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NCI CANCERLIT^® Search: Surgery for Breast Cancer - September 2002

National Cancer Institute^®
Last Modified: September 1, 2002

[Sentinel lymph nodes in breast cancer]
Paravertebral somatic nerve blocks for breast surgery in a patient with hypertrophic obstructive cardiomyopathy.
[Randomized prospective study of early removal of drainage in breast cancer surgery]
Selective axillary surgery in breast cancer patients based on positron emission tomography with 18F-fluoro-2-deoxy-D-glucose: not yet!
[Clinically non-palpable lesions of the breast: radiologic features, biologic factors, and surgical strategy]
[Sentinel node and breast cancer: fashion or surgical revolution?]
Trends in breast-conserving surgery in the Southeast Netherlands: comments on article by Ernst and colleagues. Eur J Cancer 2001, 37,
Rationale for elective contralateral mastectomy with immediate bilateral reconstruction.
Risk of recurrence after treatment of early breast cancer with skin-sparing mastectomy.
Risk of recurrence after treatment of early breast cancer with skin-sparing mastectomy: two editorial perspectives.
The value of preoperative Doppler sonography for planning free perforator flaps.
Prospective evaluation of the morbidity of axillary clearance for breast cancer.
Does sentinel lymphadenectomy improve staging and alter therapy in elderly women with breast cancer?
Lumpectomy with or without postoperative radiotherapy for breast cancer with favourable prognostic features: results of a randomized study.
Waiting time for breast cancer surgery in Quebec.
Risk-reduction mastectomy: clinical issues and research needs.
[Application of Mckissock reduction mammaplasty technique in treatment of giant breast tumor]
To excise or to sample the mammographic target: what is the goal of stereotactic 11-gauge vacuum-assisted breast biopsy?
Local recurrence after skin-sparing mastectomy: a manifestation of tumor biology or surgical conservatism?
Surgical management of primary breast sarcoma.
Breast cancer recurrences in elderly patients after lumpectomy.
Antibiotic prophylaxis in clean surgery: breast surgery and hernia repair.
Care of women with breast cancer on a surgical ward: nurses' opinions of the need for support for women, relatives and themselves.
Does radical surgery to the axilla give a survival advantage in more severe breast cancer?
Long-term complications of breast-conservation therapy: can the incidence be reduced?
Integrating surgery and radiotherapy to reduce toxicity while maintaining local control for breast cancer: a fine balance.
Long-term complications associated with breast-conservation surgery and radiotherapy.
Deltopectoral flap for reconstruction of male breast after radical mastectomy for cancer in a patient on hemodialysis.
The role of plastic surgery in the complex treatment of breast tumours (review of indications and operations).
Axillary lymphectomy in breast cancer.
[Negative sentinel node in breast cancer patients a good indicator for continued absence of axillary metastases]
[Treatment outcome after surgical management of osseous breast carcinoma metastases. Preventive stabilization vs. management after pathological
[Sentinel node biopsy and invasive breast cancer: towards a new minimal surgical approach]
Sentinel node role in breast cancer surgery.
Women's choice between sentinel lymph node biopsy and axillary clearance.
Effect of margins of excision on recurrence after local excision of ductal carcinoma in situ of the breast.
Dolasetron decreases postoperative nausea and vomiting after breast surgery.
Are breast cancer screening programmes increasing rates of mastectomy? Observational study.
Specialist surgeons and survival in breast cancer. Breast cancer is a medical, not a surgical, disease.
Specialist surgeons and survival in breast cancer. Large differences in survival are not explained.
Specialist surgeons and survival in breast cancer. More centralisation of services is not needed.
Specialist surgeons and survival in breast cancer. Case selection bias affected results.
Specialist surgeons and survival in breast cancer. Protocols are important.
Specialist surgeons and survival in breast cancer. Observational studies are essential.
[Concealed local recurrence after breast-conserving treatment]
The supply and fitting of a temporary breast prosthesis.
Factors that influence surgical choices in women with breast carcinoma.
Early discharge after surgery for breast cancer. Might not be applicable to most patients.
Randomised controlled trial of effects of early discharge after surgery for breast cancer.
Early discharge after surgery for breast cancer. More evidence in favour of early discharge.
Early discharge after surgery for breast cancer. Hotel wards are good option for patients.
Surgical management of breast cancer: today and tomorrow.
Clinical practice guidelines for the care and treatment of breast cancer: mastectomy or lumpectomy? The choice of operation for clinical
Cosmetic outcome and breast morbidity in breast-conserving treatment--results from the Danish DBCG-82TM national randomized trial
[Breast conserving surgery for mammary cancer]
Locoregional failure of postmastectomy patients with 1-3 positive axillary lymph nodes without adjuvant radiotherapy.

1
UI - 12092373
AU - Mustonen P; Vanninen E
TI - [Sentinel lymph nodes in breast cancer]
SO - Duodecim 2001;117(2):192-8; quiz 199, 211
AD - KYS:n kirurgian klinikka PL 1777, 70211 Kuopio.

