therapy component, or disease trait was
associated with decline over the full follow-up period. Women with less
than a high school education had an adjusted relative hazard of decline
of 2.3 (95% CI, 1.4-3.7) compared with women with a high school
education or more, possibly reflecting occupational or environmental
insults that predispose to functional impairment. Women who had reported
a decline in upper-body function and who subsequently saw their breast
cancer specialist were 4.8-fold more likely to report that they had
recovered their upper-body function at their next interview (95% CI,
2.0, 12). This finding suggests that attention to upper-body function
during follow-up visits may facilitate recovery.
8
UI - 11856161
AU - Naraynsingh V; Maharaj D; Rampaul R
TI -
"Swiss-roll" operation for giant fibroadenomas.
SO - Breast J 2002 Jan-Feb;8(1):45-6
AD - Department of Surgery, University of the West Indies, General Hospital,
Port-of-Spain, Trinidad, West Indies.
Giant fibroadenomas can produce breast deformity and should be excised.
Several techniques have been discussed, including a sub-mammary
incision, which often leave a disfiguring scar. We describe a new
technique for removal of such large masses via a small cosmetic
circumareolar incision.
9
UI - 11856167
AU - Carcoforo P; Basaglia E; Corcione S; Bergossi L; Soliani G; Feggi L
TI -
The main problem in treating nonpalpable breast lesion is the need for
accurate localization during surgery.
SO - Breast J 2002 Jan-Feb;8(1):66-7
10
UI - 11872286
AU - Galper S; Gelman R; Recht A; Silver B; Kohli A; Wong JS; Van Buren T;
TI -
Baldini EH; Harris JR
Second nonbreast malignancies after conservative surgery and radiation
therapy for early-stage breast cancer.
SO - Int J Radiat Oncol Biol Phys 2002 Feb 1;52(2):406-14
AD - Department of Radiation Oncology, Brigham and Women's Hospital and
Dana-Farber Cancer Institute, Boston, MA 02115, USA.
sgalper@partners.org
PURPOSE: Breast cancer patients treated with conservative surgery and
radiation therapy are at risk of developing second nonbreast
malignancies (SNBMs). The purpose of this study was to determine the
incidence of all SNBMs and SNBMs by specific location among long-term
survivors and to compare the risk of these events to the age-specific
incidence of malignancies as first cancers in the Surveillance
Epidemiology and End-Results Program (SEER) population. METHODS AND
MATERIALS: We analyzed the likelihood of SNBM development for 1884
patients with clinical Stage I or II breast cancer treated with gross
excision and > or = 60 Gy (median 63) to the breast between 1970 and
1987. Fifty-seven percent received supraclavicular/axillary radiation
(median dose 45 Gy, range 20-60) and 28% received systemic therapy. The
median age at diagnosis was 52 years. The median clinical tumor size was
2 cm. Patients were considered at risk of an SNBM until the development
of the first of distant metastases or contralateral breast cancer or
death or, if alive and disease-free, until the last follow-up visit. The
expected numbers of cancers were obtained from the SEER database, using
the age-specific incidence for white women within 5-year age groups and
5-year calendar intervals. The median time at risk for an SNBM was 10.9
years (range 0.2-27.9). RESULTS: By 8 years of follow-up, 432 patients
(23%) had developed distant metastases, 295 patients (16%) a
local/regional recurrence, and 159 (8%) a contralateral primary. Of the
1884 patients in our cohort, 147 (8%) developed an SNBM compared with
the 127.7 expected from SEER. This corresponds to an absolute excess of
1% of the study population and a relative increase of 15% greater than
that expected from SEER (p = 0.05). Within the first 5 years, the
observed and expected rates of SNBMs were identical (47 vs. 46.9). After
5 years, 24% more SNBMs were observed than expected (100 vs. 80.8, p =
0.02). Among patients <50 years old at breast cancer diagnosis, 43% more
observed SNBMs occurred than expected (40 vs. 28, p = 0.02). For
patients > or = 50 years, 7% more SNBMs were observed than expected (107
vs. 99.7, p = 0.25). Lung SNBMs were observed in 33 women, 52% more than
the 21.67 predicted by SEER (p = 0.01). Most of the lung SNBMs occurred
>5 years after treatment (n = 23) and in women who were >50 years at the
time of their breast cancer diagnosis (n = 27). The observed incidence
of ovarian cancer was significantly greater than expected among patients
<50 years (7 vs. 1.96, p = 0.004) but was not different than expected
for patients > or = 50 years (5 vs. 5.3, p = 0.61). Among the 7
sarcomas, 3 developed in the radiation field. CONCLUSIONS: SNBMs occur
in a substantial minority (8%) of patients treated with conservative
surgery and radiotherapy. However, the absolute excess risk compared
with the general population is very small (1%). This excess risk is only
evident after 5 years. In particular, a slightly increased incidence of
lung SNBMs and a somewhat larger increase in ovarian cancer among
younger patients was found. Our data suggest that preventive strategies
to reduce the incidence of certain cancers (e.g., smoking cessation and
prophylactic oophorectomy) and/or continued monitoring for SNBMs to
increase the likelihood of early detection and treatment may be prudent
in this population.
