scholarly journals Risk Assessment and Anesthesia Classification in Breast Cancer Surgery

2018 ◽  
pp. 168-172
Author(s):  
Kasra Karvandian ◽  
Jayran Zebardast ◽  
Nazila Zolfaghari Borra
Keyword(s):  
Breast Cancer ◽  
Risk Assessment ◽  
Breast Reconstruction ◽  
Cancer Surgery ◽  
Breast Cancer Surgery ◽  
Diep Flap ◽  
Breast Cancer Patients ◽  
Risk Patients ◽  
Group 2 ◽  
Group 1

Background: There are various factors affecting the effectiveness of the treatment of breast cancer patients. Although the disease pathology, along with surgery and other therapeutic modalities, plays the principal role in patient outcomes, anesthesia still plays an important role in the success of treatment. This study was designed to show the effects of anesthetic plans on risk classification and assessment in breast cancer surgeries. Methods: Two hundred sixty patients receiving different types of breast cancer surgery for therapeutic and reconstructive purposes were enrolled in this study. They were divided into three groups according to the anesthesia risk assessment. Group 1 consisted of low-risk patients (ASA I) who received small surgeries such as lumpectomy. Patients with intermediate risk of anesthesia (ASA II) or those who underwent breast cancer and axillary surgery with overnight admission (ASA I or II) were considered as group 2. Group 3 comprised the patients with higher risk for anesthesia (ASA class III) regardless of the surgery type or those in any ASA class who were about to undergo advanced and prolonged surgeries such as breast reconstruction with free or pedicle flaps. Results: Two hundred sixty-eight surgical interventions were done in 260 patients. There were 106, 107, and 47 patients in groups 1, 2, and 3, respectively. In group 1, five patients out of 106 were admitted in the hospital for 24 hours after surgery and the remaining 101 patients were discharged from the hospital in a few hours after the operation when they were fully conscious and could tolerate the diet completely. All 107 patients in group 2 were admitted in the hospital for a few days after the operation, though the vast majority of them (98 patients) discharged from the hospital the day after surgery. In the last group, 6 out of 47 patients showed the signs of surgical complications such as partial flap ischemia in the postoperative period, mostly after TRAM or DIEP flap breast reconstruction surgery. Conclusion: The findings of this study support the idea that breast surgeries can be done in an ambulatory situation with no considerable risk. In contrast, all medical and anesthetic considerations should be taken into account in more complex surgeries, especially when they are applied in high-risk patients.

scholarly journals Analysis on the Effect of Application of the DIEP Flap in Breast Reconstruction Surgery

2018 ◽  
Vol 2 (1) ◽  
Author(s):  
Tan Jia Liang
Keyword(s):  
Breast Cancer ◽  
Breast Reconstruction ◽  
Chest Wall ◽  
Early Stage ◽  
Developed Countries ◽  
Breast Cancer Surgery ◽  
Sex Reassignment Surgery ◽  
Diep Flap ◽  
Breast Reduction Surgery ◽  
Reconstruction Surgery

Breast reconstruction surgery means using autologous tissue grafts and breast prosthesis to rebuild chest wall deformities and the absence of breast caused by post mastectomy, which are possibly due to burns, trauma, infections, congenital dysplasia and sex reassignment surgery etc., with the prevalence of unilateral breast reconstruction. After attempting to carry out breast reconstruction with latissimus dorsi, many surgeons constantly improved, designed, and modified multiple forms of operation programs and thus promote increasing improvement in repair and reconstruction of the breast after breast reduction surgery and mastectomy for breast cancer [1] Currently, breast reconstruction after breast cancer surgery is just in the early stage while it has occupied an important position in developed countries,therefore, the knowledge of breast reconstruction needs to be enhanced and publicized in our country. Some data show the quality of life in patients following breast reconstruction surgery is significantly higher than that in patients undergoing lumpectomy plus radiotherapy or simple mastectomy. More and more patients pursue breast reconstruction after mastectomy for breast cancer. Breast reconstruction is roughly divided into lost chest wall skin repair, hemispherical breast reconstruction, anterior axillary fold repair, plastic surgery for subclavian depression, nipple and areola reconstruction and asymmetrical breast repair. In the reconstruction of breasts, it is necessary to endeavor to make the rebuilt breast symmetrical to the healthy side so that future adjustment will be simple and easily feasible.

