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Cancers Apr 2021use of fibrin sealants following pelvic, paraaortic, and inguinal lymphadenectomy may reduce lymphatic morbidity. The aim of this meta-analysis is to evaluate if this... (Review)
Review
BACKGROUND
use of fibrin sealants following pelvic, paraaortic, and inguinal lymphadenectomy may reduce lymphatic morbidity. The aim of this meta-analysis is to evaluate if this finding applies to the axillary lymphadenectomy.
METHODS
randomized trials evaluating the efficacy of fibrin sealants in reducing axillary lymphatic complications were included. Lymphocele, drainage output, surgical-site complications, and hospital stay were considered as outcomes.
RESULTS
twenty-three randomized studies, including patients undergoing axillary lymphadenectomy for breast cancer, melanoma, and Hodgkin's disease, were included. Fibrin sealants did not affect axillary lymphocele incidence nor the surgical site complications. Drainage output, days with drainage, and hospital stay were reduced when fibrin sealants were applied ( < 0.0001, < 0.005, = 0.008).
CONCLUSION
fibrin sealants after axillary dissection reduce the total axillary drainage output, the duration of drainage, and the hospital stay. No effects on the incidence of postoperative lymphocele and surgical site complications rate are found.
PubMed: 33923153
DOI: 10.3390/cancers13092056 -
European Journal of Surgical Oncology :... Aug 2021Primary endocrine therapy as treatment of breast cancer is only recommended in older women with limited life expectancy. However, many older women opt for endocrine...
Primary endocrine therapy as treatment of breast cancer is only recommended in older women with limited life expectancy. However, many older women opt for endocrine therapy due to concerns regarding frailty and potential decline in function after surgery. A decline in functional status after surgery is documented in some cancer types, such as colorectal, however, the full impact of breast cancer surgery is less understood. A systematic review was performed to examine the evidence for impact of breast cancer surgery on functional status in older women. PubMed and Embase databases were searched. Studies were eligible if performed within the last 10 years; included patients over the age of 65 years undergoing breast cancer surgery; included stratification of results by age; measured functional status pre-operatively and at least six months following surgery. A total of 11 studies including 12 030 women were appraised. Two studies represented level-II and nine level-IV evidence. Overall, physical activity level was negatively impacted by breast cancer surgery and this was compounded by the extent of surgery. Evidence for impact of breast cancer surgery on quality of life, fatigue and cognition, was conflicting. The possibility of decline in functional status after breast cancer surgery should be discussed in all older women considering surgery. A structured exercise program may improve the negative effects of surgery on physical activity. Further work is required in the areas of quality of life, fatigability and cognition.
Topics: Activities of Daily Living; Aged; Axilla; Breast Neoplasms; Exercise; Fatigue; Female; Functional Status; Humans; Lymph Node Excision; Mastectomy; Mastectomy, Segmental; Postoperative Cognitive Complications; Postoperative Complications; Quality of Life
PubMed: 33875285
DOI: 10.1016/j.ejso.2021.04.010 -
Breast Care (Basel, Switzerland) Feb 2021Breast cancer represents the most common type of cancer among women in the world. The presence and extent of axillary lymph node involvement represent an important...
INTRODUCTION
Breast cancer represents the most common type of cancer among women in the world. The presence and extent of axillary lymph node involvement represent an important prognostic factor. Sentinel lymph node biopsy (SLNB) is currently accepted for T1 and T2 with negative axillae (N0); however, many patients with T3-T4b tumors with N0 are often submitted to unnecessarily axillary lymph node dissection.
MATERIALS AND METHODS
This is a retrospective, observational study of patients treated for breast cancer between 2008 and 2015, with T3/T4b tumors and N0, who underwent SLNB. A systematic review of the literature was also carried out in 5 bases.
RESULTS
We analyzed 73 patients, and SLNB was negative for macrometastasis in 60.3% of the cases. With a mean follow-up of 45 months, no ipsilateral axillary local recurrence was observed. In the systematic review, only 7 articles presented data for analysis. Grouping these studies with the present series, the rate of N0 was 32.1% for T3 and 61.0% for T4b; grouping all studies (T3 and T4b = 431) the rate was 32.5%.
CONCLUSIONS
SLNB in T3/T4b tumors is a feasible and safe procedure from the oncological point of view, as it has not been associated with ipsilateral axillary relapse.
