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The New England Journal of Medicine Oct 2002We conducted 20 years of follow-up of women enrolled in a randomized trial to compare the efficacy of radical (Halsted) mastectomy with that of breast-conserving surgery. (Comparative Study)
Comparative Study
BACKGROUND
We conducted 20 years of follow-up of women enrolled in a randomized trial to compare the efficacy of radical (Halsted) mastectomy with that of breast-conserving surgery.
METHODS
From 1973 to 1980, 701 women with breast cancers measuring no more than 2 cm in diameter were randomly assigned to undergo radical mastectomy (349 patients) or breast-conserving surgery (quadrantectomy) followed by radiotherapy to the ipsilateral mammary tissue (352 patients). After 1976, patients in both groups who had positive axillary nodes also received adjuvant chemotherapy with cyclophosphamide, methotrexate, and fluorouracil.
RESULTS
Thirty women in the group that underwent breast-conserving therapy had a recurrence of tumor in the same breast, whereas eight women in the radical-mastectomy group had local recurrences (P<0.001). The crude cumulative incidence of these events was 8.8 percent and 2.3 percent, respectively, after 20 years. In contrast, there was no significant difference between the two groups in the rates of contralateral-breast carcinomas, distant metastases, or second primary cancers. After a median follow-up of 20 years, the rate of death from all causes was 41.7 percent in the group that underwent breast-conserving surgery and 41.2 percent in the radical-mastectomy group (P=1.0). The respective rates of death from breast cancer were 26.1 percent and 24.3 percent (P=0.8).
CONCLUSIONS
The long-term survival rate among women who undergo breast-conserving surgery is the same as that among women who undergo radical mastectomy. Breast-conserving surgery is therefore the treatment of choice for women with relatively small breast cancers.
Topics: Antineoplastic Combined Chemotherapy Protocols; Breast Neoplasms; Combined Modality Therapy; Female; Follow-Up Studies; Humans; Incidence; Mastectomy, Radical; Mastectomy, Segmental; Neoplasm Metastasis; Neoplasm Recurrence, Local; Neoplasms, Second Primary; Randomized Controlled Trials as Topic; Survival Rate
PubMed: 12393819
DOI: 10.1056/NEJMoa020989 -
Chirurgia (Bucharest, Romania : 1990) 2014The present paper is a presentation of our technique of axillopexy, used after the excision of the axillary lymph nodes in 29 cases of breast cancer patients. We have...
The present paper is a presentation of our technique of axillopexy, used after the excision of the axillary lymph nodes in 29 cases of breast cancer patients. We have used this technique after Madden modified radical mastectomy or after quadrantectomy for tumors in the external quadrants of the mammary gland. We have studied and compared with a 30 case control group, the duration of the lymphorrhagia the moment of removing the drains, the presence absence of other local complications. We have also measured the time until the beginning of the oncological postoperative therapy. Every one of the aspects we have studied was improved in the axillopexy group.
Topics: Axilla; Breast Neoplasms; Case-Control Studies; Drainage; Female; Humans; Lymph Node Excision; Mastectomy, Modified Radical; Mastectomy, Segmental; Romania; Treatment Outcome
PubMed: 25149619
DOI: No ID Found -
Frontiers in Surgery 2022A less-invasive surgery is often required today for many tumors, when oncologic radicality is strictly ensured, both to minimize hospital stay and health costs and to...
BACKGROUND
A less-invasive surgery is often required today for many tumors, when oncologic radicality is strictly ensured, both to minimize hospital stay and health costs and to guarantee aesthetical results. Breast surgery for cancer has been radically changed in the last years since conservative interventions are widely performed everywhere.
METHODS
The authors present 75 cases of early breast cancer, randomly treated with standard quadrantectomy and subcutaneous quadrantectomy; the totally subcutaneous surgical technique implies only a short periareolar skin incision and a complete quadrant resection with skin and subcutaneous layer preservation. Continuous data were analyzed by unpaired Student's -test. The Chi-square test was used to cumulate categorical variables. The Kaplan-Meyer method and log-rank test were used to compare the overall survival and disease-free survival.
RESULTS
No difference was found among the two groups in terms of the type of tumor, overall survival (OS), disease-free survival (DFS), early complications, radicality, and mortality. The only significant differences were both found in the length of hospital stay and in postoperative breast deformity that required further intervention in some cases.
CONCLUSION
In the era of mini-invasive surgery and quality assurance, the authors conclude that subcutaneous quadrantectomy is a safe procedure that allows less health cost and a better aesthetical result.
PubMed: 35495747
DOI: 10.3389/fsurg.2022.829975 -
Gland Surgery Aug 2016Tumors localized in the central quadrant (centrally located breast tumors) have always represented a challenge for the surgeon because of the critical aesthetical... (Review)
Review
Tumors localized in the central quadrant (centrally located breast tumors) have always represented a challenge for the surgeon because of the critical aesthetical matters related to the nipple-areola complex (NAC). Many years of experience with breast cancer patients treated by using various oncoplastic techniques, has allowed us to develop the modified hemibatwing for the treatment of central breast tumors, where the NAC is involved. Modified hemibatwing-along with the removal of the NAC-is a useful oncoplastic technique and it represents an ideal option for the treatment of central tumors because it assures oncological safety, a reduced surgical timetable and greater aesthetical results.
