Is group and save still a necessary test in the preoperative workup for breast cancer surgery?

2020 ◽  
pp. 175045892092535
Author(s):  
Jeremy Batt ◽  
Alice Chambers ◽  
Jennifer Mason ◽  
Michelle Mullan
Keyword(s):  
Breast Cancer ◽  
Blood Transfusion ◽  
Retrospective Review ◽  
Breast Surgery ◽  
Surgical Patients ◽  
Breast Cancer Surgery ◽  
Electronic Records ◽  
Blood Transfusions ◽  
Require Blood Transfusion ◽  
Preoperative Workup

Introduction Trust guidelines state that patients undergoing mastectomy have one group and save (G&S) sample preoperatively, or two for bilateral or complex mastectomy. Breast surgical patients rarely require blood transfusion, and G&S testing is costly and labour intensive. Our study assessed whether preoperative G&S testing is warranted for breast surgery patients. Methods Retrospective review of consecutive patients undergoing mastectomies from one centre, from June 2018 to June 2019 identified 190 women. Review of electronic records for G&S tests was performed and transfusions prescribed. Discussion with laboratory personnel regarding costs of processing G&S tests. Results Forty-six (32%) patients who underwent simple mastectomies had one G&S, eight (6%) patients had two. Twenty (45%) patients who underwent bilateral/complex mastectomy/reconstruction had one G&S and four (9%) had two. No patients required peri or postoperative blood transfusions. Seventy-eight G&S tests performed cost the trust £1,082. Conclusion Simple mastectomies rarely require blood transfusions. G&S tests cost £13.83 and are time consuming for the patient and laboratory. We propose that G&S tests are unnecessary for patients undergoing simple mastectomies and preoperative protocols require adjustment. Trust policy is to have ‘routine G&S'; however, 124 patients did not have any G&S testing. Had the guideline been followed, this would have cost the Trust a further £1,715.

scholarly journals Audit of Blood Transfusion in Elective Breast Cancer Surgery – Do We Need to Group and Save Pre-Operatively?

2008 ◽  
Vol 90 (6) ◽  
pp. 472-473 ◽  
Author(s):  
Hassan Malik ◽  
Hugh Bishop ◽  
John Winstanley
Keyword(s):  
Breast Cancer ◽  
Blood Transfusion ◽  
Breast Surgery ◽  
Cancer Surgery ◽  
Breast Cancer Surgery ◽  
Reconstruction Procedure ◽  
Immediate Reconstruction ◽  
Related Data ◽  
Simple Mastectomy ◽  
Operative Assessment

INTRODUCTION Current guidelines on blood ordering in our hospital require all patients undergoing elective breast cancer surgery to have blood grouped, screened and saved as an part of a pre-operative assessment. The aim of this audit was to assess the need for, and cost effectiveness of, this approach in elective breast cancer surgery. PATIENTS AND METHODS Retrospective data collection was undertaken for a 2-year period using the theatre booking system. As a result, 497 consecutive elective breast surgery operations including mastectomies, wide local excisions and breast reconstruction procedures were identified for analysis. Using the hospital blood bank computer system, we established the blood group and save or cross-match status as well as the pre- and postoperative haemoglobin results and blood transfusion related data for each of the patients identified. RESULTS Of the 497 patients, 438 (88.1%) had blood sent for group-and-save. Of the total 497 patients identified, only 19 (3.82%) patients received a blood transfusion. From the 447 patients undergoing simple mastectomy or wide local excisions alone, 9 patients (1.81%) required transfusion. Fifty patients underwent an immediate reconstruction procedure of whom 10 (20%) required a transfusion. CONCLUSIONS This study demonstrates that reconstruction is more likely to be associated with the need for a postoperative transfusion. However, in the context of all breast surgery, blood transfusion is rarely requested. Given this, the time and cost involved in processing a group-and-save pre-operatively is not justified.

