Evaluation of Clinicopathological Findings and Postoperative Outcomes of Modified Radical Mastectomy in a Tertiary Care Center in Lahore, Pakistan

Background: Modified radical mastectomy (MRM) remains the mainstay of breast cancer surgery in under-developed countries like Pakistan as it reduces the morbidity and mortality associated with radical surgery. This study aims to delineate the clinicopathological findings and postoperative outcomes of patients undergoing modified radical mastectomy for breast carcinoma in a local setting.Material and Methods: This cross-sectional study was conducted in Gulab Devi hospital Lahore, Punjab Pakistan, from January 2016 to December 2019. Patients (n=70) with carcinoma breast planned for modified radical mastectomy were included in the study. Two suction drains were placed (in the axilla and under the flap) and removed when drainage was less than 30 cc in 24 hours. The patients were followed-up weekly for one month and then at monthly intervals for up to one year. Independent t-test and chi-square test were used to study associations between different variables. A P-value less than .05 was considered statistically significant.Results: The mean age of the patients was 48.43 ± 12.3 years. Most of the patients (42.86%) had stage-II, grade-I carcinoma (50%) with invasive ductal carcinoma as the most frequent histological variety (80%). Majority of the patients (n=60; 85.57%) were ER/PR positive. Mean duration of surgery was 124.8 ± 20.33 minutes, the mean duration of drains was 3.5±4.5 days, and the mean length of hospital stay was 4.67 ± 1.07 days. Most common complications of mastectomy were wound infection (23.57%) and seroma formation (20%). Six (8.57%) developed recurrence of disease in one year follow-up. Neoadjuvant chemotherapy increased the mean duration of surgery and drains placement (P<.05) but had no effect on mean hospital stay and complications associated with surgery (P>.05).Conclusions: Grade-I invasive ductal carcinoma with ER/PR positive receptor status was the most frequent variety of breast carcinoma. Neoadjuvant chemotherapy was associated with increased operative time and increased duration of drain placement.

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Assessment of Pathological Response of Breast Carcinoma in Modified Radical Mastectomy Specimens after Neoadjuvant Chemotherapy

International Journal of Breast Cancer ◽

10.1155/2015/536145 ◽

2015 ◽

Vol 2015 ◽

pp. 1-8 ◽

Cited By ~ 4

Author(s):

Dhanya Vasudevan ◽

P. S. Jayalakshmy ◽

Suresh Kumar ◽

Siji Mathew

Keyword(s):

Breast Carcinoma ◽

Neoadjuvant Chemotherapy ◽

Lymph Nodes ◽

Tumor Response ◽

Ductal Carcinoma ◽

Locally Advanced ◽

Radical Mastectomy ◽

Tumor Characteristics ◽

Modified Radical Mastectomy ◽

Tumor Bed

Aim. Paclitaxel based neoadjuvant chemotherapy regimen (NAT) in the setting of locally advanced breast cancer (LABC) can render inoperable tumor (T4, N2/N3) resectable. The aim of this study was to assess the status of carcinoma in the breast and lymph nodes after paclitaxel based NAT in order to find out the patient and the tumor characteristics that correspond to the pathological responses which could be used as a surrogate biomarker to assess the treatment response.Materials and Methods. Clinical and tumor characteristics of patients with breast carcinoma (n=48) were assessed preoperatively. These patients were subjected to modified radical mastectomy after 3 courses of paclitaxel based NAT regimen. The pathological responses of the tumor in the breast and the lymph nodes were studied by using Chevallier’s system which graded the responses into pathological complete response (pCR), pathological partial response (pPR), and pathological no response (pNR).Results. Our studies showed a pCR of 27.1% and a pPR of 70.9% . Clinically small sized tumors (2–5 cms) and Bloom Richardson’s grade 1 tumors showed a pCR. Mean age at presentation was 50.58 yrs. 79.2% of cases were invasive ductal carcinoma NOS; only 2.1% were invasive lobular carcinoma, their response to NAT being the same. There was no downgrading of the tumor grades after NAT. Ductal carcinoma in situ and lymphovascular invasion were found to be resistant to chemotherapy. The histopathological changes noted in the lymph nodes were similar to that found in the tumor bed.Discussion and Conclusion. From our study we conclude that histopathological examination of the tumor bed is the gold standard for assessing the chemotherapeutic tumor response. As previous studies have shown pCR can be used as a surrogate biomarker to assess the tumor response.