Breast Cancer Surgery

2019 ◽  
pp. 144-156
Author(s):  
Peter A. van Dam ◽  
Cary Kaufman ◽  
Carlos Garcia-Etienne ◽  
Marie-Jeanne Vrancken Peeters ◽  
Robert Mansel
Keyword(s):  
Breast Cancer ◽  
Early Stage ◽  
Breast Conserving Surgery ◽  
Cancer Surgery ◽  
Breast Cancer Surgery ◽  
Breast Diseases ◽  
Breast Cancer Patients ◽  
Breast Conserving Treatment ◽  
Sentinel Node Concept

Abstract: The role of the surgeon managing breast diseases has been the subject of continuous evolution, moving from the cancer-extirpative surgeon to a deeply informed surgical leader, who interacts in a multidisciplinary setting also encompassing tasks for risk assessment, genetic counselling, and new diagnostic approaches. Surgical removal of the tumour remains the cornerstone in treating early stage breast cancer. During the last century, breast cancer surgery became less radical, breast-conserving treatment emerged, and the role of axillary lymphadenectomy changed from a therapeutic procedure into a staging procedure with prognostic implications. Later, the sentinel node concept reduced the need for complete axillary clearance in most cases. Nowadays, thanks to breast-conserving surgery, oncoplastic techniques, and reconstructive procedures, most breast cancer patients can overcome this disease without serious permanent physical mutilation. A multidisciplinary approach, benchmarking, and quality assurance have improved outcomes markedly.

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

Breast Care ◽  
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

<b><i>Introduction:</i></b> The aim of this study was to evaluate the accuracy and reliability of the Magseed magnetic marker in breast cancer surgery. <b><i>Methods:</i></b> 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. <b><i>Results:</i></b> 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. <b><i>Conclusion:</i></b> 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.

scholarly journals The Impact of Combined Risk-Reducing Gynecological Surgeries on Outcomes in DIEP Flap and Tissue-Expander Breast Reconstruction

2020 ◽  
Vol 28 (2) ◽  
pp. 112-116
Author(s):  
Avinash P. Jayaraman ◽  
Travis Boyd ◽  
Savannah N. Hampton ◽  
Nicholas T. Haddock ◽  
Sumeet S. Teotia
Keyword(s):  
Breast Reconstruction ◽  
Tissue Expander ◽  
Diep Flap ◽  
Group 4 ◽  
Flap Loss ◽  
Hospital Stays ◽  
Group 3 ◽  
Group 2 ◽  
Risk Reducing ◽  
Group 1

Introduction: In addition to prophylactic mastectomies, BRCA1 and BRCA2 mutation carriers are increasingly choosing to undergo risk-reducing procedures such as hysterectomies and salpingo-oophorectomies. Sometimes these surgeries are performed in the same visit as a mastectomy or a revisionary reconstruction procedure. Literature lacks descriptions of complications and trends for these combined surgeries. Methods: Group 1 patients (n = 10, flaps = 20) had abdominal gynecologic procedures at the time of deep inferior epigastric artery perforator flap (DIEP flap) reconstruction. Group 2 patients (n = 29, breasts = 58) had gynecologic procedures at the time of mastectomy and tissue-expander placement. Group 3 patients (n = 141, breasts = 257) had mastectomy and tissue-expander reconstruction without gynecologic procedures and were used as a control group for group 2. Group 4 patients (n = 357, flaps = 673) had autologous breast reconstruction without gynecologic procedures and were used as a control for group 1. Categorical variables such as complications and flap loss were analyzed using χ2 tests. Continuous variables such as age, body mass index (BMI), operative time, length of stay were analyzed with 2-tailed t tests. Multivariate analyses were run to control for group differences. Results: Groups 1 and 4 were equivalent in age and comorbidities, except group 1 (32.8 kg/m2) had significantly higher BMI than group 4 (31.4 kg/m2), P = .028. Average operating time was statistically equivalent for group 1 patients (610 minutes) and group 4 patients (503 minutes), P = .289. Average hospital stay was equivalent as well (group 1 = 4.4 days, group 4 = 4.1 days, P = .676). Operative times for group 2 patients (457 minutes) were significantly longer than for group 3 patients (288 minutes), P < .01. Group 2 patients (3 nights) had significantly longer hospital stays than group 3 patients (2 nights), P < .01. Group 1 patients (2/20 flaps, 10%) had a significantly higher rate of flap loss than group 4 patients (8/673 flaps, 1%), P < .01. There were no differences in other flap complications. Additionally, there were no significant differences in postoperative tissue-expander complications between group 2 and group 3. Discussion: Both flap losses in Group 1 patients occurred in a single patient with BMI = 39.3 kg/m2 and a personal history of recurrent DVTs. Additionally, the rates of complications across other measures were equivalent between groups. Thus, despite the increased rate of flap loss in Group 1 (10%) vs Group 4 (1.3%), along with the increased operative times and hospital stays, certain patients can be advised that a prophylactic gynecological procedure is safe to combine with breast reconstruction.

