Breast conservation surgery (BCS) for breast cancer in a resource limited country- Are we upto the challenge!

Objective: To analyse outcomes of breast conservation surgery and to identify the factors that could have affected the outcomes. Method: The retrospectively study was conducted at the Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan, and comprised data of breast conservation surgery cases done between January 2011 and October 2014 in order to cover up for the 5-year follow-up of the last enrolled patient. Data, obtained through the institutional information and database system, included disease-recurrence, 5-year disease-free survival and overall survival. Data was statistically analysed using SPSS 20. Results: Of the 553 cases, 417(75%) had no loco-regional recurrence or distant metastasis, while 136(25%) had some form of loco-regional, distant or contralateral metastasis at 5-year follow-up. In patients who had recurrence or metastasis, only progesterone receptor status, nodal status and mode of treatment showed significant association (p<0.05). Mortality at 5-year follow-up was 77(14%). Amongst the patients who died, only progesterone receptor status and nodal status had significant association (p<0.05). Five-year overall survival for the cohort was 476(86%), whereas 5-year disease-free survival was 409(74%). Conclusion: Breast conservation surgery was found to have favourable outcomes, while progesterone status, nodal involvement and mode of treatment significantly affected the outcome. Key Words: Breast cancer, Breast conserving surgery, 5-year disease free survival, 5-year overall survival Continuous...

Potential Biomarkers for Predicting the Overall Survival of Kidney Renal Papillary Cell Carcinoma: A Analysis of N6-Methylandenosine-Related lncRNAs

Background: It is well established that disease-free survival and overall survival after breast conservation surgery (BCS) followed by radiotherapy are equivalent to that after mastectomy. However, in Asian countries, the rate of BCS continues to remain low. The cause may be multifactorial including the patient’s choice, availability and accessibility of infrastructure and surgeon’s choice. We aimed to elucidate the Indian surgeons’ perspective while choosing between BCS and mastectomy, in women oncologically eligible for BCS. Methods: We conducted a survey-based cross-sectional study over 3 weeks between January-February 2021. Indian surgeons with general surgical or specialised onco-surgical training, who consented to participate were included in the study. Multinomial logistic regression was performed to assess the effect of study variables on offering mastectomy or BCS to an eligible patient.Results: A total of 347 responses were included. The mean age of the participants was 43(11) years. 63% of the surgeons were in the 25-44 years age group with the majority (80%) being males. 66.4% of surgeons ‘almost always’ offered BCS to oncologically eligible patients. Surgeons who had undergone specialised training in oncosurgery or breast conservation surgery were 35 times more likely to offer BCS (p<0.01). Surgeons working in hospitals with in-house radiation oncology facilities were 9 times more likely to offer BCS (p<0.05). Surgeons’ years of practice, age, sex and hospital setting did not influence the surgery offered.Conclusion: Our study found that two-thirds of Indian surgeons preferred BCS over mastectomy. Lack of radiotherapy facilities and specialised surgical training were deterrents to offering BCS to eligible women.

Breast Conservative Surgery for Breast Cancer: Indian Surgeon’s Preferences and Factors Influencing Them

Background: It is well established that disease-free survival and overall survival after breast conservation surgery (BCS) followed by radiotherapy are equivalent to that after mastectomy. However, in Asian countries, the rate of BCS continues to remain low. The cause may be multifactorial including the patient’s choice, availability and accessibility of infrastructure and surgeon’s choice. We aimed to elucidate the Indian surgeons’ perspective while choosing between BCS and mastectomy, in women oncologically eligible for BCS. Methods: We conducted a survey-based cross-sectional study over 3 weeks between January-February 2021. Indian surgeons with general surgical or specialised onco-surgical training, who consented to participate were included in the study. Multinomial logistic regression was performed to assess the effect of study variables on offering mastectomy or BCS to an eligible patient.Results: A total of 347 responses were included. The mean age of the participants was 43(11) years. 63% of the surgeons were in the 25-44 years age group with the majority (80%) being males. 66.4% of surgeons ‘almost always’ offered BCS to oncologically eligible patients. Surgeons who had undergone specialised training in oncosurgery or breast conservation surgery were 35 times more likely to offer BCS (p<0.01). Surgeons working in hospitals with in-house radiation oncology facilities were 9 times more likely to offer BCS (p<0.05). Surgeons’ years of practice, age, sex and hospital setting did not influence the surgery offered.Conclusion: Our study found that two-thirds of Indian surgeons preferred BCS over mastectomy. Lack of radiotherapy facilities and specialised surgical training were deterrents to offering BCS to eligible women.

