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European Journal of Surgical Oncology :... Dec 2020No consensus exists regarding adequacy of margins after mastectomy. To determine if pathological margin proximity is associated with local (LR) or distant recurrence...
BACKGROUND
No consensus exists regarding adequacy of margins after mastectomy. To determine if pathological margin proximity is associated with local (LR) or distant recurrence after mastectomy for early invasive breast cancer or ductal carcinoma in situ.
METHODS
A systematic review of literature published from 1980 to 2019 and meta-analysis was conducted. Unpublished data were sought from authors (PROSPERO (CRD42019127541)). Thirty-four studies comprising 34,833 breast cancer patients were included in the quantitative synthesis. Eligible studies reported on patients undergoing curative mastectomy for cancer allowing estimation of outcomes in relation to margin status/width. The association between pathological margin status and local (LR) and distant recurrence was considered using random effects modelling. PRISMA guidelines were followed.
RESULTS
Positive margins were associated with increased LR on multivariable analyses (HR, 2·64, (95%CI 2·01-3·46)) and LR was higher regardless of the distance of tumour from the margin defined as positive. After skin-sparing mastectomy, positive margins were associated with increased LR (HR 3·40, (95%CI 1·9-6·2)). In the 4 studies reporting distant recurrence, patients with involved margins had a higher risk (HR 1·53, (95%CI 1·03-2·25)).
CONCLUSIONS
Failure to achieve clear margins after mastectomy may increase the risks of local and distant recurrence. Adequate margin clearance should be recommended to minimize recurrence after mastectomy in National and International Guidelines.
Topics: Breast Neoplasms; Carcinoma, Ductal, Breast; Carcinoma, Intraductal, Noninfiltrating; Female; Humans; Margins of Excision; Mastectomy; Neoplasm Metastasis; Neoplasm Recurrence, Local; Proportional Hazards Models
PubMed: 32907774
DOI: 10.1016/j.ejso.2020.08.015 -
Oncotarget Dec 2023To examine the risk factors for arm morbidity following breast cancer treatments, taking a broad view of all types of physical morbidity, including prolonged pain,...
PURPOSE
To examine the risk factors for arm morbidity following breast cancer treatments, taking a broad view of all types of physical morbidity, including prolonged pain, lymphedema, decreased range of motion, and functional limitations.
METHODS
A systematic literature review was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Guidelines. Studies exploring the risk factors for prolonged arm morbidity following breast cancer surgery and treatments were included. The studies were assessed independently according to pre-eligibility criteria, following data extraction and methodological quality assessment.
RESULTS
1,242 articles were identified. After removing duplicates, the full texts of 1,153 articles were examined. Sixty-nine of these articles met the criteria and were included in the review. These 69 articles identified 29 risk factors for arm morbidity following treatments for breast cancer. The risk of bias was evaluated using NIH study quality assessment tools. The studies reviewed were published between 2001 and 2021 and included a total of 22,886 patients who were followed up for between three months and 10 years.
CONCLUSIONS
The main risk factors for long-term morbidity are removal of lymph nodes from the axilla, body mass index >30, having undergone a mastectomy, the stage of the disease, radiation therapy, chemotherapy, infection and trauma to the affected arm after surgery. An understanding of the risk factors for prolonged arm morbidity after surgery can help doctors and therapists in making personalized decisions about the need and timing of rehabilitation treatments.
Topics: Female; Humans; Arm; Breast Neoplasms; Lymph Node Excision; Mastectomy; Morbidity; Risk Factors
PubMed: 38039404
DOI: 10.18632/oncotarget.28539 -
Gland Surgery May 2022With the increasing incidence of breast cancer, breast cancer patients suffered from psychological problems in different degrees. There was no unified conclusion on...
BACKGROUND
With the increasing incidence of breast cancer, breast cancer patients suffered from psychological problems in different degrees. There was no unified conclusion on whether psychological intervention nursing can improve the quality of life (QOL) of breast cancer patients. This meta-analysis aimed to explore the impact of psychological nursing interventions on the quality of life of breast cancer patients.