2
UI - 12067868
AU - Buckenmaier CC 3rd; Steele SM; Nielsen KC; Klein SM
TI - Paravertebral somatic nerve blocks for breast surgery in a patient with hypertrophic obstructive cardiomyopathy.
SO - Can J Anaesth 2002 Jun-Jul;49(6):571-4
AD - Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina, USA. bucke001@mc.duke.edu
PURPOSE: Patients with hypertrophic obstructive cardiomyopathy (HOCM), a genetic disorder resulting in idiopathic myocardial thickening, can present the anesthesiologist with significant management difficulties. This report reviews the physiology of this important disease process and describes the use of paravertebral nerve blocks (PVB) in the management of a patient with HOCM who presented for partial mastectomy with axillary lymph node dissection. Clinical features: A 72-yr-old female presented for breast cancer surgery with a significant past medical history of HOCM diagnosed during hospitalization for non-small cell lung cancer. PVB were performed at thoracic levels 1-6 and 5 mL of 0.5% ropivacaine and epinephrine 1:400,000 was injected at each level. Intraoperatively the patient required no other medication for analgesia and was comfortable and conversant during the two-hour procedure. She remained pain free following the operation and did not require any opioid medication until the following day. CONCLUSIONS: PVB provide excellent analgesia and are a useful alternative anesthetic when faced with the HOCM patient requiring major breast surgery.

3
UI - 11873639
AU - Amanti C; Regolo L; Pucciatti I; Lo Russo M; Moscaroli A; Conte S;
TI - Coppola M; Angelini L [Randomized prospective study of early removal of drainage in breast cancer surgery]
SO - G Chir 2001 Nov-Dec;22(11-12):401-6
AD - Unita di Senologia, Dipartimento di Scienze Chirurgiche e Tecnologie Mediche Applicate, Universita degli Studi La Sapienza, Roma.
Axillary seroma is absolutely the most frequent complication of breast cancer surgery. The Authors have accrued 100 consecutive breast cancer patients in a randomized study in order to compare seroma incidence by removing drains on 2nd postoperative day (1st arm) versus 3rd postoperative day (2nd arm); 48 patients were accrued in the first arm and 52 in the second. All patients received a standard axillary dissection. Two suction drains were placed. A compressive medication was applied after surgery. Patients started physiotherapy on the 1st postoperative day. The overall seroma prevalence was 21%. We have 8/48 (16%) seromas in the 1st group and 13/52 (25%) in the 2nd. No significant differences were registered between two arms. Clinical seroma was treated by needle aspiration and medication with a steroid. Conclusions coming out from this study are: 1) early drains removal doesn't increase seroma rate; 2) axillary clearance has to be performed removing en bloc the fatty tissue respecting surgical plains; 3) apply a compressive bandaging; 4) early arm physiotherapy; 5) medication with steroid may reduce the fluid formation.

4
UI - 11881913
AU - Guller U; Nitzsche EU; Schirp U; Viehl CT; Torhorst J; Moch H; Langer I;
TI - Marti WR; Oertli D; Harder F; Zuber M Selective axillary surgery in breast cancer patients based on positron emission tomography with 18F-fluoro-2-deoxy-D-glucose: not yet!
SO - Breast Cancer Res Treat 2002 Jan;71(2):171-3
AD - Department of Surgery, University of Basel, Switzerland.
We prospectively evaluated 31 patients with invasive breast cancer. Preoperative positron emission tomography (PET) with 18F-fluoro-2-deoxy-D-glucose (18F-FDG) for detection of axillary lymph node metastases was compared with the histopathologic status of the sentinel lymph node (SLN). Sensitivity of PET imaging was 43%, specificity and negative predictive value were 94 and 67%, respectively. The smallest metastasis detected by PET measured 3 mm in diameter. The results of this study suggest that detection of small axillary lymph node metastases is limited by the currently achievable spatial resolution of PET imaging. Selective axillary surgery in breast cancer patients based on 18F-FDG PET is yet not possible.

5
UI - 11865691
AU - Arcuri MF; Del Rio P; Conti GM; Sianesi M
TI - [Clinically non-palpable lesions of the breast: radiologic features, biologic factors, and surgical strategy]
SO - Ann Ital Chir 2001 Jul-Aug;72(4):399-404
AD - Istituto di Clinica Chirurgica Generale e dei Trapianti d'Organo, Universita di Parma.
The use of mammography for early detection of breast cancer showed an increased detection of non-palpable breast-lesions (NPBL). The authors evaluate the radiologic findings, the biological factors and the surgical approach, trough the personal experience and the literature, for a correct treatment of these lesions.