11
UI - 11856696
AU - Liberman L; Goodstine SL; Dershaw DD; Morris EA; LaTrenta LR; Abramson
TI -
AF; Van Zee KJ
One operation after percutaneous diagnosis of nonpalpable breast cancer:
frequency and associated factors.
SO - AJR Am J Roentgenol 2002 Mar;178(3):673-9
AD - Department of Radiology, Breast Imaging Section, Memorial
Sloan-Kettering Cancer Center, 1275 York Ave., New York, NY 10021, USA.
OBJECTIVE: The purpose of this study was to determine the frequency of
and factors associated with performing one therapeutic operation after
percutaneous diagnosis of nonpalpable breast cancer. MATERIALS AND
METHODS: Retrospective review was performed of records of 350
consecutive women who had therapeutic surgery after percutaneous
imaging-guided core biopsy diagnosis of nonpalpable breast cancer.
Records were reviewed to determine the frequency of performing one
operation and associated factors. Statistical analysis was performed.
RESULTS: One operation was performed in 283 (80.9%) of 350 women,
including 106 (95.5%) of 111 women who had mastectomy and 177 (74.1%) of
239 women who had breast conserving surgery. At bivariate analysis, one
operation was significantly more likely in women who had no
underestimation (p < 0.001), mastectomy rather than breast conservation
(p < 0.001), axillary dissection during the first operation (p < 0.001),
percutaneous diagnosis of infiltrating carcinoma (p = 0.001), or
mammographic mass (p = 0.006). At multivariate analysis, one operation
was significantly more likely if underestimation was absent (odds ratio
[OR] = 10.1, 95% confidence interval [CI] = 4.2-24.7) or if mastectomy
was performed (OR = 8.7, 95% CI = 3.2-23.5); for women who had
breast-conserving surgery, one operation was significantly more likely
if underestimation was absent (OR = 11.4, 95% CI = 3.9-33.2) or if a
mammographic mass was present (OR = 2.4, 95% CI = 1.3-4.6). CONCLUSION:
One operation was performed in 80.9% of women with percutaneously proven
nonpalpable breast cancer, including 74.1% of women who had
breast-conserving surgery and 95.5% of women who had mastectomy. Among
women who had breast conservation, one operation was significantly more
likely if histologic underestimation was absent or if a mammographic
mass was present.
12
UI - 10856100
AU - Obedian E; Fischer DB; Haffty BG
TI -
Second malignancies after treatment of early-stage breast cancer:
lumpectomy and radiation therapy versus mastectomy.
SO - J Clin Oncol 2000 Jun;18(12):2406-12
AD - Department of Therapeutic Radiology, Yale University School of Medicine,
New Haven, CT 06520-8040, USA.
PURPOSE: To determine the risk of second malignancies after lumpectomy
and radiation therapy (LRT), and to compare it with that in a similar
cohort of early-stage breast cancer patients undergoing mastectomy
LRT. A cohort of 1,387 breast cancer patients who underwent surgical
treatment by mastectomy (MAST), and who did not receive postoperative
radiation during the same time period, served as a comparison group.