METHODS
We retrieved related articles from both English databases (including PubMed, Medline, and Embase) and Chinese databases [including China Biology Medicine DISC (CBMdisc), China National Knowledge Network (CNKI), Wanfang, and China Science and Technology Journal Database (VIP]. All of the databases were searched using a combination of the following search terms: psychological intervention nursing, psychological nursing, psychotherapy, breast loss, radical mastectomy, modified radical mastectomy, and quality of life. The quality of the included literature was assessed using RevMan 5.3 provided by the Cochrane system.
RESULTS
A total of 12 articles were included, and the meta-analysis results showed that the quality of life questionnaire core 30 (QLQ-C 30) was evaluated, and there was heterogeneity among the studies (P<0.00001, I=92%). There was no statistical difference between the intervention group and the control group [standardized mean difference (SMD) =0.58, 95% confidence interval (CI): -0.11-1.27, P=0.10]. Short Form 36 Questionnaire (SF-36) was evaluated, and there was no heterogeneity among the studies (P=0.40, I=0%). The fixed effect model was used for Meta-analysis. There were statistical differences between the intervention group and the control group [mean difference (MD) =6.12, 95% CI: 5.17-7.06, P<0.00001]. According to the evaluation of functional assessment of cancer therapy (FACT), there is heterogeneity among the studies (P=0.003, I=83%). There were statistical differences between the intervention group and the control group (MD =12.74, 95% CI: 6.34-19.14, P<0.0001).
DISCUSSION
Psychological nursing intervention can significantly improve the quality of life of patients with missing breasts undergoing radical mastectomy, which has certain guiding significance for the formulation of clinically effective nursing measures.
PubMed: 35694086
DOI: 10.21037/gs-22-206 -
Annals of Surgical Oncology Jan 2023Implant-based breast reconstruction (IBBR) remains the standard and most popular option for women undergoing breast reconstruction after mastectomy worldwide. Recently,... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Implant-based breast reconstruction (IBBR) remains the standard and most popular option for women undergoing breast reconstruction after mastectomy worldwide. Recently, prepectoral IBBR has resurged in popularity, despite limited data comparing prepectoral with subpectoral IBBR.
METHODS
A systematic search of PubMed and Cochrane Library from January 1, 2011 to December 31, 2021, was performed following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) reporting guidelines, data were extracted by independent reviewers. Studies that compared prepectoral with subpectoral IBBR for breast cancer were included.
RESULTS
Overall, 15 studies with 3,101 patients were included in this meta-analysis. Our results showed that patients receiving prepectoral IBBR experienced fewer capsular contractures (odds ratio [OR], 0.54; 95% confidence interval [CI], 0.32-0.92; P = 0.02), animation deformity (OR, 0.02; 95% CI, 0.00-0.25; P = 0.002), and prosthesis failure (OR, 0.58; 95% CI, 0.42-0.80; P = 0.001). There was no significant difference between prepectoral and subpectoral IBBR in overall complications (OR, 0.83; 95% CI, 0.64-1.09; P = 0.19), seroma (OR, 1.21; 95% CI, 0.59-2.51; P = 0.60), hematoma (OR, 0.76; 95% CI, 0.49-1.18; P = 0.22), infection (OR, 0.87; 95% CI, 0.63-1.20; P = 0.39), skin flap necrosis (OR, 0.70; 95% CI, 0.45-1.08; P = 0.11), and recurrence (OR, 1.31; 95% CI, 0.52-3.39; P = 0.55). Similarly, no significant difference was found in Breast-Q scores between the prepectoral and subpectoral IBBR groups.
CONCLUSIONS
The results of our systematic review and meta-analysis demonstrated that prepectoral, implant-based, breast reconstruction is a safe modality and has similar outcomes with significantly lower rates of capsular contracture, prosthesis failure, and animation deformity compared with subpectoral, implant-based, breast reconstruction.