PubMed: 27563564
DOI: 10.21037/gs.2016.04.01 -
Medicina (Kaunas, Lithuania) Sep 2022: Lipofilling is a commonly performed procedure worldwide for breast augmentation and correction of breast contour deformities. In breast reconstruction, fat grafting... (Review)
Review
: Lipofilling is a commonly performed procedure worldwide for breast augmentation and correction of breast contour deformities. In breast reconstruction, fat grafting has been used as a single reconstructive technique, as well as in combination with other procedures. The aim of the present study is to systematically review available studies in the literature describing the combination of implant-based breast reconstruction and fat grafting, focusing on safety, complications rate, surgical sessions needed to reach a satisfying reconstruction, and patient-reported outcomes. : We adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) throughout the whole review protocol. A systematic review of the literature up to April 2022 was performed using Medline, Embase, and Cochrane Library databases. Only studies dealing with implant-based breast reconstruction combined with fat grafting were included. : We screened 292 articles by title and abstract. Only 48 articles were assessed for full-text eligibility, and among those, 12 studies were eventually selected. We included a total of 753 breast reconstructions in 585 patients undergoing mastectomy or demolitive breast surgeries other than mastectomy (quadrantectomy, segmentectomy, or lumpectomy) due to breast cancer or genetic predisposition to breast cancer. Overall, the number of complications was 60 (7.9%). The mean volume of fat grafting per breast per session ranged from 59 to 313 mL. The mean number of lipofilling sessions per breast ranged from 1.3 to 3.2. : Hybrid breast reconstruction shows similar short-term complications to standard implant-based reconstruction but with the potential to significantly decrease the risk of long-term complications. Moreover, patient satisfaction was achieved with a reasonably low number of lipofilling sessions (1.7 on average).
Topics: Adipose Tissue; Breast Neoplasms; Female; Humans; Mammaplasty; Mastectomy; Mastectomy, Segmental; Retrospective Studies
PubMed: 36143908
DOI: 10.3390/medicina58091232 -
International Journal of Environmental... Sep 2022Post-oncological BC (breast cancer) has an increased cardiovascular risk due to the variation of some anthropometric parameters. This study investigates the differences...
BACKGROUND
Post-oncological BC (breast cancer) has an increased cardiovascular risk due to the variation of some anthropometric parameters. This study investigates the differences between a quadrantectomy and a mastectomy on the body composition over time in presence of a breast prothesis.
METHODS
A group of BC patients (n = 41 aged 56.6 ± 9.5 years; 15 mastectomy patients; and 26 quadrantectomy patients) were compared to controls (C) (n = 22 aged 46.5 ± 13.44 years). Through bioimpedance analysis (Akern-BIA 101), the body mass index (BMI), total body water (TBW), extracellular water (ECW), body cell mass (BCM), fat mass (FM), free fat mass (FFM), and angle phase (PA) were compared within each group and between different groups using the Student's Test T.
RESULTS
The BC group showed lower values of FFM and TBW compared to C. The FFM was significantly ( = 0.04) lower in those with quadrantectomy. The right hemisome of the quadrantectomy has increased values of FFM, BCM ( = 0.04) and TBW compared to the counter-lateral hemisome, and FM values ( = 0.0008) lower than the counter-lateral. The hemisome with intervention has increased values of FM and ECW compared to the counter lateral, as well the FFM, BCM, TBW, and PA.
CONCLUSIONS
The results support the hypothesis that non-conservative surgical treatment (mastectomy) is associated with a better BIA profile without any substantial impact of breast implants in the body composition analysis. The awareness of a severe diseases could play a role to ameliorate lifestyle; however, further studies will be necessary to support this theory.
Topics: Body Composition; Body Water; Breast Neoplasms; Electric Impedance; Female; Humans; Mastectomy; Postmenopause; Water
PubMed: 36141601
DOI: 10.3390/ijerph191811329 -
Gland Surgery Dec 2015A total of 45 patients underwent partial or total autologous breast reconstruction after skin-sparing mastectomy, skin-reducing mastectomy, and quadrantectomy using a... (Review)
Review
A total of 45 patients underwent partial or total autologous breast reconstruction after skin-sparing mastectomy, skin-reducing mastectomy, and quadrantectomy using a thoracodorsal artery perforator (TDAP) flap. The detailed surgical technique with its variations is explained in this report. The propeller, flip-over, conventional perforator, and muscle-sparing flaps have been described and evaluated. The flaps were partially or completely de-epithelialized. The conventional TDAP can be enlarged or "extended" as the traditional latissimus dorsi musculocutaneous (LD-MC) flap by incorporating the superior and inferior fat compartments. It can be referred to as the "extended TDAP flap". This technique augments the flap volume. In addition, this flap can serve as a scaffold for lipofilling to obtain autologous breast reconstruction in medium to large cases. There were two complete failures due to technical errors during flap elevation. Distal partial tissue suffering was observed in four flaps. These flaps were longer than usual; they reached the midline of the back. It is advisable to discard the distal medial quarter of the flap when it is designed up to the midline to avoid steatonecrosis or fibrosis. A retrospective analysis of the 39 flaps that survived completely revealed a satisfactory result in 82% of the cases. The main disadvantage of this procedure is the final scar. The TDAP flap is a reliable and safe method for partial or total breast autologous reconstruction.