Second malignancies were categorized as contralateral breast versus
nonbreast. In the cohort of patients undergoing LRT, a detailed analysis
was carried out with respect to age, disease stage, smoking history,
radiation therapy technique, dose, the use of chemotherapy or hormone
therapy, and other clinical and/or pathologic characteristics. RESULTS:
and 16 years for the MAST group. The 15-year risk of any second
malignancy was nearly identical for both cohorts (17.5% v 19%,
respectively). The second breast malignancy rate at 15 years was 10% for
both the MAST and LRT groups. The 15-year risk of a second nonbreast
malignancy was 11% for the LRT and 10% for the MAST group. In the subset
of patients 45 years of age or younger at the time of treatment, the
second breast and nonbreast malignancy rates at 15 years were 10% and 5%
for patients undergoing LRT versus 7% and 4% for patients undergoing
mastectomy (P, not statistically significant). In the detailed analysis
of LRT patients, second lung malignancies were associated with a history
of tobacco use. There were fewer contralateral breast tumors in patients
undergoing adjuvant hormone therapy, although this did not reach
statistical significance. The adjuvant use of chemotherapy did not
significantly affect the risk of second malignancies. CONCLUSION: There
seems to be no increased risk of second malignancies in patients
undergoing LRT using modern techniques, compared with MAST. Continued
monitoring of these patient cohorts will be required in order to
document that these findings are maintained with even longer follow-up
periods. With nearly 15 years median follow-up periods, however, these
data should be reassuring to women who are considering LRT as a
treatment option.
13
UI - 11550486
AU - Fodor J; Sulyok Z; Polgar C; Major T; Toth J; Nemeth G
TI -
[Breast-conserving treatment for early invasive lobular breast cancer:
15 years results]
SO - Magy Seb 2001 Aug;54(4):209-14
AD - Orszagos Onkologiai Intezet Sugarterapias Osztaly, 1122 Budapest, Rath
Gyorgy u. 7-9. fodor@oncol.hu
BACKGROUND: Infiltrating lobular cancer is biologically different from
invasive ductal cancer and there is disagreement regarding appropriate
local management of this disease. PURPOSE: To examine treatment outcomes
after breast-saving surgery for patients with invasive lobular breast
cancer. MATERIAL AND METHODS: Between 1983 and 1987, 77 women with
early, stage I-II invasive lobular breast cancer were treated with
complete gross excision of the tumour and axillary dissection.
Fifty-eight of these patients were treated with 50 Gy ipsilateral breast
irradiation, and 19 did not receive radiotherapy. During 176 month
median follow-up local-regional recurrences, distant metastases,
contralateral breast cancers, breast cancer deaths and deaths caused by
other disease were scored. The probability of survival was estimated by
Kaplan-Meier method. In uni- and multivariate analysis the Cox-model was
used. Relative risk (RR) and associated confidence intervals (CI) were
calculated from the regression coefficients. Statistical differences in
proportions and means were assessed by log rank and Fisher exact-tests.
RESULTS: In the saved breast, the actual rate of local recurrence at 15
years was 13% for irradiated and 53% for non-irradiated patients (RR:
0.1; 95% CI: 0.03-0.31; p: < 0.0001). The incidence of total breast
cancer relapses (local-regional recurrences and distant metastases) was
also higher for non-irradiated than for irradiated patients (74% vs.
40%; p: 0.0168). In multivariate analysis irradiation (no vs. yes)
showed a significant effect on local tumour control (RR: 0.08: 95% CI:
0.02-0.28; p: 0.0001), but menopausal (pre vs. post), T-(T1 vs. T2) and
N-(N0 vs. N1) status did not. The breast cancer specific survival at 15
years was 74% without and 62% with local recurrence (RR: 1.45; 95% CI:
0.53-3.96; p: 0.4697). The majority of local recurrences (9 of 14) were
curable by salvage surgery. For all patients the rate of contralateral
breast cancer was 6.5%. CONCLUSION: Results of long-term follow-up
confirmed that breast-conserving surgery and radiotherapy is a
reasonable treatment for patients with early invasive lobular breast
cancer. The majority of local recurrences are curable by salvage
surgery.
14
UI - 11727963
AU - Coster S; Poole K; Fallowfield LJ
TI -
The validation of a quality of life scale to assess the impact of arm
morbidity in breast cancer patients post-operatively.
SO - Breast Cancer Res Treat 2001 Aug;68(3):273-82
AD - Department of Oncology, University of Sussex, Brighton, UK.
This paper documents the validation of a quality of life scale (QOL)
designed to assess the impact of arm morbidity on patients following
breast cancer surgery. A four item arm subscale was developed to
supplement a multi-dimensional, validated breast cancer QOL tool, the
functional assessment of cancer therapy (FACT-B.) The new questionnaire,
the FACT-B + 4, was validated on 279 women participating in a trial of
sentinel node guided axillary therapy and 29 women attending a
lymphoedema clinic. The subscale demonstrated good internal consistency
(alpha co-efficient = 0.62 to 0.88) and stability (test-retest
reliability = 0.97). Lymphoedema patients reported significantly greater
arm problems than a matched sample of pre-operative trial participants.