Breast Conservation Surgery versus Modified Radical Mastectomy in the Management of Non Metastatic Inflammatory Breast Cancer

Background Inflammatory breast cancer (IBC), the most lethal form of breast cancer, constitutes 1–2% of all breast cancers in the United States. Multimodality therapy is the standard in management of non metastatic inflammatory breast cancer patients including neoadjuvant chemotherapy and endocrine therapy and mastectomy followed by post mastectomy radiation. A modified radical mastectomy has been the standard surgical procedure of choice. The objective of this systematic review and metanalysis is to estimate the pooled benefits and adverse effects of performing modified radical mastectomy versus breast conservation surgery in the management of non metastatic IBC. Objective To evaluate, review and analyze the outcome of non metastatic IBC patients treated with mastectomy or breast conservation surgery as an integral part of the multimodality treatment of the disease. To highlight the evidence and quality of the included studies. To share in modifying the current guidelines. Methods An electronic search was conducted from the inception till Jan 2020 in the following bibliographic databases: Medline via PubMed, SCOPUS, Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, and Google Scholar to identify relevant articles. We used different combinations of the following queries: ("Inflammatory Breast cancer" OR "breast cancer") AND ("Conservative Treatment" [Mesh] OR "conservative surgery" OR "breast conservative surgery" OR "partial mastectomy"). The search have been done with no limit regarding the year publication. Results After reviewing five studies we found that our results favors the use of modified radical mastectomy over breast conservation surgery in terms of the overall survival and breast cancer specific free survival, however, partial mastectomy could be an effective and safe option in selected group of patients with non metastatic IBC based on the response to NAC an patient’s preference. Conclusions Breast surgery is of great significance to the clinical outcomes of IBC. Standard mastectomy shouldn’t be the only recommended surgical treatment. Individualized surgical procedures can be safely performed in non-metastatic IBC patients based on the response of NAC and patient’s preference.

EP.TH.930Contemporary trends in the management of micrometastatic axillary disease in the setting of mastectomy – a 5 year single institution experience

Background Since the ACOSOG Z0011 trial, rates of axillary node clearance (ANC) for micrometastatic axillary disease have declined among women undergoing breast conservation surgery (BCS). However, for women undergoing mastectomy, it remains unclear whether omission of ANC is a safe and feasible option. Aims Identify current practice relating to management of the axilla in women with early stage, clinically node negative breast cancer, found to have micrometastatic disease on SNB, who undergo mastectomy Methods From 2013 to 2017 patients with clinical T1-T2Nmi breast cancer undergoing upfront surgery were identified from a prospective institutional database. Receipt of adjuvant radiotherapy or subsequent ANC were assessed. Patients who received neoadjuvant chemotherapy or BCS were excluded. Results 47 patients undergoing mastectomy for ESBC had micrometastasis identified on SNB. The majority of tumours had invasive ductal histology. 16/27 women underwent completion ANC (34%). Six patients had further nodal disease identified in the ANC specimen. 2 had &gt;5 nodes positive. During the study period 31 patients (65%) received adjuvant radiotherapy. Of the patients who did not undergo ANC, 21 (67.7%) received adjuvant radiotherapy. Conclusion At this institution the majority of patients requiring mastectomy with micrometastatic disease on SNB do not undergo subsequent ANC (&gt;60%). Although this is a small patient cohort, these data indicate the rate of residual axillary disease is low, and are in keeping with trends in the literature, and may help inform management decisions in this patient group.