6
UI - 12043500
AU - Clough KB; Nos C
TI - [Sentinel node and breast cancer: fashion or surgical revolution?]
SO - Gynecol Obstet Fertil 2002 Apr;30(4):273-5

7
UI - 12044517
AU - Gotzsche PC
TI - Trends in breast-conserving surgery in the Southeast Netherlands: comments on article by Ernst and colleagues. Eur J Cancer 2001, 37, 2435-2440.
SO - Eur J Cancer 2002 Jun;38(9):1288; discussion 1289-90

8
UI - 7850550
AU - Kroll SS; Miller MJ; Schusterman MA; Reece GP; Singletary SE; Ames F
TI - Rationale for elective contralateral mastectomy with immediate bilateral reconstruction.
SO - Ann Surg Oncol 1994 Nov;1(6):457-61
AD - Department of Reconstructive and Plastic Surgery, University of Texas M.D. Anderson Cancer Center, Houston 77030.
BACKGROUND: Women with breast cancer treated by mastectomy with immediate breast reconstruction can get exceptionally good results if the reconstruction is performed with autogenous tissue using the transverse rectus abdominis myocutaneous (TRAM) flap. Bilateral reconstruction with TRAM flaps is also possible, but only if both breasts are reconstructed at the same time. To avoid the possibility of subsequently developing contralateral malignancy and having to undergo assymetrical reconstruction with a different technique, some patients have chosen the alternative of bilateral mastectomy with bilateral immediate reconstruction. This is only reasonable if the incidence of failure in bilateral breast reconstruction is very low. METHODS: We prospectively studied reconstructive outcomes in 100 patients who had breast cancer and who underwent bilateral mastectomy and reconstruction (using implants as well as TRAM flaps). We also reviewed the histologic findings in 88 prophylactically removed high-risk breasts. RESULTS: Successful outcomes were initially achieved in 95 patients; of the 5 failures, two were successfully reconstructed with alternative techniques for an overall success rate of 97%. Of the 63 patients reconstructed with bilateral TRAM flaps, all but one (98%) were successful on the first try. TRAM flap reconstructions were significantly more likely to be successful than were those based on implants (p = 0.05). Previously unsuspected invasive cancer was found in 3 patients (3.4%), whereas carcinoma in situ was found in 5 patients (5.7%) and in another 18 patients (20%) cellular atypia was present. CONCLUSIONS: Bilateral breast reconstruction has a low incidence of failure, particularly if TRAM flaps are used. For selected patients, elective contralateral mastectomy with immediate bilateral reconstruction is a reasonable treatment alternative provided that the necessary expertise is available and the patients clearly understand the risks.

10
UI - 9527261
AU - Carlson GW
TI - Risk of recurrence after treatment of early breast cancer with skin-sparing mastectomy: two editorial perspectives.
SO - Ann Surg Oncol 1998 Mar;5(2):101-2

11
UI - 10845290
AU - Giunta RE; Geisweid A; Feller AM
TI - The value of preoperative Doppler sonography for planning free perforator flaps.
SO - Plast Reconstr Surg 2000 Jun;105(7):2381-6
AD - Department of Plastic Surgery, Behandlungszentrum Vogtareuth, Germany. r.giunta@t-online.de
The individual perforating vessels have a high degree of anatomical variation, therefore it is desirable to conduct a careful examination of them before undertaking a perforator flap operation. Because locating the vessels beforehand makes performing the operative procedure much easier, the aim of the present study was to assess the value of using simple acoustic Doppler sonography to plan a perforator flap operation. The vessel examinations were carried out before taking 46 free microvascular flaps from either the lower abdominal wall or the buttock for reconstructive breast surgery. The perforating vessels located were marked, and their position relative to the umbilicus or the most cranial point of the rima ani recorded using a coordinate system. In 40 patients, a perforator flap operation (deep inferior epigastric perforator flap, n = 32; superior gluteal artery perforator flap, n = 8) was actually carried out; in six of these patients, a myocutaneous flap was used because of the insufficient availability of perforating vessels. Before the operation, perforating vessels were marked for each patient, with an average of 7.3 for the deep inferior epigastric perforator flap and 6.5 for the superior gluteal artery perforator flap. Out of 286 vessels marked for later perforator flaps, 162 were identified during the operation. A preoperatively marked vessel was used in 37 of 40 patients. In the remaining patients, a vessel was used that had not been previously marked. The vertical and horizontal distance between the perforating vessels identified during the operation and the preoperative marks averaged 0.8 cm. The results show preoperative Doppler sonography to be useful for locating the position of individual perforating vessels, making it much easier to find them during the operation.

12
UI - 11136322
AU - Duff M; Hill AD; McGreal G; Walsh S; McDermott EW; O'Higgins NJ
TI - Prospective evaluation of the morbidity of axillary clearance for breast cancer.
SO - Br J Surg 2001 Jan;88(1):114-7
AD - St Vincent's University Hospital, Elm Park, Dublin 4, Ireland.
BACKGROUND: Axillary clearance, despite its morbidity, retains an essential role in the management of patients with breast cancer. The aim of this prospective study was to document the development of arm swelling and limitation of shoulder movement following complete axillary clearance. METHODS: One hundred patients who had axillary clearance to level III, for treatment of breast cancer, were followed prospectively for over 1 year. Arm volumes were measured using an optoelectronic volometer and shoulder movements with a goniometer. RESULTS: Ten patients had significant arm swelling at 1 year. The swelling was mild in eight and moderate in two. No patient developed severe swelling. Reduced arm movements were noted in the first week after operation but had returned to normal at 6 months. CONCLUSION: This study provided accurate documentation of the morbidity associated with axillary clearance, together with a reproducible method of arm volume measurement.