scholarly journals Breast Cancer Surgery During the COVID-19 Pandemic: An Observational Clinical Study of the Breast Surgery Clinic at Ospedale Policlinico San Martino – Genoa, Italy

In Vivo ◽  
2020 ◽  
Vol 34 (3 suppl) ◽  
pp. 1667-1673 ◽  
Author(s):  
PIERO FREGATTI ◽  
MARCO GIPPONI ◽  
MARIA GIACCHINO ◽  
MARCO SPARAVIGNA ◽  
FEDERICA MURELLI ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Clinical Study ◽  
Breast Surgery ◽  
Cancer Surgery ◽  
Breast Cancer Surgery

scholarly journals Is Mastectomy Oncologically Safer than Breast-Conserving Treatment in Early Breast Cancer

Breast Care ◽  
2017 ◽  
Vol 12 (6) ◽  
pp. 385-390 ◽  
Author(s):  
Fabian Riedel ◽  
André Hennigs ◽  
Sarah Hug ◽  
Benedikt Schaefgen ◽  
Christof Sohn ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Breast Surgery ◽  
Breast Conservation ◽  
Breast Cancer Surgery ◽  
Breast Cancer Patients ◽  
Aesthetic Outcome ◽  
Breast Conserving Treatment ◽  
Routine Treatment ◽  
Oncological Safety ◽  
The Individual

Aim: To describe and discuss the evidence for oncological safety of different procedures in oncological breast surgery, i.e. breast-conserving treatment versus mastectomy. Methods: Literature review and discussion. Results: Oncological safety in breast cancer surgery has many dimensions. Breast-conserving treatment has been established as the standard surgical procedure for primary breast cancer and fits to the preferences of most breast cancer patients concerning oncological safety and aesthetic outcome. Conclusions: Breast-conserving treatment is safe. Nonetheless, the preferences of the individual patients in their consideration of breast conservation versus mastectomy should be integrated into routine treatment decisions.

scholarly journals Women’s choices for breast cancer surgery in Italy: quality and equity implications

2019 ◽  
Author(s):  
Francesca Ferre ◽  
Chiara Seghieri ◽  
Sabina Nuti
Keyword(s):  
Breast Cancer ◽  
Breast Surgery ◽  
Hospital Performance ◽  
Cancer Surgery ◽  
Patient Choice ◽  
Breast Cancer Surgery ◽  
Surgical Interventions ◽  
Surgery Patient ◽  
National Quality

Abstract Background Equity and quality in healthcare are key goals embraced by universal healthcare systems; however, inequalities in access and unwarranted variations in quality of care are well documented in the Italian healthcare system. To reduce unwarranted variation and improve equal utilization of services at hospital level, national quality standards have been applied for selected clinical procedures including oncological surgery for which there is evidence of a positive relationship between volumes and clinical outcomes. However, high dispersion of surgical interventions across hospitals still exists highlighting the need to understand the determinants behind women’s choice for hospital for breast surgery. Methods We apply mixed logit regression to investigate the determinants, both at patient and provider level, associated with women’s choice of hospital for breast surgery. Patient level non-emergency hospital data are used to model breast cancer surgical choices in Tuscany region, Italy. We considered hospitalizations occurring during 2016. We focused on the effects of travel time and hospital performance for breast cancer treatments (elective surgery) in different patient groups. Hospital quality indicators include structural variables (volumes), measurement of process (timeliness) and quality of surgical procedures as recommended by clinical guidelines (proportion of breast-conservative surgery and execution of the sentinel lymph node biopsy). Results Results reveal that women prefer hospitals nearby, delivering high volumes of interventions with an appropriate surgical approach. Differences in women choice depend on education and age. Highly educated patients travelled further to seek surgical intervention for breast cancer and were likely to select high performing hospitals. Moreover, older women preferred quicker response compared to younger women when awaiting surgical interventions. Conclusions Differences in patient choice highlight equity concerns in access to elective breast cancer surgery. These results could be used to optimize the allocation of resources toward breast cancer units that meet quality and efficacy standards to increase the efficiency and responsiveness of breast cancer care.

scholarly journals Surgical Site Infections in Breast Cancer Patients Undergoing Surgery During the Covid-19 Pandemic. Preliminary Data from an Italian Oncologic Hub.