PubMed: 33716629
DOI: 10.1159/000504693 -
Breast Cancer Research and Treatment Apr 2021Marking of cytology-proven metastatic axillary lymph node in breast cancer patients before neoadjuvant treatment and its subsequent surgical retrieval have been shown to... (Review)
Review
BACKGROUND
Marking of cytology-proven metastatic axillary lymph node in breast cancer patients before neoadjuvant treatment and its subsequent surgical retrieval have been shown to reduce the false-negative rate of sentinel lymph node biopsy. A systematic review was performed to evaluate different strategies in nodal marking and localization.
METHODS
PubMed, Embase, EBSCOhost, and the Cochrane library literature databases were searched systematically to address the identification rate and retrieval rate of marked axillary lymph nodes. Studies were eligible if they performed nodal marking before neoadjuvant treatment, followed by selective extirpation of these marked axillary lymph nodes in definitive surgery RESULTS: Fifteen studies with a total of 703 patients were included. Index axillary lymph nodes were marked by clips or tattooed prior to the commencement of neoadjuvant treatment. In our pooled analysis, eighty-eight percent of the clipped nodes and ninety-seven percent of the tattooed nodes were successfully retrieved. Among these patients, seventy-seven percent of these marked axillary lymph nodes were also sentinel lymph nodes.
CONCLUSION
Marking and selectively removing cytology-proven metastatic axillary lymph nodes after neoadjuvant treatment is feasible. An acceptably high nodal retrieval rate could be achieved using various methods of nodal marking and localization techniques.
Topics: Axilla; Breast Neoplasms; Female; Humans; Lymph Node Excision; Lymph Nodes; Neoadjuvant Therapy; Neoplasm Staging; Sentinel Lymph Node Biopsy
PubMed: 33611665
DOI: 10.1007/s10549-021-06118-6 -
European Journal of Surgical Oncology :... Jul 2021Axillary surgery is still essential in the management of early breast cancer. Conservative procedures like sentinel lymph node biopsy (SLNB) are less invasive than the...
PURPOSE
Axillary surgery is still essential in the management of early breast cancer. Conservative procedures like sentinel lymph node biopsy (SLNB) are less invasive than the traditional axillary node dissection (ALND). However, some extent of ipsilateral upper limb dysfunction might still occur. This systematic review aimed to describe the incidence of lymphedema, pain, sensory, and motor disorders after SLNB in women with early breast cancer.
METHODS
We conducted a systematic review of randomized controlled trials. The search was performed on Pubmed, EMBASE, CINAHAL, and Web of Science. The search was based on the following concepts: breast cancer, sentinel lymph node biopsy, axillary dissection, upper limb complications. The risk of bias was evaluated using the Cochrane Rob 2.0 toll.
RESULTS
We obtained 979 unique registries from the primary search and 381 additional records from the included articles' reference lists. Fifty-one articles were assessed as full text. Nine studies were included in the review. A total of 5161 patients undergone SLNB, and 4110 patients were assessed for ipsilateral arm complications. Six months after the surgery, 0-11% of patients presented lymphedema, 11-16% pain, 2-22% sensory disorders, and 0-9% motor disorders.
CONCLUSIONS
SLNB was associated with persistent postoperative complications. The burden of complications, although lower when compared to ALND, should not be ignored.
PROTOCOL REGISTRATION
PROSPERO registration number CRD42018090540, registered July 09, 2018.
Topics: Breast Neoplasms; Clinical Trials as Topic; Female; Humans; Lymphedema; Pain Measurement; Postoperative Complications; Sensation Disorders; Sentinel Lymph Node Biopsy; Upper Extremity
PubMed: 33549375
DOI: 10.1016/j.ejso.2021.01.024 -
The Breast Journal Feb 2021Axillary lymph node dissection (ALND) in early-stage breast cancer with limited sentinel node metastasis may not be superior to sentinel lymph node dissection (SLND). We... (Meta-Analysis)
Meta-Analysis
Axillary lymph node dissection (ALND) in early-stage breast cancer with limited sentinel node metastasis may not be superior to sentinel lymph node dissection (SLND). We performed a meta-analysis comparing SLND/Radiotherapy (RT) with ALND. All data were analyzed using Review Manager Software 5.3. Five randomized controlled trials (RCTs) were included. Overall survival, death, and disease-free survival were estimated higher in the SLND group compared to the ALND group. Statistically significant differences in axillary recurrence were observed in favor of ALND. Omission of ALND in patients with <3 positive SLNs is indicated.