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A rare case of isolated adrenal metastasis of invasive ductal breast carcinoma

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh1410597a ◽

2014 ◽

Vol 142 (9-10) ◽

pp. 597-601 ◽

Cited By ~ 5

Author(s):

Natasa Andjelic-Dekic ◽

Ivana Bozovic-Spasojevic ◽

Snezana Milosevic ◽

Miodrag Matijasevic ◽

Katarina Karadzic

Keyword(s):

Breast Cancer ◽

Breast Carcinoma ◽

Computerized Tomography ◽

Ductal Carcinoma ◽

Radical Mastectomy ◽

Histopathological Analysis ◽

Adrenal Metastases ◽

Invasive Ductal Breast Carcinoma ◽

Ductal Breast Carcinoma ◽

One Year

Introduction. Isolated adrenal metastases of invasive ductal breast carcinoma are extremely rare. We report a case with isolated left adrenal metastases, verified three years after diagnosed breast carcinoma. Case Outline. A 58-year-old female patient with a right breast tumor, clinically staged as IIIA (T2N2M0) started neoadjuvant anthracycline chemotherapy after biopsy which revealed invasive ductal breast carcinoma. Immunohistochemical findings of tumor biopsy showed hormonal steroid receptors for estrogen and progesterone negative, and human epidermal growth factor receptor 2 (HER2) positive. After 4 cycles of chemotherapy and partial tumor regression the patient underwent radical mastectomy. Definite histopathological analysis confirmed the diagnosis of invasive ductal carcinoma. The patient continued treatment with adjuvant chemotherapy to cumulative dose of anthracyclines, postoperative radiotherapy and adjuvant trastuzumab for one year. Three years later abdominal computerized tomography showed tumor in the left adrenal gland as the only metastatic site. Left adrenalectomy was performed and histopathological finding confirmed breast cancer metastases. Postoperatively, the patient received 6 cycles of docetaxel with trastuzumab and continued trastuzumab until disease progression. One year after left adrenalectomy control abdominal computerized tomography showed a right adrenal tumor with retroperitoneal lymphadenopathy. Treatment with capecitabine was continued for one year, but eventually she developed brain metastasis causing lethal outcome. Conclusion. In order to better understand metastatic pathways of invasive ductal breast carcinoma, publications of individual patient cases diagnosed with rare metastatic sites should be encouraged. This might improve our understanding of metastatic behavior of breast cancer and stimulate further clinical research.

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Role of neoadjuvant chemotherapy in downstaging locally advanced breast carcinoma, selection of surgical procedure and its outcome

International Surgery Journal ◽

10.18203/2349-2902.isj20200309 ◽

2020 ◽

Vol 7 (2) ◽

pp. 526

Author(s):

Dakshayani S. Nirhale ◽

Rizhin Sooraj ◽

Anshu Rawat

Keyword(s):

Breast Carcinoma ◽

Neoadjuvant Chemotherapy ◽

Ductal Carcinoma ◽

Locally Advanced Breast Cancer ◽

Clinical Stage ◽

Locally Advanced ◽

Radical Mastectomy ◽

Conservative Surgery ◽

Advanced Breast ◽

Number Of Patients

Background: In clinical practice all cases of locally advanced breast carcinoma (LABC) warrant chemotherapy followed by multimodality care. Neoadjuvant chemotherapy (NACT) has been the mainstay in the management of LABC. The main aim of NACT is to downstage and prevent systemic micrometastasis early.Methods: This was a prospective study conducted on 36 diagnosed cases of stage III locally advanced breast cancer coming to the Dept. of Surgery, Dr. D. Y. Patil Medical College and hospital, Pune for a period of 2 years from 2017-2019. The effectiveness of neoadjuvant chemotherapy was assessed based on clinical, pathological and radiological response.Results: Among 36 LABC cases, maximum number of patients fell in the 41-50 years (41.6%) and presented in the Infiltrating ductal carcinoma group with a clinical stage IIIA disease. The response to NACT showed that a total of 12 patients (33.3%) showed complete clinical response and 30 patients were downstaged after neoadjuvant chemotherapy which was statistically significant. Only 4 out of the total 12 complete clinical responders went for Breast conservative surgery. Seroma formation was found to be the most common post-operative complication.Conclusions: LABC subjected to neoadjuvant chemotherapy based on taxanes/Anthracyclines show good clinical and radiological response. Patients preferred modified radical mastectomy due to the lack of awareness and low socioeconomic strata.The type of surgery did not increase the chance of recurrence in the follow up period.