13
UI - 10894135
AU - DiFronzo LA; Hansen NM; Stern SL; Brennan MB; Giuliano AE
TI - Does sentinel lymphadenectomy improve staging and alter therapy in elderly women with breast cancer?
SO - Ann Surg Oncol 2000 Jul;7(6):406-10
AD - Joyce Eisenberg Keefer Breast Cancer, John Wayne Cancer Institute at Saint John's Health Center, Santa Monica, California 90404, USA.
BACKGROUND: Routine axillary lymph node dissection (ALND) for elderly women with invasive breast cancer has been questioned because it rarely alters therapy yet carries a significant morbidity rate. Sentinel lymphadenectomy (SLND) improves axillary staging and alters therapy in women with T1 breast cancer, but it is not clear whether SLND alters therapy in elderly women with breast cancer. METHODS: A prospective breast cancer data base was used to identify women 70 years old and older who underwent SLND for axillary staging of invasive breast cancer between 1991 and 1998. RESULTS: There were 75 invasive breast cancers in 73 women. The mean patient age was 74.5 years (range, 70-90 years). Median tumor size was 1.4 cm (range, 0.1-6.2 cm). Of the 75 tumors, 42 (56%) had favorable primary characteristics; the remaining tumors had unfavorable characteristics. SLND was performed alone in 17 cases (23%) and was followed by completion ALND in 58 cases (77%). Positive lymph nodes were identified in 32 cases (43%); 26 (81.3%) were detected by hematoxylin and eosin stains, and 6 (18.7%) were detected by immunohistochemistry alone. Five patients (6.9%) received adjuvant chemotherapy. Seven patients (9.6%) received axillary/supraclavicular radiation for positive nodes. Ten (13.7%) of 73 patients had obvious alterations in therapy because of axillary nodal status. As a result of SLND, 3 (13.6%) of 22 patients with tumors 1.0 cm or smaller received tamoxifen, and 7 (15%) of 46 patients with tumors between 1.0 and 3.0 cm in size had changes in therapy. When patient and tumor characteristics were analyzed to determine relationships to therapeutic decision-making, nodal status was the variable most significantly associated with changes in therapy (P = .0001). CONCLUSIONS: SLND improves axillary staging in elderly women with invasive breast cancer. Results of immunohistochemistry do not alter therapy in this group of individuals (P = .6367). In patients with small primary tumors, SLND alters therapy by increasing the number of patients receiving tamoxifen. In addition, SLND affects adjuvant systemic chemotherapy and regional radiotherapy in a significant number of patients with larger tumors, particularly tumors between 1.0 and 3.0 cm.

14
UI - 11161371
AU - Holli K; Saaristo R; Isola J; Joensuu H; Hakama M
TI - Lumpectomy with or without postoperative radiotherapy for breast cancer with favourable prognostic features: results of a randomized study.
SO - Br J Cancer 2001 Jan;84(2):164-9
AD - Department of Palliative Medicine, University Hospital and University of Tampere, Finland.
The aim of this trial was to study the value of adding post-operative radiotherapy to lumpectomy in a subgroup of breast cancer patients with favourable patient-, tumour-, and treatment-related prognostic features. 152 women aged over 40 with unifocal breast cancer seen in preoperative mammography were randomly assigned to lumpectomy alone (no-XRT group) or to lumpectomy followed by radiotherapy to the ipsilateral breast (50 Gy given within 5 weeks, XRT group). All cancers were required to be invasive node-negative, smaller than 2 cm in diameter and well or moderately differentiated, to contain no extensive intraductal component, to be progesterone receptor-positive, DNA diploid, have S-phase fraction 15
UI - 11338798
AU - Mayo NE; Scott SC; Shen N; Hanley J; Goldberg MS; MacDonald N
TI - Waiting time for breast cancer surgery in Quebec.
SO - CMAJ 2001 Apr 17;164(8):1133-8
AD - Division of Clinical Epidemiology, McGill University Health Center, Montreal, Que. nmayo@po-box.mcgill.ca
BACKGROUND: Currently there is no agreement on the optimal time to treatment of breast cancer; however, given the considerable emphasis on early detection, one would expect a similar emphasis on early treatment. The purpose of our study was to assess the time interval to surgery from initiation of diagnosis among Quebec women with breast cancer and to examine the influence on waiting time of age, pattern of care and cancer stage. METHODS: Records of physician fee-for-service claims and of hospital admissions were obtained for all Quebec women who underwent an invasive procedure for the diagnosis or treatment of breast cancer between 1992 and 1998. Waiting time was calculated as the number of days between the first diagnostic procedure and surgical treatment. RESULTS: There were 29,606 episodes of breast cancer surgery among 28,100 women: 5922 mastectomies and 23,684 lumpectomies. The absolute number of episodes of breast cancer treated with surgery rose from 3626 in 1992 to 5162 in 1998. The overall median waiting time was 34 days (interquartile range [IQR] 19-62); 13.5% of the women waited longer than 90 days. The median waiting time rose from 29 days (IQR 15-54) in 1992 to 42 days (IQR 24-72) in 1998, representing a relative increase of 37% (95% confidence interval [CI] 32%-43%) after adjusting for age and cancer stage. The median waiting time increased with the number of diagnostic procedures, from 24 days (IQR 14-42) with 1 procedure to 48 days (IQR 27-84) with 3 procedures to 72 days (IQR 43-121) with 4 procedures, representing adjusted relative increases of 97% (95% CI 91%-103%) and 194% (95% CI 181%-208%), respectively. The proportion of women receiving 3 or more diagnostic procedures before surgery increased steadily over the study period, from 19.2% in 1992 to 33.0% in 1998. The median waiting time was shorter with more advanced stages of cancer: 53 days (IQR 30-86) for carcinoma in situ, 35 (IQR 20-62) for localized disease, 28 (IQR 16-49) for regional disease and 24 (IQR 11-52) for disseminated disease. INTERPRETATION: Waiting time between initial diagnosis and first surgery for breast cancer has increased substantially in Quebec between 1992 and 1998. Possible explanations include increased demand, decreased resources and changes in patterns of care.

