Genetic variability of tramadol pharmacokinetic genes and pain treatment outcome after breast cancer surgery.

e23133 Background: Tramadol is a treatment of choice for pain management after axillary lymph node dissection in breast cancer patients. Tramadol is metabolized via CYP2D6 and UGT2B7, while ABCB1, ABCC2 and SLC22A1 are involved in transport of tramadol metabolites. Genetic variability of metabolizing enzymes or drug transporters may therefore affect efficacy and adverse effects of tramadol. The aim of this study was to evaluate the association of genetic variability in tramadol pharmacokinetics pathway on long-term outcome of tramadol pain treatment after breast cancer surgery. Methods: The study included 102 breast cancer patients treated with either 75 or 37.5 mg of tramadol for pain relief after breast cancer surgery including axillary lymph node dissection as part of a randomized clinical trial KCT 04/2015-DORETAonko/si at Institute of Oncology Ljubljana. All patients were genotyped for 14 polymorphisms in ABCB1, ABCC2, CYP2D6, SLC22A1 and UGT2B7 genes, as well as for CYP2D6 duplication and deletion. CYP2D6 phenotype was predicted from the genotype data and patients were categorized as poor (PM), intermediate, extensive or ultrarapid metabolizers. The association of genetic factors with pain one year after treatment was evaluated using logistic regression and Mann-Whitney test. Results: One year after treatment, 21 (20.8%) patients were still experiencing chronic and 25 (24.8%) neuropathic pain. CYP2D6 PMs were significantly more likely to experience chronic and neuropathic pain after tramadol treatment (OR = 5.96, 95% CI = 1.22-29.13, p = 0.027 and OR = 9.31, 95% CI = 1.65-50.59, p = 0.011, respectively), even after adjustment for tramadol dose (p = 0.032 and p = 0.016, respectively). PMs also had higher average pain intensity compared to others regardless of tramadol dose (p = 0.042). In patients receiving lower tramadol dose, ABCB1 rs1128503, rs2032582 and rs1045642 were associated with more chronic pain in the dominant model (p = 0.004, p = 0.004 and p = 0.047, respectively). Conclusions: Genetic variability in tramadol pharmacokinetics pathway may be associated with pain treatment outcome in breast cancer patients, therefore pharmacogenetic testing could enable more effective tramadol treatment. Clinical trial information: EudraCT 2015-000992-28.

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The Findings of SPECT/CT Concerning Bypass Lymph Circulation in Lymphedema Following Breast Cancer Surgery

Healthcare ◽

10.3390/healthcare9040471 ◽

2021 ◽

Vol 9 (4) ◽

pp. 471

Author(s):

Min Young Lee ◽

Eunjung Kong ◽

Dong Gyu Lee

Keyword(s):

Breast Cancer ◽

Lymph Node ◽

Lymph Nodes ◽

Lymphatic Drainage ◽

Cancer Surgery ◽

Breast Cancer Surgery ◽

Axillary Lymph Nodes ◽

Axillary Lymph ◽

Node Dissection ◽

Positive Group

This study aimed to determine whether bypass circulation was present in lymphedema and its effect. This was a retrospective, cross-sectional study. Patients who underwent unilateral breast cancer surgery with axillary lymph node dissection were recruited and underwent single-photon emission tomography/computed tomography (SPECT/CT). SPECT/CT was performed to detect the three-dimensional locations of radio-activated lymph nodes. Patients with radioactivity in anatomical locations other than axillary lymph nodes were classified into a positive group. All patients received complete decongestive therapy (CDT). Exclusion criteria were as follows: History of bilateral breast cancer surgery, cervical lymph node dissection history, and upper extremity amputation. The difference in the upper extremity circumference (cm) was measured at four points: Mid-point of the upper arm, elbow, and 10 and 15 cm below the elbow. Twenty-nine patients were included in this study. Fifteen patients (51.7%) had bypass lymphatic systems on the affected side, six (20.7%) had a bypass lymphatic system with axillary lymph nodes on the unaffected side, and 11 (37.9%) showed new lymphatic drainage. The positive group showed significantly less swelling than the negative group at the mid-arm, elbow, and 15 cm below the elbow. Bypass lymphatic circulation had two patterns: Infraclavicular lymph nodes and supraclavicular and/or cervical lymph nodes. Changes in lymph drainage caused by surgery triggered the activation of the superficial lymphatic drainage system to relieve lymphedema. Superficial lymphatic drainage has a connection through the deltopectoral groove.