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Cutaneous Erythema at Scar Site of Modified Radical Mastectomy: An Unexpected Manifestation of Recurrent Carcinoma

Case Reports in Surgery ◽

10.1155/2017/6879626 ◽

2017 ◽

Vol 2017 ◽

pp. 1-3

Author(s):

Awrad Mohammed-Reda Nasralla ◽

Mohammed Abdulirazzaq Al-Duhileb ◽

Ali Jamal-Aldein Arini ◽

Samir Sami Amr

Keyword(s):

Ductal Carcinoma ◽

Radical Mastectomy ◽

Tram Flap ◽

Rectus Abdominis Muscle ◽

Modified Radical Mastectomy ◽

Immediate Reconstruction ◽

Inflammatory Carcinoma ◽

Erythematous Skin ◽

One Year

A 44-year-old woman presented with marked erythema over right mastectomy scar, while on Herceptin therapy. She had neoadjuvant chemotherapy, modified radical mastectomy, and radiotherapy less than one year earlier for the treatment of invasive ductal carcinoma. On physical examination, no palpable masses were detected in the erythematous skin. A biopsy revealed permeation of the skin lymphatics by emboli of metastatic ductal carcinoma, similar to what is seen in inflammatory carcinoma. The involved skin was excised, followed by immediate reconstruction with transverse rectus abdominis muscle (TRAM) flap. On follow-up, the wound was healing well, with no signs of inflammation.

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Outcomes of endoscopic suturectomy with postoperative helmet therapy in bilateral coronal craniosynostosis

Journal of Neurosurgery Pediatrics ◽

10.3171/2016.2.peds15693 ◽

2016 ◽

Vol 18 (3) ◽

pp. 281-286 ◽

Cited By ~ 14

Author(s):

S. Alex Rottgers ◽

Subash Lohani ◽

Mark R. Proctor

Keyword(s):

Hospital Stay ◽

Head Circumference ◽

Major Complication ◽

Csf Leak ◽

Perioperative Morbidity ◽

Syndromic Craniosynostosis ◽

Duration Of Surgery ◽

Coronal Synostosis ◽

The Mean

OBJECTIVE Historically, bilateral frontoorbital advancement (FOA) has been the keystone for treatment of turribrachycephaly caused by bilateral coronal synostosis. Early endoscopic suturectomy has become a popular technique for treatment of single-suture synostosis, with acceptable results and minimal perioperative morbidity. Boston Children's Hospital has adopted this method of treating early-presenting cases of bilateral coronal synostosis. METHODS A retrospective review of patients with bilateral coronal craniosynostosis who were treated with endoscopic suturectomy between 2005 and 2012 was completed. Patients were operated on between 1 and 4 months of age. Hospital records were reviewed for perioperative morbidity, length of stay, head circumference and cephalic indices, and the need for further surgery. RESULTS Eighteen patients were identified, 8 males and 10 females, with a mean age at surgery of 2.6 months (range 1–4 months). Nine patients had syndromic craniosynostosis. The mean duration of surgery was 73.3 minutes (range 50–93 minutes). The mean blood loss was 40 ml (range 20–100 ml), and 2 patients needed a blood transfusion. The mean duration of hospital stay was 1.2 days (range 1–2 days). There was 1 major complication in the form of a CSF leak. The mean follow-up was 37 months (range 6–102 months). Eleven percent of nonsyndromic patients required a subsequent FOA; 55.6% of syndromic patients underwent FOA. The head circumference percentiles and cephalic indices improved significantly. CONCLUSIONS Early endoscopic suturectomy successfully treats the majority of patients with bilateral coronal synostosis, and affords a short procedure time, a brief hospital stay, and an expedited recovery. Close follow-up is needed to detect patients who will require a secondary FOA due to progressive suture fusion or resynostosis of the released coronal sutures.

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Comparison of Outcome of one Versus two Drains Insertion for Seroma Formation Following Modified Radical Mastectomy in Breast Carcinoma

Annals of PIMS-Shaheed Zulfiqar Ali Bhutto Medical University ◽

10.48036/apims.v17i1.499 ◽

2021 ◽

Vol 17 (1) ◽

pp. 52-55

Author(s):

Shiraz Shaikh ◽

Ambreen Munir ◽

Shahnawaz Abro ◽

Shahida Khatoon ◽

Zameer Hussain Laghari ◽

...