The lymphoedema group also scored lower than trial patients on the
FACT-B + 4 indicating a poorer quality of life (p < 0.05). A subset of
66 trial patients who had completed three consecutive assessments was
used to evaluate the sensitivity of the questionnaire to change over
time. Scores on the FACT-B + 4 were found to decline significantly
between the pre-operative assessment and post-operative assessment at 1
month. Arm problems significantly increased during this period. FACT-B +
4 score increased again from 1 month to 12 weeks post-surgery and
symptoms reduced, as the extent of arm morbidity resolved. The FACT-B +
4 appears to be psychometrically robust and sensitive to patient
rehabilitation, making it suitable for use in longitudinal surgical
trials. Given the dearth of existing scales available to measure arm
morbidity, we hope this new tool will prove useful to researchers.
15
UI - 11833331
AU - Driuk MF; Galych SP; Driuk MM; Lytvynenko OO
TI -
[Technical aspects of one stage reconstruction of mammary glands using
autologous tissue after mastectomy for the mammary gland cancer]
SO - Klin Khir 2001 Oct;(10):61-4
In 36 patients the first experience of performance of one-stage
mammarial glands reconstruction is presented, using tissues of their own
after conduction of mastectomy for the mammarial gland cancer. In 27
women patients the transposition or free microvascular transplantation
of lower musculocutaneous flap basing on m. Rectus abdominis (transverse
rectus abdominis musculocutaneous TRAM-flap) was performed, in
9--transposition of m. Latissimus dorsi flap.
16
UI - 11847506
AU - Miyashita T; Tateno A; Kumazaki T; Furukawa K; Minobe K; Shimizu K
TI -
Breast-conserving therapy in the management of early stage breast
cancer: Our experience in 103 cases.
SO - J Nippon Med Sch 2002 Feb;69(1):24-30
AD - Department of Radiology, Nippon Medical School, Tokyo, Japan.
miyasita@nms.ac.jp
PURPOSE: The aim of this study is to determine whether our results in
breastconserving therapy of 103 patients with earlystage breast cancer
are comparable to those of other facilities or not. MATERIALS AND
breast cancer were treated by breastconserving surgery and whole breast
irradiation. All patients were of Stages I or II, and the greatest
dimensions of primary tumor were less than 3 cm. The median followup
time was 47 months from the completion of postoperative radiotherapy.
Local, regional and distant failure rates, and survival rate were
presumed using the KaplanMeyer method. RESULTS: One patient suffered
from local recurrence 30 months later. She was followed by simple
mastectomy and kept from further recurrence. No regional relapse
occurred. Distant metastases were seen in three patients:two patients in
bones, and one patient in a bone and the liver after 19, 35, and 32
months, respectively. One patient died from disseminated cancer in 41
months. Only one patient died due to intercurrent disease. Both 5year
and 10year diseasefree survival rates were 94.2%, and both 5year and
10year causespecific survival rates were 98.3%. CONCLUSION: Our results
were comparable to previously reported data. In this stage although the
followup time was too short to define the longterm outcome, it suggested
that breast conserving therapy was acceptable and effective in the
management of earlystage breast cancer.
17
UI - 11822858
AU - Tamaki Y; Sakita I; Miyoshi Y; Sekimoto M; Takiguchi S; Monden M;
TI -
Noguchi S
Transareolar endoscopy-assisted partial mastectomy: a preliminary report
of six cases.
SO - Surg Laparosc Endosc Percutan Tech 2001 Dec;11(6):356-62
AD - Department of Surgical Oncology, Osaka University, Graduate School of
Medicine, Yamadaoka, Suita, Japan. tamaki@onsurg.med.osaka-u.ac.jp
Six patients with breast cancer in the upper inner quadrant underwent
endoscopy-assisted partial mastectomy. The tumor was removed with a
2-cm-wide surgical margin through a periareolar semicircular incision
using a special retractor and endoscope system for plastic surgery.
Another small incision was made in the axilla for total lymph node
dissection or sentinel lymph node biopsy. The average of total operation
time in five patients who underwent partial mastectomy was 241 minutes
(range, 190-315 minutes), and the average time for the procedure of
partial mastectomy in six cases was 84 minutes (range, 69-113 minutes).
The cosmetic outcome was excellent. Transareolar endoscopic partial
mastectomy can be considered as an alternative surgery option and can
offer great cosmetic advantage for patients with small cancers in the
inner quadrants of the breast.
18
UI - 11822859
AU - Klimberg VS
TI -
Just because you can?
