Comparison of wire-guided localization (WGL) and radio-guided occult lesion localization (ROLL) in localization of non-palpable breast lesions.

BACKGROUND: The number of patients with non-palpable breast lesions has increased gradually. This is because of the technological development in imaging techniques and the screening programs that lead to early detection of breast lesions. The number of patients with non-palpable breast lesions has increased gradually. This is because of the technological development in imaging techniques and the screening programs that lead to early detection of breast lesions. The aim of marking the non-palpable breast lesions is to achieve accurate lesion localization, to obtain the better cosmetic result with less tissue loss and to provide negative surgical margin. AIM OF THE STUDY: In the current study, we aimed to compare the wire-guided localization (WGL) technique with the radio-guided occult lesion localization (ROLL) technique to assess their accuracy and efficacy in non-palpable breast lesions localization. METHODS: This is a retrospective study conducted at Baheya center for Early Detection and Treatment of Breast Cancer from January 2018 and June2022,where 670 patients with non-palpable breast lesions underwent an excision were enrolled randomly in ROLL group (n = 320) and WGL (n = 350). RESULTS: Both the localization time and the time of operation were significantly decreased with the ROLL in comparison to WGL(P < 0.001). Complete lesion excision with clear margins were reported in 119/135(88.2%) of ROLL group and in 130/159 (81.8%) of WGL group and the difference was significant (P < 0.001). Reoperations (re-lumpectomy or mastectomy) were done as a second procedure on 16(11.8%) of the ROLL patients compared with 29(18.2%) in the WGL patients(P < 0.001). CONCLUSION: This study shows that ROLL is as effective as WGL for non-palpable breast lesions excision. Also, ROLL improve the outcomes by decreasing the duration of surgery, localization time, achieving a higher percentage of clear margin in spite of lower specimen size and scar length.

Changes in breast cancer staging trends among Egyptian women after COVID-19: A retrospective single-center study.

OBJECTIVES: Since being declared a global pandemic, the SARS-CoV-2 virus had a significant impact on the entire globe. The pandemic has placed a heavy burden on healthcare systems worldwide, and cancer patients are particularly prone. Despite the fact that initial international reports suggest delays in breast cancer (BC) diagnosis and screening programs, the Egyptian context requires additional research on this topic. To examine whether COVID-19 has changed the pattern of disease presentation before and after the pandemic, focusing on the tumor, node, and metastasis (TNM) staging of the disease at the initial presentation. METHODS: This single-center, retrospective study of female BC patients initially diagnosed at Baheya Foundation was conducted during the following time frames: from Jan 2019 to Jan 2020 (Pre COVID-19 cohort) and from Mar 2020 to Mar 2021 (post-COVID-19 cohort). We compared the two cohorts in terms of clinical characteristics, tumor characteristics, and the number of days from presentation to treatment. Our primary endpoint was the difference in the TNM stage of BC at the initial presentation. RESULTS: This analysis included 710 BC patients, 350 from the pre-COVID cohort and 360 from the post-COVID group. We detected a 27.9% increase in late-stage BC (stages III-IV) in the post-pandemic cohort compared to the pre-pandemic (60.1% vs. 47%, p < 0.001). The time from diagnosis to commencement of treatment was significantly longer (28.34 ± 18.845 vs 36.04 ± 23.641 days, p < 0.001) in the post-COVID cohort (mean difference = 7.702, 95% CI 4.54-10.85, p < 0.001). A higher percentage of patients in the post-pandemic cohort received systemic neoadjuvant therapy (p-value for Exact's test for all treatment options = 0.001). CONCLUSIONS: The number of patients requiring systemic neoadjuvant chemotherapy increased dramatically in the post-pandemic group with advanced stages of BC at presentation. This study highlights the need for proper management of cancer patients during any future pandemic.

Randomized Controlled Trial of Laparoscopic versus Open Radical Cystectomy in a Laparoscopic Naïve Center.

BACKGROUND: Laparoscopic radical cystectomy is a challenging surgical procedure; however, it has been largely abandoned in favor of the more intuitive robotic-assisted cystectomy. Due to the prohibitive cost of robotic surgery, the adoption of laparoscopic cystectomy is of relevance in low-resource institutes. Methodology. This is a randomized controlled trial comparing laparoscopic radical cystectomy (LRC) to open radical cystectomy (ORC) at a single institute. Each group included thirty patients. The trial was designed to compare both approaches regarding operative time, blood loss, transfusion requirements, length of hospital stay, time to oral intake, requirement of opioid analgesia, and complications. RESULTS: LRC was associated with less hospital stay (9.8 vs. 13.8 days, P=0.001), less time to oral solid intake (6 vs. 8.6 days, P=0.031), and lower opioid requirements (23.3% vs. 53.3%, P=0.033). There was a trend towards lower blood loss and transfusion requirements, but this did not reach statistical significance. Overall complication rates were comparable. CONCLUSION: Laparoscopic radical cystectomy was associated with comparable postoperative outcomes when compared to ORC in the first laparoscopic cystectomy experience in our center. Benefitting from the assistance of an experienced laparoscopic surgeon is recommended to shorten the learning curve.

First experience of the Egyptian National Cancer Institute using the robot-assisted laparoscopic approach in radical hysterectomies for cervical cancer.

AIM OF WORK: Robotics in surgery led to an improvement of visualization, a better handling of tissues and better suturing. This study aimed to document the first experience of the Egyptian National Cancer Institute (NCI) using the robot-assisted laparoscopic approach in radical hysterectomies for cervical cancer and to highlight observed advantages, disadvantages, morbidity and oncological outcomes. PATIENTS AND METHODS: Data of cases that had either early cervical cancer (stage IB-IIA1 with a tumor ≥2 cm) or locally advanced cervical cancer (Stage IIA2-IIB after chemo-radiotherapy) were collected prospectively. Study patients underwent robotic radical hysterectomies for their cervical cancers at the NCI, Cairo University, between January 1, 2015 and December 31, 2016. For each patient, duration of surgery, amount of blood loss, and intra-operative complications were recorded. Similarly, the duration of postoperative hospital-stay, analgesia used and post-operative gastrointestinal recovery were documented. Pathological assessment of safety margins and the lymph nodes number yield were also assessed. RESULTS: Twenty patients underwent robotic radical hysterectomy during the study period. Twelve cases had early cervical cancer while 8 suffered locally advanced disease. The mean procedure time was 319 (range 240-560) minutes; the mean blood loss was 309 (range 150-600) ml. Three cases had bladder injuries during their procedures. The median hospital stay was 6 (range 4-10) days. One case had a positive margin. The median of lymph nodes yield number was 15 (range 10-25). Follow-up ranged 9-31 months, with only one case developing local recurrence. CONCLUSION: Robotic radical hysterectomy is a feasible approach with a tolerable rate of complications.