Keyword(s):

Breast Carcinoma ◽

General Surgery ◽

Stable Condition ◽

Radical Mastectomy ◽

Seroma Formation ◽

University Hospital ◽

P Value ◽

Modified Radical Mastectomy ◽

Group A ◽

Group B

Objective: Comparative outcome of one versus two drains insertion for in the term of seroma formation following modified radical mastectomy in breast carcinoma. Methodology: This Prospective Interventional trial was conducted at Department of General Surgery, Liaquat University Hospital Hyderabad from February 2018 to January 2019. Females with breast carcinoma admitted for modified radical mastectomy were included. Patients were divided into two groups. Groups I underwent one drain placement and group II underwent two drains placement. All patients were observed to measure and record the volume of the fluid. Patients were discharged from Hospital in stable condition and after removal of drains, and followed up weekly for one month. Data was recorded on self-made proforma and analyzed by using SPSS-20. Results: Total of 80 patients were selected, 38 in group A and 42 in group B. Mean age of patients of group A was 49.08 ± 9.89 years and group B was 51.40 ± 13.59 years. , Excised Mass weight was lesser in group A as compared to group B. Mean volume of drain discharge was significantly higher in Group B 323.43 ± 158.88 ml, while it was in group A 230.29± 200.98, findings were statistically significant 0.013. Seroma formation was statistically insignificant among both groups as 8(21.1%) in group A and 10(23.8%) in group B, p-value 0.768. Conclusion: One-drain and two-drain insertion are equally effective to reduce the seroma formation after modified radical mastectomy; however, one drain insertion leads to more patient compliance and comfort with probably less morbidity and cost.

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Comparison of electrocautery and plasmablade on ischemia and seroma formation after modified radical mastectomy for locally advanced breast cancer

Surgical Techniques Development ◽

10.4081/std.2017.7011 ◽

2017 ◽

Vol 7 (1) ◽

Cited By ~ 2

Author(s):

Husnu Alptekin ◽

Huseyin Yılmaz ◽

Bahadir Ozturk ◽

Ilhan Ece ◽

Mehmet Ertugrul Kafali ◽

...

Keyword(s):

Locally Advanced Breast Cancer ◽

Statistical Significance ◽

Locally Advanced ◽

Radical Mastectomy ◽

Seroma Formation ◽

Modified Radical Mastectomy ◽

Drainage Volume ◽

Drain Removal ◽

Postoperative Drainage ◽

The Mean

The aim of this study was to compare postoperative drainage volumes and IMA levels in patients who underwent modified radical mastectomy (MRM) with using PlasmaBlade (PB) or electrocautery (EC). A total of 36 patients who underwent MRM with PB or EC in our clinic between August 2012 to February 2013 were enrolled. Number of removed and positive lymph nodes, duration of drainage and total drainage volume was recorded. Seroma formation after drain removal and number of aspirations were also recorded. Serum ischemia modified albümine (IMA) levels were analysed before surgery, 1 hour and 24 hour after surgery. In total, 36 patients were treated with MRM in the study period. Of the 36 patients, 16 underwent MRM with PB, and 20 underwent MRM with EC. The patients demographics were similar in both groups. The mean drainage volume and seroma formation were significantly higher in the PB group when compared with EC group (P<0.05). Number of aspirations due to the seroma were also high in PB group. The total aspiration volume of seroma was not different in both groups. IMA levels 24 hours after surgery in the PB group was significantly higher than EC group. There was no statistical significance between the groups for IMA levels at 1st hour. PB is a monopolar energy device and is associated with increased levels of ischemia. This situation resulted with an increased volume of total axillary drainage and elevated risk of seroma formation.

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A Study of the Clinical Features and the Treatment of Breast Cancer in 374 Patients in Iran

Tumori Journal ◽

10.1177/030089160308900205 ◽

2003 ◽

Vol 89 (2) ◽

pp. 132-135 ◽

Cited By ~ 3

Author(s):

Morteza Salsali ◽

Dehghan Tazejani ◽

Amir Javadi ◽

Babak Mahmud ◽

Hamid-Reza Sali ◽

...

Keyword(s):

Breast Cancer ◽

Clinical Features ◽

Hospital Admissions ◽

Ductal Carcinoma ◽

Radical Mastectomy ◽

Entire Series ◽

The Mean ◽

Second Year ◽

Metastatic Involvement ◽

Exact Size

For evaluation of clinical features and state of the art in the treatment of breast cancer in Iran, we studied 347 consecutive patients among 1123 hospital admissions (in 14 hospitals in three cities) who had undergone surgery for a mass in their breasts during a 2-year period, 1991 to 1992. Thirty-nine additional patients with breast cancer had been treated in the second year of the study, an increment of 8.9%. The relative frequency of positive biopsies for breast cancer was 31% for the entire series. In Teheran, Babol and Yazd, it was 35%, 24.2% and 18.1%, respectively. The mean age for the entire series was 48 ± 1 years. The mean age for patients from Yazd was 51 ± 9, which was higher than the mean age (41.5 ± 16) of patients from Babol. The pathologic diameter was >2.1 cm (pT2 and pT3) in 59.36% of the tumors. In 15.56% of the patients, the exact size of the tumor was not available. In 83.45% of the patients, the tumors were reported as infiltrating ductal carcinoma. Of 173 patients in whom regional nodes had been histologically examined, 80% had metastatic involvement (stage II disease). Modified radical mastectomy had been used more than radical mastectomy in this series, but the choice of the operation was not related to the size of tumor.