Topics: Axilla; Breast Neoplasms; Female; Humans; Lymph Node Excision; Lymphatic Metastasis; Neoplasm Recurrence, Local; Sentinel Lymph Node Biopsy
PubMed: 33368762
DOI: 10.1111/tbj.14140 -
Clinical Breast Cancer Jun 2021Although arm lymphedema following breast cancer treatment is a common complication; breast lymphedema following treatment is not uncommon. Several risk factors were...
Although arm lymphedema following breast cancer treatment is a common complication; breast lymphedema following treatment is not uncommon. Several risk factors were found to contribute to breast lymphedema, including axillary surgery, high body mass index (BMI), increased bra cup size, adjuvant chemotherapy, locoregional and radiotherapy boost, and upper outer quadrant tumors. We aimed to provide a review to help avoiding or management of breast lymphedema. The search term 'breast lymphedema' was combined with 'breast conservative surgery' and was used to conduct a literature research in PubMed and Medline. The term lymphedema was combined with breast, conservative, and surgery to search the Embase database. All papers published in English were included with no exclusion date limits. A total of 2155 female patients were included in this review; age ranged from 26 to 90 years. The mean BMI was 28.4 of the studies that included patients who underwent conservative breast surgery. Incidence of breast lymphedema ranged from 24.8% to 90.4%. Several risk factors were linked to breast lymphedema after conservative breast surgery, such as BMI, breast size, tumor size, tumor site, type of surgery, and adjuvant therapy. Treatment options focused on decongestive lymphatic therapy, including manual lymphatic drainage, self-massaging, compression bras, or Kinesio taping. Breast lymphedema is a relatively common complication, yet there is no clear consensus on the definition or treatment options.
Topics: Body Mass Index; Breast Neoplasms; Chemotherapy, Adjuvant; Combined Modality Therapy; Female; Humans; Lymph Node Excision; Lymphedema; Mastectomy; Risk Assessment; Risk Factors
PubMed: 33358602
DOI: 10.1016/j.clbc.2020.11.017 -
European Journal of Surgical Oncology :... Apr 2021Seroma is a common complication after mastectomy. The aim of this review is to elucidate whether closed suction drainage can safely be omitted in patients undergoing...
BACKGROUND
Seroma is a common complication after mastectomy. The aim of this review is to elucidate whether closed suction drainage can safely be omitted in patients undergoing mastectomy when assessing seroma formation and its complications. The second aim is to assess the influence of flap fixation on seroma related complications, as there is existing evidence showing that combining mastectomy with flap fixation may make the use of drainage systems obsolete.
SEARCH & SELECTION
A review of the literature was performed and articles that compared mastectomy with drainage and mastectomy without drainage were selected. Due to the small number of eligible studies, no selection based on whether flap fixation was performed was possible. If outcome was described in terms of seroma formation or seroma related complications, papers were eligible for inclusion. Studies older than 20 years, animal studies, studies not written in English and studies with male patients were excluded.
RESULTS
A total of eight articles were eligible for inclusion. Four prospective studies and four retrospective studies were included. In four studies, flap fixation was performed. Frequency of seroma formation as well as seroma that required intervention was reported. The included studies demonstrated that omitting closed suction drainage does not lead to a higher incidence of seroma formation in patients undergoing mastectomy.
CONCLUSION
Despite substantial heterogeneity, there is evidence that drainage can safely be omitted without exacerbating seroma formation and its complications. A well-powered, randomized controlled trial evaluating the effect of drainage omission on seroma formation, with or without flap fixation, is needed.
Topics: Axilla; Breast Neoplasms; Drainage; Female; Humans; Lymph Node Excision; Mastectomy; Postoperative Complications; Sentinel Lymph Node Biopsy; Seroma; Surgical Flaps; Surgical Wound Infection; Sutures
PubMed: 33051116
DOI: 10.1016/j.ejso.2020.10.010 -
Breast (Edinburgh, Scotland) Oct 2020The axillary reverse mapping (ARM) technique, identify and preserve arm nodes during sentinel lymph node biopsy (SLNB) or axillary lymph node dissection (ALND), was... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The axillary reverse mapping (ARM) technique, identify and preserve arm nodes during sentinel lymph node biopsy (SLNB) or axillary lymph node dissection (ALND), was developed to prevent breast-cancer related lymphedema (BCRL) remains controversial.