2021 ◽  
Author(s):  
Sonia Cappelli ◽  
Fabio Pelle ◽  
Marco Clementi ◽  
Maddalena Barba ◽  
Patrizia Vici ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Median Time ◽  
Breast Surgery ◽  
Surgical Site Infections ◽  
Final Analysis ◽  
Cancer Surgery ◽  
Breast Cancer Surgery ◽  
Breast Cancer Patients ◽  
Intrinsic Nature

Abstract Background: Over the Covid-19 pandemic, the compelling need of containing the virus spread while providing diseased people with adequate assistance has inevitably reflected on treatment priorities, which have been sometimes radically revised according to the intrinsic nature of the institution considered and its role and action within the pandemic context. We report on the experience matured at the Regina Elena National Cancer Institute concerning the effects of the restriction measures adopted during the pandemic on the outcomes of surgical site infections (SSIs) in breast cancer patients (BC-pts) undergoing non-deferrable breast cancer surgery. Methods: Within the frame of an observational study, we compared evidence from two cohorts, namely, the lockdown cohort (LDC) and non-lockdown cohort (NLDC). Patients from the LDC underwent breast cancer surgery between the 15th March 2020 and the 4th May 2020. Breast surgery was performed by the same team and postsurgical controls were performed regularly for a minimum of 12-months. SSIs were defined according to the criteria established by the Center for Disease Control and Prevention. Results: The LDC originally included 79 breast cancer patients, of whom 62 provided data to the final analysis. In the LDC, initially 64 breast cancer patients, only 52 were finally considered. No relevant differences emerged between LDC and NLDC by general characteristics. We observed significant evidence of lower SSIs in the subgroups of patients having undergone skin reducing mastectomy compared with the remaining subgroups (p=0.003). The overall number of surgical site infections was 10 (8.7%), and the median time to their occurrence17.1 days (7- 42). In the NLDC, 7 (13.5) SSIs were identified, with a median time to occurrence of 18.2 days (7-42). In the LDC, 3 (4.8%) SSIs occurred, with a median time to occurrence of 14.3 days (7 to 21). None of these patients was in need of re-hospitalization and there were no delays in adjuvant treatment starting. Conclusions: The restrictive measures issued during the lockdown period seemed to lower the SSI rates in breast cancer patients undergoing non-deferrable breast surgery, although, caution is needed due to the limited sample size.

scholarly journals Impact of COVID-19 pandemic on breast surgery and breast reconstruction in a Japanese university hospital setting.

2020 ◽  
Author(s):  
Dai Shibata ◽  
Takahiko Kawate ◽  
Takako Komiya ◽  
Itaru Nakamura ◽  
Takashi Ishikawa ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Breast Reconstruction ◽  
Chart Review ◽  
Breast Surgery ◽  
Hospital Setting ◽  
Retrospective Chart Review ◽  
University Hospital ◽  
Breast Cancer Surgery ◽  
Short Term ◽  
Japanese University

Abstract The new coronavirus disease (COVID-19) is spreading worldwide. In Japan, the number of people infected has been increasing since March 2020. The COVID-19 pandemic has had a significant impact on hospitals, although Tokyo, Japan did not experience a collapse of the medical system. Patients were triaged and prioritized due to surgical limitations during the pandemic period. The purpose of this study was to determine how patients with breast cancer or breast reconstruction were affected by the COVID-19 pandemic at a university hospital in Tokyo. In this retrospective chart review we investigated how patients were treated, including surgical postponements during three periods: April to July 2020, August to November 2019 (after the Allergan recall), and April to July 2019. More than half of breast surgeries and breast reconstructions had to be postponed during the COVID-19 pandemic, and the number of candidates for surgery was also lower compared to the pre-pandemic periods. Triage of patients with breast cancer did not result in any adverse oncological outcomes for these patients. COVID-19 has had a major impact on breast cancer surgery and breast reconstruction, and there was substantial postponement of surgery. Due to triage and prioritization, no patients experienced disease progression in the short-term period, demonstrating that our strategy was appropriate.

