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Cancer de mama: cirugía conservadora vs mastectomia radical Breast cancer: conservative surgery versus radical mastectomy  [cached]
Gilberto Cabrera Nogueira,Carlos Sánchez Portela,Roberto Sosa Hernández
Revista de Ciencias M??dicas de Pinar del R?-o , 2005,
Abstract: Se realizó un estudio retrospectivo y comparativo tomando como universo 530 pacientes portadoras de cáncer de mama en las etapas I y II de la enfermedad, operadas en el servicio de Cirugía General del Hospital Clínico Quirúrgico "Abel Santamaría Cuadrado" de Pinar del Río, en el período de tiempo comprendido entre el 1ero. de Enero de 1988 y el 31 de Diciembre de 2003, las que fueron intervenidas por diferentes técnicas, 345 (65,09%) con proceder conservador y 185 (34,90%) con técnicas radicales (Patey, mastectomía total ampliada y mastectomía simple). El comportamiento de las recidivas locales fue significativo (pAimed at assessing breast cancer behaviour according to operative procedures a retrospective and comparative study was conducted taking as universe 530 female patients suffering from breast cancer (I and II stages of the disease) at Abel Santamaría University Hospital during the period of January 1st, 1998 and December 31, 2003 using different operative procedures, 345 (65.09 %) with conservative operative procedure and 185 (34.90 %) with radical mastectomy (Patey total wide mastectomy and simple mastectomy). Behaviour of local relapses was significant (p < 0.005) in favour of conservative operation 9.59 % and 18.37 % of radical operative procedures; a similar behaviour was present with distant metastases 8.11 % in those treated conservatively and 20.0 % in radical treatments. Global survival in 5 years favoured those patients who underwent conservative operation (90.47 %) in relation to those with radical mastectomy (73.64 %) p < 0.005.
Erector Spinae Plane Block for Mastectomy and Breast Flap Reconstructive Surgery: A Three Case Series  [PDF]
Wei Shyan Siow, Jimmy Guan Cheng Lim, Kwee Lian Woon
Open Journal of Anesthesiology (OJAnes) , 2020, DOI: 10.4236/ojanes.2020.101003
Abstract: Uncontrolled pain after breast surgery can have early to chronic repercussions. The repertoire of pre-emptive opioid-sparing analgesic options includes regional blocks such as paravertebral blocks to myofascial blocks and more recently the Erector Spinae (ESP) block. Case 1 demonstrates the ESP block as an easy and conveniently performed post-operative rescue block for a patient who still experienced uncontrolled pain despite a combination of myofascial blocks and systemic analgesics. Case 2 and 3 demonstrate the advantage of providing an extensive coverage of surgical field in breast reconstruction surgery covering variable donor sites. It was due to the extent of coverage, that allowed the placement of ESP block catheter distantly without interrupting the surgical site. Post operative prolongation of pain relief was also successful by titrating analgesia via intermittent boluses. In our case series, the ESP block consistently and safely provided satisfactory pain relief for breast reconstruction surgery. It can be a viable option for peri-operative analgesia compared to other more invasive or less extensive alternatives.
The Professional Medical Journal , 2004,
Abstract: Modified radical mastectomy is the operation of choice in an operable breast cancer inthis part of the world. This operation has fewer complications than radical mastectomy. Objectives: Toidentify the early complications of Patey’s modified radical mastectomy. Design: Descriptive study.Setting: Department of Surgery, Allama Iqbal Medical College/Jinnah Hospital Lahore. Period: FromNov 1998 to Aug 2003. Material & Methods: 114 consecutive patients undergoing modified radicalmastectomy were studied and followed up to 30th post operative day. All patients were female, with agerange of 35-67 years. The hospital stay was 8-21 days. Results: Wound infection was the commonestcomplication occurring in 19 patients (16.6%). Seroma formation occurred in 17 patients (14%). Whilehaematoma occurred in 4 patients (3.5%). Marginal necrosis of flap was seen in 6 patients (5.2%), whereas the extensive flap necrosis occurred in 2 patients only (1.75%). One patient developed early lymphedema of the arm and partial limitation of the shoulder joint movements. At the end of 30th day, allcomplications resolved except for lymph edema of arm. Conclusions: The procedure of modified radicalmastectomy gave good results as far as early morbidity due to surgical procedure itself is concerned.Morbidity can be further deceased by detailed assessment of the patients preoperatively.