SO - Surg Laparosc Endosc Percutan Tech 2001 Dec;11(6):363
19
UI - 11847034
AU - Rouanet P; Duchene M; Quenet F
TI -
[Cancer update on breast reconstruction]
SO - Bull Cancer 2002 Jan;89(1):125-9
AD - CRLC Val-d'Aurelle, 326, rue des Apothicaires, parc Euromedecine, 34298
Montpellier Cedex 5.
Breast reconstruction is evolving towards immediate reconstruction
(IBR). Adjuvant radiotherapy remains an esthetical contraindication to
classical techniques due to complication rate (capsular contracture,
flap necrosis and contracture). Tissue expansion combined with
radiotherapy must be evaluated. IBR quality of life raises the issue of
its evaluation. IBR current limits seem to be psychological. The quality
of preoperative information will determine IBR real life experience.
20
UI - 11870664
AU - Ernst MF; Voogd AC; Balder W; Klinkenbijl JH; Roukema JA
TI -
Early and late morbidity associated with axillary levels I-III
dissection in breast cancer.
SO - J Surg Oncol 2002 Mar;79(3):151-5; discussion 156
AD - Department of Surgery, St. Elisabeth Hospital, Tilburg, The Netherlands.
BACKGROUND AND OBJECTIVES: Axillary dissection may cause substantial
morbidity in breast cancer patients. The purpose of this study was to
investigate the value of a registration method of morbidity of the arm
and shoulder, which is frequently used by surgeons and which includes
the measurement of range of movement, strength, and pain. METHODS: We
surveyed 148 patients who had received an axillary dissection as part of
breast cancer surgery. Of these patients, 77 had undergone axillary
dissection 6-12 months ago and 71 patients more than 5 years ago. In all
patients, an objective measurement of shoulder movement and a subjective
measurement of pain and arm strength was performed. RESULTS: A
difference of more than 20 degrees in abduction, ventral elevation, or
dorsal elevation occurred in 12% of the patients. Pain or loss of
strength were measured in half of the patients. Shoulder movement, pain,
and arm strength were not significantly different between the patients
who underwent mastectomy or breast conserving surgery. Also, no
significant difference could be found in shoulder movement, pain, and
arm strength between the patients who underwent axillary dissection 6-12
months ago and those who underwent it more than 5 years ago.
CONCLUSIONS: Pain, loss of arm strength, and limitation of shoulder
movement are frequent complaints after axillary dissection for breast
cancer and appear to be independent of the length of follow-up and the
type of surgery (i.e., breast-conservation or mastectomy). Copyright
2002 Wiley--Liss, Inc.
21
UI - 11869698
AU - Burak WE; Hollenbeck ST; Zervos EE; Hock KL; Kemp LC; Young DC
TI -
Sentinel lymph node biopsy results in less postoperative morbidity
compared with axillary lymph node dissection for breast cancer.
SO - Am J Surg 2002 Jan;183(1):23-7
AD - Division of Surgical Oncology, Department of Surgery, Ohio State
University, N914 Doan Hall, 410 W. 10th Ave., Columbus, OH 43210, USA.
Burak.1@osu.edu
BACKGROUND: This study was designed to compare the postoperative
morbidity and socioeconomic impact of sentinel lymph node biopsy (SLNB)
with axillary lymph node dissection (ALND) in patients with early stage
breast cancer. METHODS: A prospective, nonrandomized, controlled study
was designed to include patients who underwent breast conservation
surgery and SLNB +/- ALND. Group A consisted of patients who had a
negative SLNB and did not go on to completion ALND. Group B consisted of
patients who underwent a SLNB followed by a completion ALND because
either (1) their sentinel node contained cancer or (2) they were within
the validation phase of our institution's sentinel lymph node protocol.
Patients were evaluated with a questionnaire and underwent a
standardized physical examination to determine arm circumference.
RESULTS: Data were obtained from 96 patients with a mean follow-up
period of 15 months (range 8 to 29). Significant differences were seen
in subjective measurements of arm complaints and arm numbness (P
<0.001), with fewer complaints reported in group A. The difference in
mid-bicep and antecubital fossa circumferences was significant when
comparing the ratio of the procedure arm with the nonprocedure arm and
when subtracting the nonprocedure arm from the procedure arm (P <0.003
and P <0.016, respectively) in favor of group A. Axillary surgery was
performed as an outpatient procedure in 88% of group A patients,
compared with 15% in group B (P <0.001). Furthermore, 71% of group A
patients returned to "normal activity" in less than 4 days, in
comparison with 7% of group B (P <0.001). CONCLUSIONS: SLNB results in
less postoperative morbidity in terms of subjective arm complaints and
mid-arm swelling. Expeditious return to work or normal activity after
SLNB has potentially significant socioeconomic consequences.