scholarly journals THE COMBINATION OF ULTRASOUND-GUIDED PECTORAL NERVES II AND PARASTERNAL BLOCKS AS A VALID ALTERNATIVE FOR ANESTHESIA IN BREAST SURGERY: AN OBSERVATIONAL STUDY

2017 ◽  
pp. 175-179
Author(s):  
Erika Basso Ricci
Keyword(s):  
Breast Cancer ◽  
Postoperative Pain ◽  
Observational Study ◽  
Breast Surgery ◽  
Cancer Surgery ◽  
Breast Cancer Surgery ◽  
Thoracic Wall ◽  
Lateral Part ◽  
Ultrasound Guided ◽  
Mastectomy Group

Background: Breast cancer surgery is often associated with severe postoperative pain that may compromise systemic homeostasis, which increases perioperative morbidity, the length of stay in the hospital, and costs. Scientifi c evidence has also shown that an inadequate analgesia could promote the risk of persistent pain development after breast surgery. Objective: Recent literature suggested that the pectoral nerves II (PECS II) block may represent a valid alternative to general anesthesia (GA) and conventional, regional techniques for analgesia in breast surgery. This technique may provide complete anesthesia of the lateral part of the thorax but cannot block, by itself, the anterior cutaneous branches of the intercostal nerves. The combination of a parasternal block (PSB) and a PECS II block has been performed as a single anesthetic technique. Study Design: This is an observational, monocenter, prospective, and cohort study. We obtained the approval of our scientifi c ethic committee and clinical trials registration. Setting: This study enrolled patients undergoing an elective breast surgery. In particular, we enrolled patients who were scheduled for a mastectomy or quadrantectomy of the medial part of the breast. Methods: We recruited 40 patients who were scheduled for breast surgery. A PECS II block was performed with an injection of ropivacaine 0.5% 20 mL + 10 mL. Then, a PSB was performed by 2 separate injections of 3 mL of 0.5% ropivacaine, for each one, at the level of the second and fourth intercostal space. All of the patients received intraoperative sedation and multimodal analgesia. During the intraoperative period, the accessory need of a local anesthetic infi ltration, conversion to GA, and the total amount of propofol required to maintain good comfort of the patients were recorded. In the fi rst 24 postoperative hours, every 6 hours, postoperative pain was assessed by an investigator using a numerical rating scale (NRS). The consumption of analgesic and antiemetic drugs and the incidence of postoperative nausea and vomiting (PONV) were also recorded. Results: Our observational analysis yielded 40 patients in a period of 6 months. The population was subdivided into 2 groups: a mastectomy group or a quadrantectomy group. All of the population reported their pain scores at rest (rNRS < 3) and during activity (iNRS < 5) in the postoperative period. None of the patients required GA. Six patients (27.3%) in the mastectomy group required a supplemental anesthetic infi ltration. Eleven (27.5%) patients required a rescue analgesic drug: 9 (40.9%) in the mastectomy group and 2 (11.1%) in the quadrantectomy group. Two patients reported events of PONV, one for each group (4.54% for the mastectomy group and 5.55% for the quadrantectomy group). No complications occurred. Conclusion: This study indicates the safety and feasibility of the novel ultrasound-guided thoracic wall blocks during inpatient and outpatient breast surgery for the management of intraoperative anesthesia and postoperative analgesia. Limitations: This is an observational study; a randomized control trial is mandatory to confi rm the results. Key words: Breast cancer surgery, pectoralis nerve block, parasternal block, ultrasound-guided anesthesia, regional anesthesia, pain control

scholarly journals Preoperative Paravertebral Block and Chronic Pain after Breast Cancer Surgery: A Double-blind Randomized Trial

