Time trends in real-world treatment patterns and survival in patients diagnosed with de novo HER2+ metastatic breast cancer: an analysis of the SONABRE registry.

PURPOSE: The aim was to determine whether the real-world first-line progression-free survival (PFS) of patients diagnosed with de novo human epidermal growth factor receptor 2 positive (HER2+) advanced breast cancer (ABC) has improved since the introduction of pertuzumab in 2013. In addition to PFS, we aimed to determine differences in overall survival (OS) and the use of systemic and locoregional therapies. METHODS: Included were patients systemically treated for de novo HER2+ ABC in ten hospitals in 2008-2017 from the SONABRE Registry (NCT-03577197). First-line PFS and OS in 2013-2017 versus 2008-2012 was determined using Kaplan-Meier analyses and multivariable Cox proportional hazards modelling. First-given systemic therapy and the use of locoregional therapy within the first year following diagnosis were determined per period of diagnosis. RESULTS: Median and five-year PFS were 26.6 months and 24% in 2013-2017 (n = 85) versus 14.5 months and 10% in 2008-2012 (n = 81) (adjusted HR = 0.65, 95%CI:0.45-0.94). Median and five-year OS were 61.2 months and 51% in 2013-2017 versus 26.1 months and 28% in 2008-2012 (adjusted HR = 0.55, 95%CI:0.37-0.81). Of patients diagnosed in 2013-2017 versus 2008-2012, 84% versus 60% received HER2-targeted therapy and 59% versus 0% pertuzumab-based therapy as first-given therapy. Respectively, 27% and 23% of patients underwent locoregional breast surgery, and 6% and 7% surgery of a metastatic site during the first year following diagnosis. CONCLUSION: The prognosis of patients with de novo HER2 + ABC has improved considerably. Since 2013 one in four patients were alive and free from progression on first-given therapy for at least five years.

A long-term follow up of the laparoscopically harvested free omental flap for breast reconstruction.

BACKGROUND: There are different types of reconstruction after mastectomy and breast-conserving surgery. Autologous reconstructions are nowadays more often preferred over implant-based reconstructions for many reasons. A more natural looking breast with a durable long-term result is one of the advantages. The greater omentum is frequently used in the general field of reconstructive surgery but has not been widely adopted in breast surgery. This report is the first larger series of patients who underwent a breast reconstruction using the laparoscopically harvested omental free flap (LHOFF). The aim of this report is to provide information about indication, surgical technique, short- and long-term complications, and patient satisfaction with aesthetic outcomes and health-related quality of life (HR-QoL). METHODS: Patients underwent a breast reconstruction with the LHOFF from 2014 to 2021 in Máxima Medical Center, Veldhoven, the Netherlands. All patients underwent a diagnostic laparoscopy prior to the reconstruction to examine whether the volume of omentum was deemed sufficient. Outcome measures included the Breast-Q for HR-QoL, patient satisfaction, short- and long-term complications, and abdominal complaints related to the transplanted omentum. Surgical data were retrieved retrospectively. RESULTS: Twenty-six patients were included in this article. Patients were 40 to 71 years old with a mean BMI of 21.5 (range 17.0-25.0). Mean weight of the omental free flap was 228 g (range 112-395). Four out of 26 cases underwent surgery due to venous congestion. There was one case of flap failure due to venous thrombosis. Mean time of follow-up was 54 months (range 8-179). Secondary corrections include a nipple reconstruction (n = 11), lipofilling (n = 11), a contralateral breast reduction (n = 3) or a breast implant (n = 2). Patients reported improvement in HR-QoL and good satisfaction with aesthetic outcomes. No abdominal complications were reported during the follow-up period. CONCLUSION: The LHOFF is an autologous breast reconstruction technique that results in a soft, small breast with natural ptosis and minimal donor site morbidities. Patients report satisfactory aesthetic outcomes and good quality of life. The main limitation of this technique is the limited amount of volume of the omentum and the possible need for secondary corrections. No abdominal complications were reported. In the future, larger prospective studies are required to support implementation of the LHOFF reconstruction on a broader scale.

Awareness and management of low anterior resection syndrome: A Dutch national survey among colorectal surgeons and specialized nurses.

INTRODUCTION: Substantial progress has been made in the treatment of rectal cancer in the past two decades. Low anterior resection is a cornerstone in current treatment, combined with neo-adjuvant (chemo-) radiation in selected cases. However, side effects such as increased frequency, urgency and incontinence are seen in a majority of patients postoperatively. These symptoms, referred to as low anterior resection syndrome (LARS), have a severe impact on quality of life. Management of LARS is complex, and surgeons seem to underestimate and misinterpret the impact of symptoms associated with LARS. AIM AND METHODS: We investigated the awareness and management of LARS in The Netherlands, conducting a national survey in which colorectal surgeons and colorectal care nurses were asked for their views on this complex syndrome. RESULTS: 242 health-care professionals participated in the survey. Most participants estimate the prevalence of major LARS is 20-40% after low anterior resection (LAR); a severe underestimation of actual prevalence - around 70%. Only 10% of surgeons use LARS screening tools in the preoperative period, and fewer than half of surgeons use LARS scores before or after a LAR. Although most surgeons inform their patients preoperatively about the changes in bowel function that they may experience after rectal cancer treatment, a majority of these surgeons indicate more information and patient counselling would improve the quality of life of their patients. DISCUSSION: Impact and prevalence of LARS is underestimated by their physicians. Uniform clinical guidelines should be developed to guide physicians in adequate management of patients with LARS.