From Radical Mastectomy to Breast-Conserving Therapy and Oncoplastic Breast Surgery: A Narrative Review Comparing Oncological Result, Cosmetic Outcome, Quality of Life, and Health Economy  [PDF]
Ahmad Kaviani,Nassim Sodagari,Sara Sheikhbahaei,Vahid Eslami,Nima Hafezi-Nejad,Amin Safavi,Maryam Noparast,Alfred Fitoussi
ISRN Oncology , 2013, DOI: 10.1155/2013/742462
Abstract: Surgical management of breast cancer has evolved considerably over the last two decades. There has been a major shift toward less-invasive local treatments, from radical mastectomy to breast-conserving therapy (BCT) and oncoplastic breast surgery (OBS). In order to investigate the efficacy of each of the three abovementioned methods, a literature review was conducted for measurable outcomes including local recurrence, survival, cosmetic outcome, quality of life (QOL), and health economy. From the point of view of oncological result, there is no difference between mastectomy and BCT in local recurrence rate and survival. Long-term results for OBS are not available. The items assessed in the QOL sound a better score for OBS in comparison with mastectomy or BCT. OBS is also associated with a better cosmetic outcome. Although having low income seems to be associated with lower BCT and OBS utilization, prognosis of breast cancer is worse in these women as well. Thus, health economy is the matter that should be studied seriously. OBS is an innovative, progressive, and complicated subspeciality that lacks published randomized clinical trials comparing surgical techniques and objective measures of outcome, especially from oncologic and health economy points of view. 1. Introduction Until recently, surgical management of Breast Cancer (BC) has focused on two main choices: tumor resection using breast conserving therapy (BCT) and mastectomy with optional tissue displacement by breast reconstruction. From 2003, the techniques that combine the skill of resection and reconstruction in one procedure were introduced that can be named as the third approach, oncoplastic breast surgery (OBS). This approach involves reconstruction of the resection defects by volume displacement using adjacent breast tissue. Both techniques are adopted from the conventional methods of breast reduction and reconstruction [1]. Mastectomy includes excision of the breast tissue and is divided into subtypes according to the resection of lymph nodes and muscles. Traditionally, it is employed when the risk of local recurrence is increased by tumor size of greater than 5?cm, presence of lymphovascular invasion, presence of more than 4 suspected nodes, and involved or closed margins [2]. BCT is composed of lumpectomy or wide local excision and axillary dissection with or without radiotherapy. It was accepted as a surgical option after thorough evaluation in six international prospective randomized trials for early stages of BC (Stages I and II) [3, 4]. Traditional contraindication to perform BCT
Recent advances and controversies in head and neck reconstructive surgery  [cached]
Kuriakose Moni,Sharma Mohit,Iyer Subramania
Indian Journal of Plastic Surgery , 2007,
Abstract: Advances in head and neck reconstruction has made significant improvement in the quality of life and resectability of head and neck cancer. Refinements in microsurgical free tissue transfer leave made restoration of form and complex functions of head and region a reality. Standardized reconstructive algorithms for common head and neck defects have been developed with predictable results. Some of the major advances in the field include- sensate free tissue transfer, osseo integrated implant and dental rehabilitation, motorized tissue transfer and vascularized growth center transfer for pediatric mandible reconstruction. However there exist several controversies in head and neck reconstructive surgery. Some are old; resolved partially in the light of recent clinical evidences and others are new, developed as a result of newly introduced reconstructive techniques. These include, primary versus secondary reconstruction, pedicled versus free flaps, primary closure versus free tissue transfer for partial glossectomy defects, reconstruction of posterior mandible and reconstruction of orbital exenteration defects. Rapid advances in the field of tissue engineering and stem cell research is expected to make radical change in the field of reconstructive surgery. This manuscript review progress in head and neck reconstructive surgery during the last decade, current controversies and outline a road map for the future.