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Neoadjuvant Chemotherapy Does Not Decrease the Dose Requirement of Propofol for Inducing the Loss of Consciousness in Patients with Breast Cancer: A Prospective Study

Clinical Oncology and Research ◽

10.31487/j.cor.2020.01.05 ◽

2020 ◽

pp. 1-4

Author(s):

Juanyin Zhu ◽

Fei Xiao ◽

Guangfa Xia ◽

Juanyin Zhu ◽

Liu Lin ◽

...

Keyword(s):

Neoadjuvant Chemotherapy ◽

Physiological Function ◽

Radical Mastectomy ◽

Modify Radical Mastectomy ◽

Loss Of Consciousness ◽

Modified Radical Mastectomy ◽

Dose Requirement ◽

A Prospective Study ◽

To Receive ◽

Variable Dose

Background: Neoadjuvant chemotherapy can cause certain damage to patients’ physiological function. Therefore, we suspected that the sensitivity to propofol would also be altered by neoadjuvant chemotherapy. We aimed to compare the ED50 for inducing loss of consciousness (LOC) in patients with and without preoperative neoadjuvant chemotherapy. Methods: Sixty-two patients were randomized to receive neoadjuvant chemotherapy (group N) or not (group C) 10 to 15 days before elective modify radical mastectomy. The up-down method was used to determine the ED50 of propofol. Patients in each group received an initial dose of 4.0 μg/mL of propofol and a variable dose (increments or decrements) of 0.4 μg/mL of propofol based on the effective or ineffective response of the prior patient. The effective dose of propofol for induction of LOC in 50% patients was calculated and compared. Results: The EC50 and 95% confidence intervals (95%CI) of propofol in the two groups were 3.27 μg/mL (95%CI, 3.09～3.43 μg/mL) and 3.33μg/mL (95%CI, 3.19～3.47 μg/mL) for patients undergoing elective modified radical mastectomy with and without neoadjuvant chemotherapy respectively. Thus, there was no difference in the EC50s between the two groups, P = 0.55. Conclusions: Under the condition of this study, we found the EC50s of propofol for induction of LOC were 3.27 and 3.33 μg/mL for patients undergoing elective modified radical mastectomy in the presence or absence of neoadjuvant chemotherapy. We do not recommend reducing the dose of propofol for induction of LOC in patients with neoadjuvant chemotherapy.

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Experience with modified radical mastectomy in a low-income country: a multi-center prospective observational study

BMC Surgery ◽

10.1186/s12893-021-01374-1 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Giziew Bawoke ◽

Segni Kejela ◽

Abebe Alemayehu ◽

Girmaye Tamirat Bogale

Keyword(s):

Neoadjuvant Chemotherapy ◽

Observational Study ◽

Surgical Site Infection ◽

Low Income ◽

Prospective Observational Study ◽

Radical Mastectomy ◽

Surgical Site Infections ◽

Site Infection ◽

Modified Radical Mastectomy ◽

Retroviral Infections

Abstract Background Modified radical mastectomy is the procedure of choice in centers with little to no radiotherapy services. Studying the in-hospital outcome and complications associated with the procedure is important in low-income countries. Methods This is a multi-center prospective observational study involving all patients operated with modified radical mastectomy with curative intent. Results A total of 87 patients were studied with 10.3% of which were male and 54% were between the age of 30–49 years. Clinical stage IIB and IIIA were reported in 33 (37.9%) and 25 (28.7%) respectively and 62.1% had clinically positive lymph nodes at presentation. All of the studied patients underwent curative surgery, with an average lymph node dissection of 10.2 ± 0.83. Seroma rate was 17.2% and was significantly associated with diabetes (AOR: 6.2 (CI 1.5–8.7)) and neoadjuvant chemotherapy (AOR: 8.9 (CI 1.2–14.2)). Surgical site infection occurred in 14.9% and was significantly associated with Retroviral infections (AOR: 4.2 (CI 2.1–5.8)) and neoadjuvant chemotherapy (AOR: 1.8 (CI 1.3–3.9)). No in-hospital mortality occurred during the course of the study. Conclusion Seroma rate was lower than published studies while surgical site infections rate was higher. Neoadjuvant chemotherapy was associated with increase in seroma and surgical site infection rates. Additionally, diabetes increased the rate of seroma. Surgical site infections were higher in patients with retroviral infections.

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