PubMed: 26645006
DOI: 10.3978/j.issn.2227-684X.2015.04.20 -
Journal of Clinical Medicine May 2020Neuroendocrine breast cancer (NEBC) is a rare histotype of breast carcinoma that presents, in most cases, positive hormone receptors and negative HER2. Indeed, the... (Review)
Review
Neuroendocrine breast cancer (NEBC) is a rare histotype of breast carcinoma that presents, in most cases, positive hormone receptors and negative HER2. Indeed, the analysis of gene expression profiles revealed that NEBC belongs mainly to the luminal subtype. Cases of HER2-positive and triple-negative NEBC are rare. The cardinal treatment of early NEBC is surgery, similar to the treatment of invasive non-special histological type carcinoma. The use of radiotherapy follows the criteria applied in infiltrating breast cancer of non-special histotype. In the post-operative phase, therefore after the surgical treatment of mammary quadrantectomy, or mastectomy associated with homolateral sentinel lymph node removal ± axillary dissection, based on the histopathological characteristics of the tumor, the use of chemotherapy (anthracycline + taxane) and/or hormone therapy, whether or not associated with anti-HER2 therapy (trastuzumab) is the rule. Literature data report the use of cisplatin and etoposide, as in small cell lung cancers. Most of the information currently available derive from single case reports or a series of clinical cases; it follows the difficulty of formulating definite recommendations on the correct management of this histological type of breast cancer. This review describes available knowledge on this rare entity to improve the diagnostic and therapeutic strategies and offer insights to stimulate exploration of the many aspects still unknown.
PubMed: 32414120
DOI: 10.3390/jcm9051452 -
Journal of Anesthesia, Analgesia and... Oct 2021Breast cancer surgery is usually managed using opioid-inclusive anesthesia (OIA), although opioids are associated with several adverse events, including nausea,...
BACKGROUND
Breast cancer surgery is usually managed using opioid-inclusive anesthesia (OIA), although opioids are associated with several adverse events, including nausea, vomiting, and constipation. Multimodal opioid-free anesthesia (OFA) has been introduced to reduce the incidence of these side effects. In this single-center retrospective study, we investigated whether ketamine, combined with magnesium and clonidine, could effectively control postoperative pain in patients undergoing quadrantectomy, while reducing postoperative nausea and vomiting (PONV).
RESULTS
A total of 89 patients submitted to quadrantectomy were included and divided into an OFA group (38 patients) and an OIA group (51 patients) according to the received anesthetic technique. Analgesia in the OIA group was based on an intraoperative infusion of remifentanil, and analgesia in the OFA consisted of an intraoperative infusion of ketamine and magnesium sulfate. Postoperative pain in both groups was managed with nonsteroidal anti-inflammatory drugs (NSAIDs) and paracetamol. Postoperative pain, assessed with the numeric rating scale (NRS), requirements for additional analgesics, the incidence of PONV, and patient satisfaction evaluated using a QoR-40 questionnaire were compared between the two groups. Levels of pain at 30 min and 6, 12, and 24 h after surgery; number of paracetamol rescue doses; and the incidence of PONV were lower in the OFA group (p <0.05). Patient satisfaction was comparable in the two groups.
CONCLUSIONS
A combination of ketamine, magnesium, and clonidine could be more effective than opioid-based analgesia in reducing postoperative pain and lowering PONV occurrence after quadrantectomy for breast cancer.
PubMed: 37386556
DOI: 10.1186/s44158-021-00008-5 -
Ecancermedicalscience 2017Following a clinical trial in which the Halsted mastectomy was compared to the less invasive quadrantectomy, no differences were reported in terms of local recurrence,...
Following a clinical trial in which the Halsted mastectomy was compared to the less invasive quadrantectomy, no differences were reported in terms of local recurrence, disease-free or overall survival between the two. As a result, Umberto Veronesi was the first in the world to state that the radical mastectomy appeared to involve unnecessary mutilation in patients with breast cancer of less than 2 cm and no palpable axillary nodes. To date, the Veronesi quadrantectomy is routinely considered for breast cancer treatment. This brief review, which highlights the main advances over the last 50 years, is dedicated to Professor Umberto Veronesi.
PubMed: 28690674
DOI: 10.3332/ecancer.2017.743