Applications of Nanotechnology in Reconstructive Surgery
Timothy Varghese
Open Access Library Journal (OALib Journal) , 2016, DOI: 10.4236/oalib.1102455
The objective of this review was to critically present and evaluate recent investigations into nanotechnology and it’s applications in reconstructive surgery. In addition, this review aims to looks at a plethora of applications with nanotechnology in the subject area of reconstructive surgery. The Medline and PubMed databases were searched for clinical trial and case report publications dealing with reconstructive surgeries involving nanotechnology. Reports that were identified addressed different areas of reconstructive surgery and outlined a clear methodology for their studies. Eight publications show that the use of nanotechnology in reconstructive surgery is promising yet still in its early stages and that extensive research needs to be carried out if the expectation of this advancing technology is to overtake current surgical procedures. However, it is clear that there will be a continued interest and progression in this subject field as nanotechnology science is unveiled.
Cirugía conservadora y mastectomía radical modificada en el cáncer de mama de etapas I y II Conservative surgery and radical mastectomy in stage I and II breast cancer
Inés Casadevall Galán,Pastor Villavicencio Crespo,Ivis Margarita Castillo Naranjo,María Isabel Rojas Gispert
Revista Cubana de Cirugía , 2008,
Abstract: INTRODUCCIóN. El cáncer de mama es la primera causa de muerte por cáncer en la mujer y se ha convertido en una pandemia que amenaza continuar si no se halla la forma de prevenirlo. El objetivo de este trabajo fue evaluar la supervivencia global y el intervalo libre de enfermedad en pacientes que recibieron como tratamiento inicial cirugía conservadora más radioterapia y mastectomía radical modificada; y determinar otras variables pronósticas, como la edad, clínicas histológicas, recaídas y tiempo entre la cirugía y la radioterapia. MéTODOS. Entre enero del 2000 y diciembre del 2005 se realizó en el Hospital Julio Trigo López un estudio retrospectivo y descriptivo de un grupo de pacientes con cáncer primario de mama, en etapas I y II. Los datos se extrajeron de las historias clínicas y de encuestas. Se creó una base de datos y se realizó un análisis descriptivo de los datos, frecuencia y porcentajes para el caso de las variables cualitativas y medias, y desviaciones estándares para las cuantitativas. Se estimó la supervivencia y el intervalo libre de enfermedad utilizando el método de Kaplan Meir y se compararon en curvas según las variables de interés de Sug Rank. El análisis de las variables pronósticas de supervivencia e intervalo libre de enfermedad se realizó mediante análisis de regresión de Cox. RESULTADOS. El intervalo libre de enfermedad fue mayor en la cirugía conservadora que en la mastectomía radical modificada, y de igual manera se comporto la supervivencia global. Las pacientes con Rh positivo presentaron mayor intervalo libre de enfermedad (88 %). El carcinoma infiltrante fue la variedad más frecuente y de mayor número de recaídas, en las cuales influyó el tiempo entre la cirugía y la radioterapia. La frecuencia más alta de cáncer de mama se observó en las mujeres mayores de 50 a os. En la cirugía conservadora predominó la conducta terapéutica de cirugía más radioterapia y quimioterapia y en la mastectomía radical modificada, la quimioterapia. En la cirugía conservadora fueron más frecuentes las recaídas locorregionales, mientras que en la mastectomía radical, las recaídas más frecuentes se registraron a distancia. CONCLUSIONES. El tipo de cirugía no influyó significativamente en el intervalo libre de enfermedad, pero sí hubo diferencias entre las técnicas conservadoras. Los factores pronósticos tama o del tumor, estado ganglionar y receptores hormonales influyeron en la supervivencia y en el intervalo libre de enfermedad en todas las pacientes. INTRODUCTION. Breast cancer is the first cause of death from cancer in females and it has beco
Reconstructive surgery in oral cancers  [cached]
Yadav Prabha
Indian Journal of Plastic Surgery , 2007,