16
UI - 11535704
AU - Stefanek M; Hartmann L; Nelson W
TI - Risk-reduction mastectomy: clinical issues and research needs.
SO - J Natl Cancer Inst 2001 Sep 5;93(17):1297-306
AD - Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA. ms496r@nih.gov
Risk-reduction mastectomy (RRM), also known as bilateral prophylactic mastectomy, is a controversial clinical option for women who are at increased risk of breast cancer. High-risk women, including women with a strong family history of breast cancer and BRCA1/2 mutation carriers, have several clinical options: risk-reduction surgery (bilateral mastectomy and bilateral oophorectomy), surveillance (mammography, clinical breast examination, and breast self-examination), and chemoprevention (tamoxifen). We review research in a number of areas central to our understanding of RRM, including recent data on 1) the effectiveness of RRM in reducing breast cancer risk, 2) the perception of RRM among women at increased risk and health-care providers, 3) the decision-making process for follow-up care of women at high risk, and 4) satisfaction and psychological status after surgery. We suggest areas of future research to better guide high-risk women and their health-care providers in the decision-making process.

17
UI - 12189692
AU - She Y; Zhu W; Ren S
TI - [Application of Mckissock reduction mammaplasty technique in treatment of giant breast tumor]
SO - Zhonghua Zheng Xing Wai Ke Za Zhi 2002 May;18(3):133-4
AD - Affiliated Hospital of Medical College, Ningbo University, Ningbo 315020, China.
OBJECTIVE: To obtain postoperative desirable appearance of the deformed breast we apply Mckissock reduction mammaplasty technique in treatment of giant benign breast tumor. METHODS: According to the principle of Mckissock reduction mammaplasty technique, we design a special incision to remove the tumor in company with the proceeding of mammaplasty. RESULTS: 11 cases of operation with satisfactory results for giant benign tumors have been performed since 1993. CONCLUSIONS: Standard reduction mammaplasty technique has turned out to be an effective remedy for giant tumor spoiling the appearance of the breast.

19
UI - 9831102
AU - Carlson GW
TI - Local recurrence after skin-sparing mastectomy: a manifestation of tumor biology or surgical conservatism?
SO - Ann Surg Oncol 1998 Oct-Nov;5(7):571-2

20
UI - 12206600
AU - Shabahang M; Franceschi D; Sundaram M; Castillo MH; Moffat FL; Frank DS;
TI - Rosenberg ER; Bullock KE; Livingstone AS Surgical management of primary breast sarcoma.
SO - Am Surg 2002 Aug;68(8):673-7; discussion 677
AD - Department of Surgery, University of Miami School of Medicine, Florida 33136, USA.
Primary sarcoma constitutes less than one per cent of breast malignancies. A retrospective review of this disease at our institution was undertaken to assess the effect of different treatment modalities on outcome. Over a 24-year period 28 patients were identified. Follow-up ranged from one to 228 months. Partial mastectomy was done in seven patients, whereas ten underwent total mastectomy and nine had modified radical mastectomy. Two refused surgery. All margins of resection were negative. In total ten axillary lymph node dissections were done with no positive nodes identified. Pathologic analysis of tumors revealed a variety of sarcomas including high-grade malignant cystosarcoma phyllodes in 13. Recurrence of disease occurred in two women, both with malignant cystosarcoma phyllodes. One was a local recurrence in a patient who had undergone partial mastectomy. This was successfully treated with a total mastectomy. The second recurrence involved a distant metastasis in a patient treated with modified radical mastectomy that eventually led to her death. For the entire group the disease-free survival was 75 per cent at 10 years whereas overall survival was 87.5 per cent. In conclusion an adequate margin of resection is the single most important determinant of long-term survival. Axillary lymph node dissection is not necessary for the treatment of these tumors.

