Patient choice significantly affects mastectomy rates in the treatment of breast cancer.

Mastectomy rates may be affected by patient choice. 203 patients who had a Total Mastectomy for breast cancer were invited to complete questionnaires at routine follow up clinics to ascertain if they had been offered a choice of Breast Conserving Surgery (BCS), and to establish the reasons for their preference. Questionnaires were checked against medical and nursing records to confirm the reasons for the patients' choice of mastectomy. 130 patients (64%) chose to have a mastectomy, reporting that they felt safer (n = 119); wanted to decrease the risk of further surgery (n = 87) and/or wished to avoid radiotherapy (n = 34). Some were advised not to have BCS if they had a large tumour size, central or multifocal tumours and/or associated extensive microcalcification on mammography (n = 29). 24 patients had BCS as first operation but had repeat surgery for involved or narrow excision margins. Despite being advised that there is no difference between survival rates of this and breast conserving surgery, many patients still feel safer with mastectomy.

Colorectal cancer outcomes in nonagenarian patients: A case series.

BACKGROUND: Increased life expectancy and improved medical management of co-morbidities has led to an increasing number of nonagenarian patients with colorectal cancer being considered for surgical intervention. This study aims to describe the morbidity and mortality of nonagenarians who had operative and non-operative management for colorectal cancer. MATERIALS AND METHODS: A retrospective study of consecutive colorectal cancer patients from 2010 to 2016 in a district general hospital in Scotland who were 90 years old or above was performed. Demographic and perioperative data were obtained from case note review. Survival analysis and multivariable regression was conducted to determine factors associated with cancer-specific and all-cause mortality. RESULTS: Forty-nine patients were identified; 24 patients underwent operative management (median age: 91) while 25 received non-operative management (median age: 92). Fifteen patients (62.5%) had an elective operation, and 8 (37.5%) had an urgent or emergency procedure. None of the patients treated operatively suffered a significant complication or anastomotic leakage. Median hospital stay was 14 days. Five patients (20.8%) required a higher level of care in the community following discharge. Surgical mortality within 30 days was 4.2%. Patients undergoing an elective operation had a significantly improved survival compared to those undergoing an emergency operation or non-operative management. On multivariable analyses, non-operative management, and presence of metastases at diagnosis were associated with higher cancer-specific mortality. CONCLUSION: Elective operative management for carefully selected nonagenarian patients with colorectal cancer is generally acceptable in terms of morbidity and mortality. The majority of operatively managed patients returned to the same functional level of care following discharge. Patients with metastases at the outset and those requiring emergency surgery have a poorer prognosis.

Ruptured pseudocyst of pancreas presenting with paraplegia: a case report.

INTRODUCTION: Acute pancreatitis is recognised to cause both local and extra pancreatic systemic complications. Sequelae like pseudocyst of the pancreas can further be complicated by infection, intracystic haemorrhage and rupture with high mortality and morbidity. Extra pancreatic manifestations include alterations in blood coagulation factors and pro-thrombotic tendencies. CASE PRESENTATION: We report an atypical presentation of intracystic haemorrhage and rupture of a pancreatic pseudocyst into the peritoneal cavity, presenting with acute onset paraplegia. CONCLUSION: Considering the serious consequences of this pathology, high index of suspicion, early identification and management of pancreatic pseudocyst is paramount in reducing morbidity and mortality.