Abstract: Surgery forms the mainstay of treatment of cancers in involving oral cavity. Unfortunately the functional and aesthetic outcomes of surgical treatment can be unacceptable depending on the extent and site of the resection. Immediate reconstruction, by the use of local and distant flaps and implants can mitigate these problems to a great extent. The anatomical and functional requirements for reconstruction vary according to the subsite, which is involved in the oral cavity. This article attempts to review the current understanding about the reconstructive requirements and the methods available according to the oral cavity subsites namely tongue, floor of mouth, buccal mucosa and floor of the mouth
Management of leiomyosarcomas of the spermatic cord: the role of reconstructive surgery
Stuart Enoch, Simon M Wharton, Douglas S Murray
World Journal of Surgical Oncology , 2005, DOI: 10.1186/1477-7819-3-23
Abstract: This article reviews the pathophysiology of spermatic cord leiomyosarcomas (LMS), and discusses the various reconstructive surgical options available to repair the inguinal region and the lower anterior abdominal wall after excision of the tumour and the adjacent soft tissues.There is paucity of literature on LMS of spermatic cord. The majority of paratesticular neoplasms are of mesenchymal origin and up to 30% of these are malignant. In adults, approximately 10% of spermatic cord sarcomas are LMS. Approximately 50% of these tumours recur loco-regionally following definitive surgery; however, the incidence decreases if resection is followed by adjuvant radiotherapy.It is therefore important to achieve negative histological margins during the primary surgical procedure, even if adjuvant radiotherapy is instituted. If extensive resection is required, either during the primary procedure or following recurrence, reconstructive surgery may become necessary. This article reviews the pathophysiology of spermatic cord LMS, the reasons for recurrence, and discusses the management options including the role of reconstructive surgery.Tumours of the spermatic cord and paratesticular tissue are rare [1,2], and as such, their true incidence has never been established. Radical inguinal orchiectomy and high ligation of the cord is the standard primary surgical procedure. However, the extent of surrounding soft tissue excision required, including margins, and the role of adjuvant radiotherapy (RT), remains controversial. The paucity of literature in this area often makes treatment decisions difficult; prospective trials are precluded by the rarity of this tumour and no series is sufficiently large to accurately evaluate the most appropriate treatment option.Recurrence is a commonly encountered problem, which might necessitate further radical excision of adjacent soft tissues. It hence becomes important to achieve negative histological margins during the primary surgery even if adjuv
Prevalence of major depressive disorder in patients with modified radical mastectomy without reconstruction
Gloria Lucía Suárez Carre?o,Ana Celina Rueda López
MedUNAB , 2007,
Abstract: Antecedents: Major depressive disorder (MDD) is a psychiatric dysfunction that appears with relative frequency in the women with breast cancer diagnosis or which they are in treatment forthe same one. Nevertheless, specific data don’t exist in Colombia about the prevalence of depression in the patients with cancer who suffer from subjected to modified radical mastectomy without reconstruction. Objective: To determine the prevalence of MDD in resident patients in the metropolitan area of Bucaramanga with modified radical mastectomy without reconstruction. Method: It is a descriptive transversal study; it included women older than 18 years. We applied the SCID I. A semi structured interview for MDD based on approaches of the DSM-IV. Results: 80 women were evaluated with ages among the 30-85 years, with a 58.1 year-old average, SD13.79; the prevalence was of 42.5%, (95%CI 31.68 – 53.30) for MDD. The MDD was lower than in those women who had social support in 41.2% (PR 2.41; 95%CI 1.56-3.73) and was higher than in women who had problems due to the surgery in 88.2% (PR 3.41;95%CI 1.35- 8.64), we didn’t find association with age, the grade ofstudy, the marital status, the socioeconomic level, pain scale, the occupation and the time of the surgery. Conclusion: In this study TDM prevalence was higher than similar ones with general population; TDM was related directly with the problems derived from surgery and inversely with the social support.
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