Topics: Female; Humans; Breast Neoplasms; Mammaplasty; Mastectomy; Prosthesis Failure
PubMed: 36245049
DOI: 10.1245/s10434-022-12567-0 -
Journal of Plastic, Reconstructive &... Nov 2023Animal-derived acellular dermal matrices (ADMs) are increasingly being used in prepectoral direct-to-implant (DTI) breast reconstruction. However, the indications and... (Review)
Review
BACKGROUND
Animal-derived acellular dermal matrices (ADMs) are increasingly being used in prepectoral direct-to-implant (DTI) breast reconstruction. However, the indications and complication profile associated with this type of reconstruction remain unclear. This study aimed to perform a systematic review of the available literature on the use of animal-derived ADM in prepectoral DTI breast reconstruction.
METHODS
Three different literature databases, namely, PubMed, Web of Sciences, and Embase were screened using the following keywords: "immediate" AND "pre-pectoral" OR "prepectoral" AND "ADM breast reconstruction." Animal-derived ADM used (porcine - Braxon® and non-Braxon® - and bovine - Surgimend®) anthropometric information, clinical data, and complications profile were considered.
RESULTS
A total of 340 articles were initially identified, of which only 45 articles (5089 patients and 6598 reconstructed breasts) satisfied our inclusion criteria. The most widely used ADM was Braxon® in the context of conservative mastectomies. In most studies, a subcutaneous layer > 1 cm and lack of previous radiotherapy were considered prerequisites for this type of reconstruction. An increased risk of complications was found in smokers, patients who underwent radiation treatment, patients with high breast volumes, and patients with cancers requiring axillary dissection. Data related to the role of diabetes, high body mass index, and breast implant size on surgical outcomes were instead inconcludent. Age was not directly proportional to the complications.
CONCLUSION
The complications associated with different animal-derived ADMs are generally comparable. The profile of patients required for eligibility for this type of reconstruction appears to have been identified and is in line with current recommendations.
Topics: Humans; Animals; Cattle; Swine; Female; Mastectomy; Acellular Dermis; Breast Neoplasms; Mammaplasty; Breast Implantation; Breast Implants; Retrospective Studies
PubMed: 37716255
DOI: 10.1016/j.bjps.2023.08.020 -
European Journal of Surgical Oncology :... Nov 2023This systematic review and meta-analysis aimed to synthesize the evidence on the preoperative characteristics, operative outcomes, and postoperative complications of... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
This systematic review and meta-analysis aimed to synthesize the evidence on the preoperative characteristics, operative outcomes, and postoperative complications of simple and complex segmentectomy for lung cancer.
METHODS
A systematic review of EMBASE (through Ovid), MEDLINE (via PubMed), and Cochrane CENTRAL (January 1990 - January 2023) was done. We included studies to compare simple versus complex segmentectomies for lung cancer in terms of characteristics and operative and postoperative outcomes.
RESULTS
There was a statistically significant difference regarding higher operative time in favor of simple segmentectomies (Mean Difference, MD = 15.76, 95% Confidence Interval, CI: 2.46 - 29.07, p = 0.02). The incidence of postoperative complications did not change between the two groups (Risk Ratio, RR = 0.86, 95% CI: 0.66 - 1.13, p = 0.27). There were no significant differences regarding postoperative length of hospital stay between simple or complex segmentectomies (MD = -0.02, 95% CI: 0.56 - 0.51, p = 0.93).
CONCLUSIONS
Simple and complex segmentectomies have comparable postoperative outcomes; in particular, postoperative complication rates and length of hospital stay were similar. Complex segmentectomies were associated with a longer operative time.
Topics: Humans; Lung Neoplasms; Mastectomy, Segmental; Postoperative Complications; Length of Stay
PubMed: 37778194
DOI: 10.1016/j.ejso.2023.107101 -
Plastic and Reconstructive Surgery.... May 2024Nipple adenomas (NAs) are rare benign proliferative tumors presenting as palpable nodules, erosive lesions, or nipple discharge, mimicking other conditions. This...
BACKGROUND
Nipple adenomas (NAs) are rare benign proliferative tumors presenting as palpable nodules, erosive lesions, or nipple discharge, mimicking other conditions. This systematic review categorizes cases into sole NA (ONA) or co-diagnoses with other conditions (CONA) to enhance clinical recognition, diagnosis, and treatment efficacy.
