Limitations in predicting PAM50 intrinsic subtype and risk of relapse score with Ki67 in estrogen receptor-positive HER2-negative breast cancer.

PAM50/Prosigna gene expression-based assay identifies three categorical risk of relapse groups (ROR-low, ROR-intermediate and ROR-high) in post-menopausal patients with estrogen receptor estrogen receptor-positive (ER+)/ HER2-negative (HER2-) early breast cancer. Low risk patients might not need adjuvant chemotherapy since their risk of distant relapse at 10-years is below 10% with endocrine therapy only. In this study, 517 consecutive patients with ER+/HER2- and node-negative disease were evaluated for Ki67 and Prosigna. Most of Luminal A tumors (65.6%) and ROR-low tumors (70.9%) had low Ki67 values (0-10%); however, the percentage of patients with ROR-medium or ROR-high disease within the Ki67 0-10% group was 42.7% (with tumor sizes ≤2 cm) and 33.9% (with tumor sizes > 2 cm). Finally, we found that the optimal Ki67 cutoff for identifying Luminal A or ROR-low tumors was 14%. Ki67 as a surrogate biomarker in identifying Prosigna low-risk outcome patients or Luminal A disease in the clinical setting is unreliable. In the absence of a well-validated prognostic gene expression-based assay, the optimal Ki67 cutoff for identifying low-risk outcome patients or Luminal A disease remains at 14%.

[Elective inguinal hernioplasty in patients on chronic anticoagulation therapy. Management and outcome]. / Hernioplastia inguinal electiva en pacientes con anticoagulación oral. ¿Son candidatos a cirugía ambulatoria?

BACKGROUND: Perioperative management of patients on anticoagulant therapy increases the complexity of elective inguinal hernia repair. We assessed the safety of our standardised anticoagulation protocol and investigated the outpatient and one day surgery rates. MATERIAL AND METHODS: The records of 1184 patients undergoing elective inguinal hernioplasty between 2005 and 2007 were reviewed; 14 patients on chronic anticoagulation therapy were identified. We used a standard bridging therapy protocol with low-molecular-weight heparins. Outcomes were assessed at 30 days post-procedure and included bleeding, thromboembolic events or death and type of hospital admission. RESULTS: Mean age was 74+/-10 years; 12 (25%) patients were high risk for thromboembolism and 31 (67%) patients were ASA III. Almost all inguinal repairs were performed using a polypropylene mesh; 6 (13%) patients had a surgical site haematoma and there was 1 (2.7%) major bleeding, that was re-operated on. No thromboembolic events or deaths occurred; 11 (23%) patients were treated on an outpatient basis and 16 (34%) on a one day surgery regimen. Mean hospital stay was 2.4+/-5.1 days. CONCLUSIONS: Elective inguinal hernioplasty in patients on chronic oral anticoagulation therapy using a standard bridging protocol is a safe procedure. Chronic anticoagulation therapy is not a contraindication for ambulatory surgery.

Hernioplastia inguinal electiva en pacientes con anticoagulación oral. ¿Son candidatos a cirugía ambulatoria? / Elective inguinal hernioplasty in patients on chronic anticoagulation therapy. Management and outcome

Introducción El tratamiento perioperatorio de los pacientes con anticoagulantes orales (ACO) incrementa la complejidad de la hernioplastia inguinal electiva. Objetivo Analizar la seguridad de nuestro protocolo de tratamiento en pacientes con ACO intervenidos de hernioplastia inguinal electiva y valorar el porcentaje de pacientes tratados mediante cirugía ambulatoria y cirugía de corta estancia. Material y métodos Se revisaron los datos administrativos de 1.184 pacientes intervenidos de hernioplastia inguinal en 2005 2007 y se identificó a 47 pacientes en tratamiento con ACO. Se utilizó, como tratamiento puente perioperatorio, un protocolo estandarizado con heparinas de bajo peso molecular (HBPM). Los resultados se analizaron hasta 30 días después del procedimiento e incluían las siguientes variables: hemorragia, episodios tromboembólicos o muerte y régimen hospitalario (cirugía mayor ambulatoria, corta estancia o ingreso convencional).Resultados La media de edad fue 74±10 años; 12 (25%) pacientes tenían un alto riesgo tromboembólico y 31 (67%) pacientes tenían la categoría ASA III. La técnica quirúrgica de elección fue la hernioplastia sin tensión con mallas de polipropileno. En 6 (13%) pacientes se diagnosticó hematoma de la herida quirúrgica y 1 (2,1%) paciente sufrió una hemorragia mayor que precisó de reintervención. Ningún paciente tuvo episodios tromboembólicos y no hubo fallecimientos. A 11 (23%) pacientes se trató de forma ambulatoria y a 16 (34%), en régimen de cirugía de corta estancia. La media de estancia hospitalaria fue 2,4±5,1 días. Conclusiones La hernioplastia inguinal electiva en pacientes con ACO, mediante una terapia puente con HBPM, es un procedimiento seguro. La anticoagulación oral no es una contraindicación absoluta para la cirugía ambulatoria (AU)

Background Perioperative management of patients on anticoagulant therapy increases the complexity of elective inguinal hernia repair. We assessed the safety of our standardised anticoagulation protocol and investigated the outpatient and one day surgery rates. Material and methods The records of 1184 patients undergoing elective inguinal hernioplasty between 2005 and 2007 were reviewed; 14 patients on chronic anticoagulation therapy were identified. We used a standard bridging therapy protocol with low-molecular-weight heparins. Outcomes were assessed at 30 days post-procedure and included bleeding, thromboembolic events or death and type of hospital admission. Results Mean age was 74±10 years; 12 (25%) patients were high risk for thromboembolism and 31 (67%) patients were ASA III. Almost all inguinal repairs were performed using a polypropylene mesh; 6 (13%) patients had a surgical site haematoma and there was 1 (2.7%) major bleeding, that was re-operated on. No thromboembolic events or deaths occurred; 11 (23%) patients were treated on an outpatient basis and 16 (34%) on a one day surgery regimen. Mean hospital stay was 2.4±5.1 days. Conclusions Elective inguinal hernioplasty in patients on chronic oral anticoagulation therapy using a standard bridging protocol is a safe procedure. Chronic anticoagulation therapy is not a contraindication for ambulatory surgery (AU)