METHODS
A comprehensive search of Medline Ovid, Pubmed, Web of Science and the Cochrane CENTRAL databases was conducted from the inception till January 2020. The key word including "breast cancer", "axillary reverse mapping", and "lymphedema". Stata 15.1 software was used for the meta-analysis.
RESULTS
As a result, twenty-nine related studies involving 4954 patients met our inclusion criteria. The pooled overall estimate lymphedema incidence was 7% (95% CI 4%-11%, I = 90.35%, P < 0.05), with SLNB showed a relatively lower pooled incidence of lymphedema (2%, 95% CI 1%-3%), I = 26.06%, P = 0.23) than that of ALND (14%, 95% CI 5%-26%, I = 93.28%, P < 0.05) or SLNB and ALND combined (11%, 95% CI 1%-30%). The ARM preservation during ALND procedure could significantly reduce upper extremity lymphedema in contrast with ARM resection (OR = 0.27, 95% CI 0.20-0.36, I = 31%, P = 0.161). Intriguingly, the result favored ALND-ARM over standard-ALND in preventing lymphedema occurrence (OR = 0.21, 95% CI 0.14-0.31, I = 43%, P = 0.153). The risk of metastases in the ARM-nodes was not significantly lower in the patients who had received neoadjuvant chemotherapy, as compared to those without neoadjuvant treatment (OR = 1.20, 95% CI 0.74-1.94, I = 49.4%, P = 0.095).
CONCLUSIONS
ARM was found to significantly reduce the incidence of BCRL. The selection of patients for this procedure should be based on their axillary nodal status. Preoperative neoadjuvant chemotherapy has no significant impact on the ARM lymph node metastasis rate.
Topics: Adult; Aged; Axilla; Breast Cancer Lymphedema; Breast Neoplasms; Female; Humans; Incidence; Lymph Node Excision; Lymph Nodes; Lymphatic Metastasis; Middle Aged; Postoperative Complications; Risk Assessment; Sentinel Lymph Node Biopsy
PubMed: 32858404
DOI: 10.1016/j.breast.2020.08.007 -
Annals of Surgical Oncology Feb 2021After the publication of the Z0011 trial, the American Society of Clinical Oncology published an updated clinical practice guideline stating that clinicians should not... (Meta-Analysis)
Meta-Analysis
Axillary Management in Women with Early Breast Cancer and Limited Sentinel Node Metastasis: A Systematic Review and Metaanalysis of Real-World Evidence in the Post-ACOSOG Z0011 Era.
BACKGROUND
After the publication of the Z0011 trial, the American Society of Clinical Oncology published an updated clinical practice guideline stating that clinicians should not recommend axillary lymph node dissection (ALND) for early-stage breast cancer patients with the involvement of one or two sentinel lymph nodes (SLNs). However, these recommendations have been challenged because they were mainly based on data from limited studies. The aim of the current study is to systematically compare the real-world outcomes of SLN biopsy (SLNB) alone and SLNB + ALND in patients with early-stage breast cancers and limited positive SLN metastasis in the post-Z0011 era PATIENTS AND METHODS: We searched articles in the PubMed, EMBASE, and Cochrane library databases. The primary endpoints were overall survival (OS) and disease-free survival (DFS). The secondary endpoints were recurrence rate and the incidence of lymphedema.
RESULTS
One randomized controlled trial and six retrospective studies with 8864 patients were retrieved. For patients with early-stage breast cancer with one or two SLN metastases, receiving SLNB alone showed no significant difference in OS, DFS, and recurrence rate compared with receiving SLNB + ALND. The incidence of lymphedema in patients who received SLNB alone was significantly lower than those who received SLNB + ALND (odds ratio 1.95, 95% confidence interval 1.02-3.71).
CONCLUSIONS
Current real-world evidence proved that the Z0011 strategy is safe with respect to survival outcomes and effective in reducing the incidence of lymphedema. ALND should be avoided in patients with early-stage breast cancer with one or two SLN metastases in the post-Z0011 era.
Topics: Axilla; Breast Neoplasms; Female; Humans; Lymph Node Excision; Neoplasm Recurrence, Local; Randomized Controlled Trials as Topic; Retrospective Studies; Sentinel Lymph Node; Sentinel Lymph Node Biopsy
PubMed: 32705512
DOI: 10.1245/s10434-020-08923-7