METHODS
Following PRISMA guidelines, a PubMed search was conducted for NA. Inclusion criteria covered original research, excluding reviews or other breast diseases. Bias risk was assessed through a thorough search, authors independently evaluated studies, and data were synthesized using varied measures. Subgroups ONA and CONA were formed. Analyses were conducted in Excel and R, complemented by a qualitative review due to case report predominance. Biases in case reports were transparently addressed.
RESULTS
Of the 86 studies, 387 cases were analyzed, showing 10.34% with co-diagnoses of malignant or premalignant conditions. Mean age was 44, with a female predominance (97%). ONA (347 cases) and CONA (40 cases) subgroups exhibited variations in symptoms, physical findings, and imaging. Treatment modalities included excision (51.39%), biopsy alone (11.1%), and mastectomy (8.6%). Mean follow-up of 56.73 months revealed recurrence (2.87%) and malignancy development (1.79%), notably in CONA cases (33.33%).
CONCLUSIONS
This study provides insights into the broader age range of NA and its associations. Higher co-diagnosis rates were correlated with older age, highlighting the necessity for thorough investigation, with excision as the primary treatment. Follow-up emphasizes the significance of identifying and monitoring CONA cases, which pose a higher malignancy risk. Recurrence is presumed to be linked to proper lesion excision and co-diagnosis.
PubMed: 38798941
DOI: 10.1097/GOX.0000000000005827 -
Journal of Plastic, Reconstructive &... Mar 2021Post-mastectomy breast reconstruction (PMBR) is an important component of the multidisciplinary care of breast cancer patients. Despite the improved quality of life,...
INTRODUCTION
Post-mastectomy breast reconstruction (PMBR) is an important component of the multidisciplinary care of breast cancer patients. Despite the improved quality of life, significant racial disparities exist in the receipt of PMBR. Given the increasing population of Black, Asian and minority ethnic (BAME) women in UK, it is important to address this disparity. Our review aims to identify the barriers and facilitators influencing the uptake of PMBR in BAME women and raise awareness for physicians on interventions that could improve uptake of PMBR in BAME women.
METHODS
The methodology outlined by the Cochrane guidelines was used to structure this systematic review. Systematic searches for qualitative studies on barriers and/or facilitators to PMBR in ethnic women published in English were conducted. The following databases were searched from their inception up to June 2019: MEDLINE, EMBASE, PubMed, Cochrane Library, Google Scholar and Scopus. Reference lists of all included articles and relevant systematic reviews were also hand-searched for possible additional publications. Publication year or status restrictions were not applied. Only full text articles published in English and by peer reviewed journals are included. Exclusion criteria were as follows: quantitative studies on barriers and/or facilitators to PMBR, abstracts, conference proceedings, non-English language and non-specific to BAME women. A thematic synthesis approach was used through the development of sub-themes and themes from the findings of the included qualitative studies.
RESULTS
Five studies satisfied the inclusion and exclusion criteria. Three overarching themes emerged from our review: physician-associated factors (physician recommendations), patient-associated factors (knowledge, language, community and cultural, emotions, logistics, patient characteristics) and system-associated factors (insurance coverage, income status).
CONCLUSION
Our systematic review suggests that there is a paucity of data in the literature on the barriers and facilitators to PMBR in BAME women. Considering the expanding population of BAME women and increasing breast cancer incidence, it is imperative that future research in this field is carried out. Physician and patient-associated factors were identified as the most important yet modifiable factors. Adopting a combination of culturally tailored interventions targeting these factors may help improve the access of PMBR in BAME women.
REGISTRATION
Prospero ID: CRD42019133233.
Topics: Breast Neoplasms; Culturally Competent Care; Ethnicity; Female; Humans; Mammaplasty; Mastectomy; Patient Acceptance of Health Care; Quality of Life
PubMed: 33309318
DOI: 10.1016/j.bjps.2020.10.055 -
JPRAS Open Mar 2022Post-mastectomy pain syndrome (PMPS) is a surgical complication of breast surgery characterized by chronic neuropathic pain. The development of PMPS is multifactorial...