2021 ◽  
Author(s):  
Aline Albi-Feldzer ◽  
Sylvain Dureau ◽  
Abdelmalek Ghimouz ◽  
Julien Raft ◽  
Jean-Luc Soubirou ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Chronic Pain ◽  
Odds Ratio ◽  
Breast Surgery ◽  
Paravertebral Block ◽  
Breast Cancer Surgery ◽  
Control Group ◽  
Control Groups ◽  
Double Blind ◽  
And Control

Background The effectiveness of paravertebral block in preventing chronic pain after breast surgery remains controversial. The primary hypothesis of this study was that paravertebral block reduces the incidence of chronic pain 3 months after breast cancer surgery. Methods In this prospective, multicenter, randomized, double-blind, parallel-group, placebo-controlled study, 380 women undergoing partial or complete mastectomy with or without lymph node dissection were randomized to receive preoperative paravertebral block with either 0.35 ml/kg 0.75% ropivacaine (paravertebral group) or saline (control group). Systemic multimodal analgesia was administered in both groups. The primary endpoint was the incidence of chronic pain with a visual analogue scale (VAS) score greater than or equal to 3 out of 10, 3 months after surgery. The secondary outcomes were acute pain, analgesic consumption, nausea and vomiting, chronic pain at 6 and 12 months, neuropathic pain, pain interference, anxiety, and depression. Results Overall, 178 patients received ropivacaine, and 174 received saline. At 3 months, chronic pain was reported in 93 of 178 (52.2%) and 83 of 174 (47.7%) patients in the paravertebral and control groups, respectively (odds ratio, 1.20 [95% CI, 0.79 to 1.82], P = 0.394). At 6 and 12 months, chronic pain occurred in 104 of 178 (58.4%) versus 79 of 174 (45.4%) and 105 of 178 (59.0%) versus 93 of 174 (53.4%) patients in the paravertebral and control groups, respectively. Greater acute postoperative pain was observed in the control group 0 to 2 h (area under the receiver operating characteristics curve at rest, 4.3 ± 2.8 vs. 2.9 ± 2.8 VAS score units × hours, P &lt; 0.001) and when maximal in this interval (3.8 ± 2.1 vs. 2.5 ± 2.5, P &lt; 0.001) but not during any other interval. Postoperative morphine use was 73% less in the paravertebral group (odds ratio, 0.272 [95% CI, 0.171 to 0.429]; P &lt; 0.001). Conclusions Paravertebral block did not reduce the incidence of chronic pain after breast surgery. Paravertebral block did result in less immediate postoperative pain, but there were no other significant differences in postoperative outcomes. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

Locoregional lymphatic recurrence following axillary dissection for breast cancer.

2011 ◽  
Vol 29 (27_suppl) ◽  
pp. 19-19
Author(s):  
S. M. L. Lim ◽  
F. L. Lam ◽  
S. J. N. Remulla
Keyword(s):  
Breast Cancer ◽  
Axillary Dissection ◽  
Breast Surgery ◽  
Bilateral Breast Cancer ◽  
Breast Cancer Surgery ◽  
Low Grade ◽  
Axillary Lymph ◽  
Tumour Grade ◽  
Primary Surgery ◽  
Small Series