Effect of neoadjuvant chemotherapy on women undergoing breast cancer surgery and immediate breast reconstruction with latissimus dorsi flap and silicone implants

2016 ◽  
Vol 40 (4) ◽  
pp. 299-308
Author(s):  
Gabriel Salum D’Alessandro ◽  
Alejandro Povedano ◽  
Lauren Klas Iurk Leme dos Santos ◽  
Alexandre Mendonça Munhoz ◽  
Rolf Gemperli ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Breast Reconstruction ◽  
Latissimus Dorsi ◽  
Immediate Breast Reconstruction ◽  
Cancer Surgery ◽  
Latissimus Dorsi Flap ◽  
Breast Cancer Surgery ◽  
Silicone Implants

Breast Reconstruction with the Free Tram Flap after Breast Cancer Surgery

1992 ◽  
Vol 8 (01) ◽  
pp. 1-6 ◽  
Author(s):  
Atsushi Yamada ◽  
Kiyonori Harii ◽  
Shinichi Hirabayashi ◽  
Takao Kawashima ◽  
Hirotaka Asato
Keyword(s):  
Breast Cancer ◽  
Breast Reconstruction ◽  
Cancer Surgery ◽  
Breast Cancer Surgery ◽  
Tram Flap

scholarly journals Laparoscopic Abdominal Surgery after Primary Breast Reconstruction Using an Abdominal Flap

Medicina ◽  
2021 ◽  
Vol 57 (9) ◽  
pp. 952
Author(s):  
Tsuyoshi Nakagawa ◽  
Goshi Oda ◽  
Hiroki Mori ◽  
Noriko Uemura ◽  
Kimio Wakana ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Laparoscopic Surgery ◽  
Abdominal Surgery ◽  
Breast Reconstruction ◽  
Myocutaneous Flap ◽  
Uterine Cancer ◽  
Cancer Surgery ◽  
Rectus Abdominis ◽  
Breast Cancer Surgery ◽  
Rectus Abdominis Myocutaneous Flap

Background and objectives: Our department has been performing primary breast reconstruction for breast cancer surgery, incorporating a transverse rectus abdominis myocutaneous flap (TRAM)/vertical rectus abdominis myocutaneous flap (VRAM) since 1998 and a deep inferior epigastric artery perforator flap (DIEP) since 2008. Currently, most gastrointestinal operations in abdominal surgery are performed laparoscopically or are robot-assisted. Cases in which abdominal surgery was performed after breast reconstruction using an abdominal flap were reviewed. Method: A total of 119 cases of primary breast reconstruction using an abdominal flap performed in our department were reviewed. Result: The reconstructive techniques were DIEP in 69 cases and TRAM/VRAM in 50 cases. After breast surgery, seven abdominal operations were performed in six cases. In DIEP cases, one robotic surgery was performed for uterine cancer, and one laparoscopic surgery was performed for ovarian tumor. In TRAM/VRAM cases, two laparoscopic cholecystectomies, one laparoscopic total gastrectomy, one laparoscopic ileus reduction, and one open total hysterectomy oophorectomy were performed. Six surgeries were completed by laparoscopy or robotic assistance. Conclusion: The survival rate after breast cancer surgery is improving, and the choice of breast reconstruction procedure should take into account the possibility of performing a prophylactic resection of the ovaries due to the genetic background and possibly postoperative abdominal surgery due to other diseases. However, in cases in which laparoscopic surgery was attempted after breast reconstruction using an abdominal flap, the laparoscopic surgery could be completed in all cases.

scholarly journals Expression level of serum circulating miRNA-21, miRNA-10b and miRNA-200c in breast cancer patients with sentinel lymph node metastasis*

2019 ◽  
Vol 73 ◽  
pp. 325-332
Author(s):  
Sebastian Niedźwiecki ◽  
Janusz Piekarski ◽  
Bożena Szymańska ◽  
Zofia Pawłowska ◽  
Arkadiusz Jeziorski
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Lymph Node Metastasis ◽  
Cancer Patients ◽  
Sentinel Lymph Node Metastasis ◽  
Breast Cancer Patients ◽  
Node Metastasis ◽  
Group 2 ◽  
Group 1

MicroRNAs (miRNAs) act a role in regulation numerous processes crucial for oncogenesis. The aim of the study was to compare the blood serum concentrations of selected microRNAs (miRNA-21, miRNA-10b and miRNA-200c) between breast cancer patients without sentinel lymph node metastasis (Group 1) and those with metastasis (Group 2). The serum levels of miRNA-21, miRNA-10b and miRNA-200c were measured with using TaqMan PCR assays performed on a 7900HT Fast Real-Time PCR System in two groups of breast cancer patients: Group 1 – without sentinel lymph node metastasis (32 patients) and Group 2 – with sentinel lymph node metastasis (14 patients). The mean level of miRNA-200c was noticeably lower in Group 2 than in Group 1. The mean fold change of miRNA-200c level in the metastatic group (Group 2) was approximately 1.3 times lower than that in non-metastatic group (Group 1). However, this result just approached the arbitrary threshold for significance (p = 0.05). Breast cancer patients with sentinel lymph node metastasis demonstrate diminished levels of circulating miR-200c compared to non-metastatic patients.

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