A PROSPECTIVE COMPARATIVE STUDY BETWEEN MODIFIEDRADICAL MASTECTOMY AND BREAST CONSERVATION SURGERY IN EARLY BREAST CANCER

Background: The improvement in the treatment of breast cancer is due to early diagnosis, better understanding of the natural history of this disease and therapeutic improvements over the years. There is a gradual shift away from radical surgery advocated by Halsted to the breast conservative surgery during the last few decades all over the world mainly influenced by the results of several large trials of lesser surgical procedures. Methods: Hospital based descriptive study was conducted on patients with Early Breast Cancer presenting to the Department of General Surgery in Guru Gobind Singh Medical College & Hospital, Faridkot. Results: Mean blood loss of the subjects of the BCS group was observed to be 44.07±15.76 ml as compared to 94.36 ± 31.50 ml in the subjects of the MRM. Mean operative time of the subjects of the BCS group was observed to be 46.03±8.68 minutes as compared to the mean operative time of 64.03±16.56 minutes in the subjects of the MRM group. Mean VAS score on day-1 in BCS group and in MRM group was 5.3±1.98 and 6.73±1.70 respecively. Mean VAS score on day-3 in BCS group and in MRM group was 4.46±1.50 and 5.1±1.56 respectively. Mean VAS score on day-5 in BCS group and in MRM group was 2.96±0.76 and 2.96±1.06 respectively. Seroma Formation was observed in 3.33 % cases in BCS group and 16.67 % in MRM group. Flap necrosis was observed in 0 % in BCS group whereas 10.00 % of the patients had flap necrosis in MRM group. Positive margins were absent in both BCS group and MRM group. Wound infection was observed in 6.67% of the patients in the BCS group and 20.00% in the MRM group. Quality of life score for BCS and MRM was 108.53±14.62 and 95.26±14.70 respectively. Conclusion: Breast conservation surgery should be the preferred treatment for Stage-I and Stage-II Breast cancer disease due to its lesser post-operative pain, shorter duration of surgery, lesser blood loss and short hospital stay thus helping in early returning to normal activity. Breast conservation surgery has better outcomes compared with Modified radical mastectomy. Keywords: BCS, MRM, Breast surgery

Reduction Mammoplasty Approach to Oncoplasty—Zone-Wise Planning in Indian Patients

Introduction This article is an attempt to formulate certain guidelines for planning of zone-wise reconstruction after breast conservation surgery. The planning involves applying reduction mammoplasty principles with certain modifications to address the defect. Patients and Methods This is a retrospective study of 61 patients with breast cancer who underwent breast conservation surgery and reconstruction of partial breast defects with oncoplastic techniques between January 2014 to March 2019. Patients having low tumor to breast ratio and thus good candidates for volume displacement techniques were included in the study. Results A total of 61 breast cancer cases were included; 22 cases were located in zone 1, nine in zone 2, seven in zone 3, three in zone 4, four in zone 5, one in zone 6, 12 in zone 7, two in zone 8, and three in zone 9. The most common pedicle design used was superomedial in 38 cases, followed by inferior in 19 and medial in 6 cases. Vertical short scar technique was used in 33 cases and Wise pattern skin incision in 30 cases. Follow-up period ranged from 4 months to 65 months, with a mean of 31 months. Four patients had partial skin necrosis, three had suture line dehiscence, two had wound infection, one had seroma, and eight patients had fat necrosis. All patients were satisfied with the cosmetic outcome. Conclusion Breast oncoplastic techniques are effective, reliable, oncologically safe, and conducted with minimal complications in patients with moderately large ptotic breasts, thereby making planning easier and more reproducible by following the reconstruction procedures described in the article. We believe that these techniques should be incorporated in the armamentarium of every plastic surgeon to manage the defects created after breast conservation surgery, in order to achieve the best cosmetic outcomes.