21
UI - 12206612
AU - Shah S; Doyle K; Lange EM; Shen P; Pennell T; Ferree C; Levine EA;
TI - Perrier ND Breast cancer recurrences in elderly patients after lumpectomy.
SO - Am Surg 2002 Aug;68(8):735-9
AD - Department of General Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157, USA.
Approximately half of breast cancers occur in women 65 years or older. Some studies suggest that breast cancer may be a more indolent disease in this group of patients. Debate exists over the appropriate treatment of these women as they are significantly underrepresented in breast cancer research studies. As a result of comorbid conditions and patient refusal many are often treated less aggressively than their younger counterparts. This study investigated the recurrence rate in elderly breast cancer patients who had undergone lumpectomy as their primary treatment at our institution. A chart review was conducted on breast cancer patients treated from January 1, 1995 through September 26, 2000 with lumpectomy performed at Wake Forest University Baptist Medical Center. Study criteria included female gender and age greater than 65 years, first incidence of breast cancer, no evidence of distant disease at presentation, and availability follow-up assessed by clinical examination and mammogram records. Clinical and pathological features and treatments were evaluated. The Cox proportional-hazards model, Fisher's exact test, and analysis of variance were used for statistical analysis. One hundred thirteen patients met study criteria. The stage distribution was as follows: stage 0 (T(IS)), 16 per cent; stage I, 56 per cent; stage IIA, 24 per cent; and stage IIB, 4 per cent. With a median follow up of 30 months six (5%) patients developed locoregional recurrence, four (4%) developed contralateral cancer, and two patients (2%) developed distant disease. Mean time to recurrence was 21 months. No patient has died of breast cancer, but one patient died of a second malignancy. Radiation therapy and tamoxifen decreased recurrence as compared with no adjuvant treatment or with adjuvant radiation only (P < 0.05). We conclude that patients treated with tamoxifen and radiation therapy had a significantly smaller risk of recurrences than those treated with lumpectomy only or those receiving radiation alone. This supports similar treatment patterns recommended for younger patients. Women over 65 years of age should be carefully evaluated for adjuvant therapy.

22
UI - 11936352
AU - D'Amico DF; Parimbelli P; Ruffolo C
TI - Antibiotic prophylaxis in clean surgery: breast surgery and hernia repair.
SO - J Chemother 2001 Nov;13 Spec No 1(1):108-11
AD - Department of Surgery and Gastroenterology, University of Padua, Italy. cc1@ux1.unipd.it
Use of prophylactic antibiotics in clean surgery is still controversial. We reviewed the literature of the last 10 years to identify the best way to approach clean surgery. The question is more important for patients undergoing breast surgery. The presence of an infected breast wound delays the beginning of postoperative adjuvant anticancer therapy: there is good evidence to suggest that delayed adjuvant therapy compromises the outcome for patients in terms of both local control and survival. There are several clinical trials that have addressed the efficacy of prophylactic antibiotics for patients undergoing breast surgery and hernia repair. Platt et al assessed the efficacy of preoperative antibiotic prophylaxis in a clinical trial of 1218 patients undergoing clean surgery with an absolute reduction rate of 39% in wound infections. Gupta et al reported no influence on the incidence of infective complications by antibiotic prophylaxis in 357 patients undergoing elective breast surgery. Like breast surgery, use of prophylaxis in hernia repair is not clear: a prospective, randomized, double-blind, multicenter study of 619 patients assessed no benefit of antibiotic prophylaxis. On the other hand Lewis et al reported a 75% reduction of infections in low-risk patients when a single dose of cefotaxime was used in clean operations. A particularly interesting point is the use of prosthetic mesh in hernia repair and primary reconstructive surgery in breast surgery. Amland et al reported a significant reduction of the incidence of wound infections in a group of patients undergoing reconstructive breast surgery, receiving azithromycin vs placebo (5% vs 20%). In hernia repair we stress the need to prevent wound infections: currently Liechtestein's technique is widely performed all over the world. Mesh infection is an unpleasant event that requires prosthesis removal. The lack of conclusive studies about antibiotic prophylaxis in clean surgery suggests that a single-dose of cephalosporin at the induction of anesthesia may be prudent. This procedure is certainly inexpensive and safe and, more importantly, probably does not have an impact on antibiotic resistance.

23
UI - 12074754
AU - Odling G; Norberg A; Danielson E
TI - Care of women with breast cancer on a surgical ward: nurses' opinions of the need for support for women, relatives and themselves.
SO - J Adv Nurs 2002 Jul;39(1):77-86
AD - Department of Nursing, Umea University, Umea, Sweden. gunvor.odling@mh.se
BACKGROUND: In Sweden women with newly diagnosed breast cancer are admitted to surgical wards in order to undergo surgery and receive postoperative care. On these wards, nursing staff take care of women both with newly diagnosed breast cancer and those with cancer in advanced stages. Nurses have to meet the varying needs of patients and their relatives. AIM: To describe nurses' opinions of the need for care and support for women and their relatives in connection with surgery for breast cancer, as well as their own need for support on a surgical ward. METHODS: Thirty-one nurses from a surgical ward participated in semi-structured interviews. The interviews were tape-recorded and transcribed verbatim. Thereafter a step-by-step, qualitative content analysis was carried out. RESULTS: The nurses described the need to talk and receive information as being the most important among women and their relatives, as well as among themselves. Only a few nurses mentioned the need for physical care among the women. Contact with relatives was described as being almost nonexistent. There was a discrepancy between what nurses described as important needs and how these needs were provided for. CONCLUSION: This study shows that what the nurses described as being the most important needs, and the way how these needs were provided for, was more often seen from a theoretical point of view with few examples of self-experienced situations in the daily care. Needs among women and their relatives seemed to be not fully known to nurses and therefore, possibly, were not met. Nurses themselves had a pronounced need for support, which was sometimes unsatisfactorily met.