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Effect of Axillary Lymph Node Dissection on Prevalence and Intensity of Chronic and Phantom Pain After Breast Cancer Surgery

Journal of Pain ◽

10.1016/j.jpain.2008.04.001 ◽

2008 ◽

Vol 9 (9) ◽

pp. 813-822 ◽

Cited By ~ 62

Author(s):

Monique A. Steegers ◽

Bas Wolters ◽

Andrea W. Evers ◽

Luc Strobbe ◽

Oliver H. Wilder-Smith

Keyword(s):

Breast Cancer ◽

Lymph Node ◽

Axillary Lymph Node Dissection ◽

Lymph Node Dissection ◽

Axillary Lymph Node ◽

Cancer Surgery ◽

Breast Cancer Surgery ◽

Phantom Pain ◽

Axillary Lymph ◽

Node Dissection

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EARLY COMPLICATIONS AFTER RADICAL OPERATIONS IN BREAST CANCER PATIENTS

EUREKA Health Sciences ◽

10.21303/2504-5679.2020.001119 ◽

2020 ◽

Vol 1 ◽

pp. 3-9

Author(s):

Yuri Vinnyk ◽

Vadym Vlasenko ◽

Anna Baranova

Keyword(s):

Breast Cancer ◽

Lymph Node ◽

Wound Infection ◽

Cancer Patients ◽

Lymph Node Dissection ◽

Early Period ◽

Radical Mastectomy ◽

Axillary Lymph ◽

Breast Cancer Patients ◽

Node Dissection

Breast cancer is one of the most common malignancies in women. In many cases, a major component of complex treatment for breast cancer is surgery - radical mastectomy or radical breast resection. The aim of the work – to investigate the frequency and structure of complications after radical surgery with dissection of axillary lymph nodes in breast cancer patients. Material and methods. The baseline and surgical results of 147 women with breast cancer who underwent radical mastectomy or radical breast resection with lymph node dissection were analysed. Results. Complications in the early period after surgery for breast cancer were found in 76 (51.7 %), including postoperative extremity edema in 60 (40.8 %); lymphorrhea – in 37 (25.2 %), seroma – in 33 (22.4 %); wound infection in 18 (12.2 %), necrosis of the wound edges – in 15 (10.2 %) patients. Correlation of postoperative edema with almost all other complications was found, lymphorrhea and seroma were most associated with swelling and with each other; necrosis of edges with postoperative edema. Wound infection was significantly associated with lymphorrhea. Patients' age, stage of disease, and immunohistochemical type of tumour did not affect the development of complications. With increasing BMI, the incidence of complications increased significantly (χ2=9.530; p=0.009). The tendency to decrease the frequency of complications during reconstructive surgery was revealed (42.6 % versus 58.1 %, p=0.064), and adjuvant radiotherapy, on the contrary, contributed to the increase of complications (57.8 % versus 43.8 %, p=0.090). Conclusion. Radical operations with lymph node dissection in patients with breast cancer are characterized by a high frequency of early postoperative complications, mainly associated with disorders of lymphatic outflow, which indicates the need for a set of measures of preoperative preparation, improvement of surgical technique.

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Surgical Predictive Model for Breast Cancer Patients Assessing Acute Postoperative Complications: The Breast Cancer Surgery Risk Calculator

Annals of Surgical Oncology ◽

10.1245/s10434-021-09710-8 ◽

2021 ◽

Author(s):

Michael M. Jonczyk ◽

Carla Suzanne Fisher ◽

Russell Babbitt ◽

Jessica K. Paulus ◽

Karen M. Freund ◽

...

Keyword(s):

Breast Cancer ◽

Postoperative Complications ◽

Predictive Model ◽

Cancer Patients ◽

Cancer Surgery ◽

Breast Cancer Surgery ◽

Risk Calculator ◽

Breast Cancer Patients

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Magnetic Seed (Magseed) Localisation in Breast Cancer Surgery: A Multicentre Clinical Trial

Breast Care ◽

10.1159/000510380 ◽

2020 ◽

pp. 1-6

Author(s):

Jan Žatecký ◽

Otakar Kubala ◽

Oldřich Coufal ◽

Markéta Kepičová ◽

Adéla Faridová ◽

...

Keyword(s):

Breast Cancer ◽

Cancer Patients ◽

Surgical Oncology ◽

Breast Tumour ◽

Axillary Node ◽

Cancer Surgery ◽

Breast Cancer Surgery ◽

Breast Cancer Patients ◽

Magnetic Marker ◽

Magnetic Seeds

Introduction: The aim of this study was to evaluate the accuracy and reliability of the Magseed magnetic marker in breast cancer surgery. Methods: Thirty-nine patients with 41 implanted Magseeds undergoing surgical treatment in 3 surgical oncology departments were included in the retrospective trial to study pilot use of the Magseed magnetic marker in the Czech Republic for localisation of breast tumours or pathological axillary nodes in breast cancer patients. Results: Thirty-four breast cancer and 7 pathological lymph node localisations were performed by Magseed implantation. No placement failures, or perioperative detection failures of Magseeds were observed (0/41, 0.0%), but one case of Magseed migration was present (1/41, 2.4%). All magnetic seeds were successfully retrieved (41/41, 100.0%). Negative margins were achieved in 29 of 34 (85.3%) breast tumour localisations by Magseed. Conclusion: Magseed is a reliable marker for breast tumour and pathological axillary node localisation in breast cancer patients. Magseed is comparable to conventional localisation methods in terms of oncosurgical radicality and safety.

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