BACKGROUND
Post-mastectomy pain syndrome (PMPS) is a surgical complication of breast surgery characterized by chronic neuropathic pain. The development of PMPS is multifactorial and research on its prevention is limited. The objective of this systematic review is to synthesize the existing evidence on interventions for lowering the incidence of persistent neuropathic pain after breast surgery.
METHODS
Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we performed a comprehensive search of the electronic databases of MEDLINE, Cochrane Library, Embase, CINAHL, PsycINFO, Web of Science, and ClinicalTrials.gov using a combination of database-specific controlled vocabulary and keyword searches. Two reviewers independently screened all unique records. Publications on chronic (>3-month duration) pain after breast cancer-related surgery were included. Studies were classified by modality.
RESULTS
Our literature search yielded 7092 articles after deduplication. We identified 45 studies that met final inclusion criteria for analysis, including 37 randomized-controlled trials. These studies revealed seven major intervention modalities for prevention of PMPS: physical therapy, mindfulness-based cognitive therapy, oral medications, surgical intervention, anesthesia, nerve blocks, and topical medication therapy.
CONCLUSION
High-quality data on preventative techniques for PMPS are required to inform decisions for breast cancer survivors. We present a comprehensive assessment of the modalities available that can help guide breast and reconstructive surgeons employ effective strategies to lower the incidence and severity of PMPS. Our review supports the use of multimodal care involving both a peripherally targeted treatment and centrally acting medication to prevent the development of PMPS.
PubMed: 34926777
DOI: 10.1016/j.jpra.2021.10.009 -
Breast (Edinburgh, Scotland) Apr 2021The non-inferiority of combined breast conservation surgery (BCS) and radiotherapy (breast conservation therapy or BCT) compared to mastectomy in sporadic breast cancer... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The non-inferiority of combined breast conservation surgery (BCS) and radiotherapy (breast conservation therapy or BCT) compared to mastectomy in sporadic breast cancer cases is well recognised. Uncertainty remains regarding optimal surgical practice in BRCA mutation carriers.
AIMS
To evaluate the oncological safety of combined BCT versus mastectomy in BRCA mutation carriers following breast cancer diagnosis.
METHODS
A systematic review was performed as per PRISMA and MOOSE guidelines. Observational studies comparing BCS and mastectomy in BRCA carriers were identified. Dichotomous variables were pooled as odds ratios (OR) using the Mantel-Haenszel method. Log hazard ratios (lnHR) for locoregional recurrence (LRR), contralateral breast cancer, disease-free and overall survival and their standard errors were calculated from Kaplan-Meier or cox-regression analyses and pooled using the inverse variance method.
RESULTS
Twenty three studies of 3807 patients met inclusion criteria; 2200 (57.7%) were BRCA1 and 1212 (31.8%) were BRCA2 carriers. Median age at diagnosis was 41 years with 96 months follow up. BCS was performed on 2157 (56.7%) while 1408 (41.5%) underwent mastectomy. An increased risk of LRR was observed in patients treated with BCS (HR:4.54, 95% Confidence Interval: 2.77-7.42, P < 0.001, heterogeneity (I) = 0%). However, the risks of contralateral breast cancer (HR:1.51, 95%CI: 0.44-5.11, P = 0.510, I = 80%), disease recurrence (HR:1.16, 95%CI: 0.78-1.72, P = 0.470, I = 44%), disease-specific recurrence (HR:1.58, 95%CI: 0.79-3.15, P = 0.200, I = 38%) and death (HR:1.10, 95%CI: 0.72-1.69, P = 0.660, I = 38%) were equivalent for combined BCT and mastectomy.
CONCLUSIONS
Survival outcomes following combined BCT is comparable to mastectomy in BRCA carriers. However, the risk of LRR is increased. Patient counselling should be tailored to incorporate these findings.
Topics: Breast Neoplasms; Female; Genes, BRCA2; Humans; Mastectomy; Mastectomy, Segmental; Mutation; Neoplasm Recurrence, Local; Radiotherapy, Adjuvant
PubMed: 33582622
DOI: 10.1016/j.breast.2021.02.001