22
UI - 11579955
AU - Hashida H; Honda T; Morimoto H; Sasaki T; Aibara Y; Yamanaka M
TI -
Breast cancer presenting with the syndrome of inappropriate secretion of
antidiuretic hormone after simple mastectomy.
SO - Intern Med 2001 Sep;40(9):911-4
AD - Department of Internal Medicine, Ehime Prefectural Iyomishima Hospital.
A 71-year-old woman showed disorientation 7 days after simple mastectomy
for right breast cancer. Computed tomography of the brain was normal.
The level of serum sodium was very low (110 mEq/l), while the urine
sodium level was normal. The osmolality of urine was higher (342
mosmol/kg) than that of serum (220 mosmol/kg). These data suggested a
syndrome of inappropriate secretion of antidiuretic hormone. A fluid
restriction, infusion of hypertonic saline and administration of
diuretics gradually increased the level of serum sodium. Subsequently,
disorientation disappeared. This is a rare case of the syndrome of
inappropriate secretion of antidiuretic hormone caused by simple
mastectomy, a relatively minor surgical procedure.
23
UI - 11750976
AU - Polgar C; Fodor J; Major T; Nemeth G
TI -
Is boost irradiation with interstitial brachytherapy less favourable
than with teletherapy after breast conserving surgery?
SO - Eur J Obstet Gynecol Reprod Biol 2002 Jan 10;100(2):255-6
24
UI - 11880791
AU - Ann Gilligan M; Kneusel RT; Hoffmann RG; Greer AL; Nattinger AB
TI -
Persistent differences in sociodemographic determinants of breast
conserving treatment despite overall increased adoption.
SO - Med Care 2002 Mar;40(3):181-9
AD - Department of Medicine, Medical College of Wisconsin, Milwaukee 53226,
USA. gilligan@mcw.edu
BACKGROUND: Use of breast-conserving treatment (BCT) has previously
demonstrated variability by sociodemographic factors. OBJECTIVE: To
determine whether variation in use of BCT by age, race, county income,
county education, and population density declined between 1983 and 1996.
DESIGN: Trends in use of BCT over time were modeled with logistic
regression. SETTING: Surveillance, Epidemiology, and End Results
national tumor registry data. PATIENTS: Population-based cohort of
158,496 women with local or regional stage breast cancer. MAIN OUTCOME
MEASURE: Receipt of BCT. RESULTS: Use of BCT increased overall, and
among all subgroups of age, county income, county education, population
density, and race. There was no decline in age-related variation in use
of BCT over time. However, older women were less likely to undergo BCT
including radiotherapy (RT) and lymph node dissection (LND), and were
more likely to undergo BCT omitting RT and/or LND. Variation in use of
BCT by county income persisted, with women residing in poorer counties
less likely to undergo BCT, whether accompanied by RT and LND. Variation
in overall use of BCT by county education also persisted. Although women
residing in better-educated counties were more likely to undergo BCT
accompanied by RT and LND, they were not more likely to undergo BCT
omitting RT, LND, or both. No decline in variation by population density
occurred, with women residing in urban areas more likely to use BCT
whether accompanied by RT and LND. CONCLUSIONS: Sociodemographic
differences in BCT use have persisted over time. The increased overall
adoption of BCT has not led to consistency in use of this treatment.
25
UI - 11692927
AU - Marinova L
TI -
[Local treatment of axillae and its impact on survival in patients with
early breast cancer (EBC) after breast conservative surgery (BCS)]
SO - Khirurgiia (Sofiia) 2000;56(5-6):21-4
Following a shut survey showing the influence of the local therapeutic
approaches (operative and radiation) for axillaries region on the
distant survival, dissemination and lethality in patients with early BC
after BCS, the author presents her treatment results. It is pointed out
that BC is a systemic disease in some criteria taking in a
consideration. In this aspect no significant influence of the local
therapeutic methods is found. Furthermore a long-term follow up is still
met to prove that a less extensive local treatment methods lead to
irreversible consequences: increasing the local recurrences, distant
dissemination and lethality.
The above citations and abstracts reflect those newly added to CANCERLIT for the month and topic listed in the title. The citations have been retrieved from CANCERLIT using a predefined search strategy of indexed subject terms. Although the search strategy has been refined as best as possible, citations may appear that are not directly related to the topic, and occasionally relevant references may be omitted.
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