24
UI - 12110493
AU - Sinha PS; Thrush S; Bendall S; Bates T
TI - Does radical surgery to the axilla give a survival advantage in more severe breast cancer?
SO - Eur J Cancer 2002 Jul;38(11):1474-7
AD - Breast Unit, William Harvey Hospital, Ashford, TN24 0LZ, Kent, UK.
There is some evidence that more radical treatment of the axilla may improve survival in node-positive disease, but there are concerns about the resultant morbidity from axillary surgery and radiotherapy. The aim of this study was to compare the outcome of axillary node clearance with axillary sampling in similar patients by comparing loco-regional recurrence and overall survival. Patients with invasive breast cancer undergoing axillary surgery between 1986 and 1997 were included. The axillary procedure performed in these patients was either an axillary sample or a level III axillary clearance. To compare like with, the patients were separated into good, moderate and poor prognostic groups by the Nottingham Prognostic Index (NPI) and overall survival was compared by a Kaplan-Meier life table analysis and the log rank test. 734 consecutive patients with operable invasive breast cancer were treated by axillary clearance n=350 or sampling n=384. The mean follow-up in the clearance group was 65 months versus 66 months in the sampled group. Local recurrence in the clearance group was 11% versus 6% in the sampled group, regional recurrence 2% versus 3% and distant metastasis 28% versus 13%. Kaplan-Meier analysis of the three prognostic groups for the clearance versus sampled groups showed no differences in the absolute survival (log rank: P=0.3, P=0.8 and P=0.6 for the good, moderate and poor prognostic groups, respectively). A conservative surgical approach to the axilla did not significantly increase the incidence of local or regional recurrence and the expected survival benefit from a radical axillary clearance was not apparent.

25
UI - 12095964
AU - Beenken SW; Bland KI
TI - Long-term complications of breast-conservation therapy: can the incidence be reduced?
SO - Ann Surg Oncol 2002 Jul;9(6):524-5

26
UI - 12095965
AU - Punglia RS; Harris JR
TI - Integrating surgery and radiotherapy to reduce toxicity while maintaining local control for breast cancer: a fine balance.
SO - Ann Surg Oncol 2002 Jul;9(6):526-8

27
UI - 12095969
AU - Meric F; Buchholz TA; Mirza NQ; Vlastos G; Ames FC; Ross MI; Pollock RE;
TI - Singletary SE; Feig BW; Kuerer HM; Newman LA; Perkins GH; Strom EA; McNeese MD; Hortobagyi GN; Hunt KK Long-term complications associated with breast-conservation surgery and radiotherapy.
SO - Ann Surg Oncol 2002 Jul;9(6):543-9
AD - Department of Surgical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston 77030, USA.
BACKGROUND: Breast-conservation surgery plus radiotherapy has become the standard of care for early-stage breast cancer; we evaluated its long-term complications. METHODS: We selected patients treated with in which standard radiation dosages were used) with follow-up for at least 1 year. Patients were prospectively monitored for treatment-related complications. Median follow-up time was 89 months. RESULTS: A total of 294 patients met the selection criteria. Grade 2 or higher late complications were identified in 29 patients and included arm edema in 13 patients, breast skin fibrosis in 12, decreased range of motion in 4, pneumonitis in 2, neuropathy in 2, fat necrosis in 1, and rib fracture in 1. Arm edema was more common after lumpectomy plus axillary node dissection than after lumpectomy alone. Arm edema occurred in 18% of patients who underwent surgery plus irradiation of the lymph nodes and 10% who underwent surgery without nodal irradiation. CONCLUSIONS: Breast-conservation surgery plus radiotherapy was associated with grade 2 or higher complications in only 9.9% of patients. Half of these complications were attributable to axillary dissection, it is hoped that lower complication rates can be achieved with sentinel lymph node biopsy. Breast-conservation surgery and radiotherapy is associated with grade 2 or greater complications in only 9.9% of patients. Nearly half of these complications are attributable to axillary dissection.

28
UI - 12174947
AU - Nakao A; Saito S; Naomoto Y; Matsuoka J; Tanaka N
TI - Deltopectoral flap for reconstruction of male breast after radical mastectomy for cancer in a patient on hemodialysis.
SO - Anticancer Res 2002 Jul-Aug;22(4):2477-9
AD - Department of Surgery I, Okayama University Medical School, Okayama, Japan. anakao@imap.pitt.edu
A rare case of advanced male breast cancer in a patient on hemodialysis was successfully treated with radical mastectomy and chemotherapy. Computed tomography of the chest revealed multiple pulmonary metastases. After administration of chemotherapy consisting of 5-fluorouracil (4000 mg) and epirubicin (280 mg), the pulmonary metastases disappeared and this was associated with a decrease of serum CEA levels and tumor size. Radical mastectomy and reconstruction for the chest wall defect using a deltopectoral flap (DP flap) were performed. Histopathological examination of the resected specimen showed intraductal adenocarcinoma with nodal metastases. The patient has remained well without clinical recurrence of distant metastasis for a follow-up period of two years. Our experience has demonstrated that the DP flap was a feasible approach in male breast reconstruction despite the debilitated condition of the patient.