19 Background: The risk of locoregional recurrence is of concern for women following breast cancer surgery. We report a single surgeon’s experience of locoregional lymphatic recurrence following axillary dissection (AD) in women with breast cancer. Methods: The aim of this study is to identify risk factors for locoregional lymphatic recurrence in women who have undergone breast surgery and AD for T1, T2 tumours. 14 women were identified over 10 years with documented recurrence in the regional lymphatic basin; ipsilateral, contralateral, supraclavicular and internal mammary lymph nodes. One patient presented with bilateral breast cancer. Patient characteristics as well as the tumour grade, ER, PR, HER2 reactivity and presence of lymphovascular invasion (LVI) were analysed. Results: Between 1996 and 2006, 756 women underwent primary surgery for breast cancer in our practice. We identified 14 women who relapsed with locoregional lymphatic recurrence and underwent further surgical management after a median follow-up of 4.5 years. 13/14 had undergone primary breast surgery at our centre, of which 73% underwent total mastectomy and AD. The median age was 48 years, 14% were nulliparous, and 50% were premenopausal. The mean tumour size was 2.48 cm and 7% had a contralateral cancer. The median axillary lymph node (LN) yield was 11.5 of which 57% (8/14) were node negative at primary surgery. In those 8 patients with negative AD, 50% recurred in the ipsilateral axillary LNs, 37.5% recurred in the ipsilateral supraclavicular LNs in the absence of axillary relapse, and 12.5% recurred in the contralateral axillary LNs in the absence of ipsilateral axillary relapse. Of the primary tumour characteristics, 13% were low grade, 43% had LVI, 57% were ER+, 64% PR+, 43% HER2+, and 14% triple negative. None of the patients had distant metastases at the time of relapse in the locoregional lymphatic basin. Conclusions: An axillary dissection did not prevent locoregional lymphatic recurrence in 14 women in our small series. On retrospective analysis, there was no dominant risk factor which could help to identify this group at high risk of relapse, although at least 50% who relapsed locoregionally were less than 50 years, premenopausal with a high tumour grade.

scholarly journals The impact of age on patient-reported outcomes after oncoplastic versus conventional breast cancer surgery

2021 ◽  
Author(s):  
M. Ritter ◽  
B. M. Ling ◽  
I. Oberhauser ◽  
G. Montagna ◽  
L. Zehnpfennig ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Patient Reported Outcomes ◽  
Breast Surgery ◽  
Perforator Flap ◽  
Well Being ◽  
Breast Cancer Surgery ◽  
Oncoplastic Breast Surgery ◽  
Age Related ◽  
Patient Reported ◽  
The Impact

Abstract Purpose Some studies have indicated age-specific differences in quality of life (QoL) among breast cancer (BC) patients. The aim of this study was to compare patient-reported outcomes after conventional and oncoplastic breast surgery in two distinct age groups. Methods Patients who underwent oncoplastic and conventional breast surgery for stage I-III BC, between 6/2011–3/2019, were identified from a prospectively maintained database. QoL was prospectively evaluated using the Breast-Q questionnaire. Comparisons were made between women < 60 and ≥ 60 years. Results One hundred thirty-three patients were included. Seventy-three of them were ≥ 60 years old. 15 (20.5%) of them received a round-block technique (RB) / oncoplastic breast-conserving surgeries (OBCS), 10 (13.7%) underwent nipple-sparing mastectomies (NSM) with deep inferior epigastric perforator flap (DIEP) reconstruction, 23 (31.5%) underwent conventional breast-conserving surgeries (CBCS), and 25 (34.2%) received total mastectomy (TM). Sixty patients were younger than 60 years, 15 (25%) thereof received RB/OBCS, 22 (36.7%) NSM/DIEP, 17 (28.3%) CBCS, and 6 (10%) TM. Physical well-being chest and psychosocial well-being scores were significantly higher in older women compared to younger patients (88.05 vs 75.10; p < 0.001 and 90.46 vs 80.71; p = 0.002, respectively). In multivariate linear regression, longer time intervals had a significantly positive effect on the scales Physical Well-being Chest (p = 0.014) and Satisfaction with Breasts (p = 0.004). No significant results were found concerning different types of surgery. Conclusion Our findings indicate that age does have a relevant impact on postoperative QoL. Patient counseling should include age-related considerations, however, age itself cannot be regarded as a contraindication for oncoplastic surgery.

Sign in / Sign up

Export Citation Format

Share Document