29
UI - 12197160
AU - Duskova M
TI - The role of plastic surgery in the complex treatment of breast tumours (review of indications and operations).
SO - Acta Chir Plast 2002;44(2):43-9
AD - Department of Plastic Surgery, 3rd Medical Faculty, Charles University, Prague, Czech Republic.
The indications and possibilities of plastic surgery are detailed for the treatment of benign and malignant breast tumours and precancerous. The necessity of perfect surgical technique and results is emphasized with regard to the somatopsychosocial response of these operations.

30
UI - 11941288
AU - Barillari P; Leuzzi R; D'Angelo F; Bassiri-Gharb A; Naticchioni E
TI - Axillary lymphectomy in breast cancer.
SO - Minerva Chir 2002 Apr;57(2):129-33
AD - IX Patologia Chirurgica, Dipartimento di Chirurgia Pietro Valdoni, Universita degli Studi La Sapienza, Rome, Italy.
BACKGROUND: The aim of the study was to demonstrate the prognostic value of sentinel node biopsy compared to the sampling of clinically suspected nodes and lymphectomy of the 3 axillary levels. METHODS. From October 4 cm or under using different procedures of axillary lymphadenectomy. Sentinel node biopsy was performed using Giuliano's technique, followed by lymph nodes larger than 5 cm (lymph node sampling) and lastly all axillary lymph nodes (axillary lymphectomy at 3 levels). RESULTS: Sentinel nodes were identified in all patients and a mean of 3 sentinel nodes (range 1-5) were removed during the procedure. Histological analysis showed metastatic sentinel nodes in 21 cases. Lymph node sampling was possible in 43 patients who presented enlarged nodes. The mean number of lymph nodes removed was 6 (range 3-10). Lymph node metastasis was found in 10 patients and of these 7 had a metastatic sentinel node, whereas 3 had presented negative results. Histological tests in all 60 cases of complete axillary lymphectomy showed positive results in 4 cases confirming metastasis present in sentinel nodes. CONCLUSIONS: The results show that the association of lymph node sampling can improve the efficacy of sentinel node dissection, highlighting the rare cases of false negatives. In our study, total axillary lymphectomy did not add any information to the N parameter and was resolutive in a small percentage of cases.

31
UI - 12051063
AU - Meijer S; Torrenga H; van der Sijp JR
TI - [Negative sentinel node in breast cancer patients a good indicator for continued absence of axillary metastases]
SO - Ned Tijdschr Geneeskd 2002 May 18;146(20):942-6
AD - VU Medisch Centrum, afd. Chirurgische Oncologie, De Boelelaan 1117, 1081 HV Amsterdam. s.meijer@vumc.nl
OBJECTIVE: To determine the prevalence of axillary recurrences in sentinel-node-negative patients with breast cancer who had no axillary dissection. DESIGN: Follow-up study. METHOD: The first one hundred consecutive sentinel-node-negative patients with a minimal follow-up of 36 months (median 47) were included in this study. All patients underwent sentinel-node biopsy using the triple technique. During the first year after the operation patients were seen on a 3-monthly basis and thereafter every 6 months. RESULTS: Intensive pathological examination of the harvested sentinel nodes revealed no (micro)metastases in any patient. One patient developed an axillary recurrence after 24 months. Three out of the 100 patients developed distant metastases during follow-up; 2 of them died as a result of these metastases. One patient was treated for a local mammary recurrence. In terms of survival the sentinel-node procedure did not appear to be disadvantageous: the 3-year survival rate in our study was 98% for node-negative patients, compared to 88-94% quoted in the literature for node-negative patients after axillary dissection. This apparent improvement may be due to better staging of breast-cancer patients through the use of the sentinel-node procedure (stage migration). CONCLUSION: The triple technique was a reliable method for identifying the sentinel node in breast-cancer patients. Compared to the historical data on node-negative breast cancer, the sentinel-node procedure improved the prognosis of node-negative breast-cancer patients. This effect was probably due to the more accurate staging of breast-cancer patients using the sentinel-node procedure.

32
UI - 12071194
AU - Popken F; Schmidt J; Oegur H; Gohring UJ; Konig DP; Braatz F;
TI - Hackenbroch MH [Treatment outcome after surgical management of osseous breast carcinoma metastases. Preventive stabilization vs. management after pathological fracture]
SO - Unfallchirurg 2002 Apr;105(4):338-43
AD - Klinik und Poliklinik fur Orthopadie, Universitat zu Koln, Josef-Stelzmann-Str. 9, 50924 Koln, Deutschland.
AIM OF THE STUDY, METHOD: The advantages of a prophylactic care of fracture-endangered, osseous metastasis of the mammary cancer stand opposite to the perioperative risk and to conservative alternatives. As a pathologic fracture cannot surely be excluded while performing a conservative proceeding, a retrospective trial was set up to compare the results of treatment after a pathologic fracture (n = 35) with those undergoing a prophylactic attendance (n = 44). RESULTS: The intraoperative, cardio-pulmonary complications were distributed in balance totally amounting to 20.3% (n = 16). Intraoperative complications concerning surgical procedure (n = 3) exclusively occurred within the fracture group. Generally, postoperative complications arose in 20.3% (n = 16) of all cases, in which t

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