When mastectomy is needed: is the nipple-sparing procedure a new standard with very few contraindications?

BACKGROUND AND OBJECTIVES: Nipple-sparing mastectomy (NSM) improves cosmetic results after mastectomy. As most consider advanced tumors, or tumors near the nipple-areola complex (NAC), as a contraindication for this type of surgery, we challenged this hypothesis. METHODS: One hundred thirty-eight NSM were performed in 121 consecutive patients. In 122 procedures for cancer, patients were included if there was no evidence of NAC proximity (<1 cm), and if the retro-areolar margin was negative, even for locally advanced tumors or after neoadjuvant chemotherapy. RESULTS: Total NAC necrosis occurred in six cases (4.3%). Additionally, NAC was removed after histological exam of the retro-areolar tissue in 19 cases (16% of cancer patients). Among 93 cases whose tumor-to-NAC distance was recorded, NAC was removed in 11/31 cases (35%) if the distance was 1 cm, and in 8/62 cases (12.9%) if it was more than 1 cm (P = 0.01). NAC was removed more frequently in the first half of the study (17/69 vs. 8/69: P = 0.05). At a median follow-up of 26 months for the cancer patient group, there was only one local recurrence (outside the NAC). CONCLUSIONS: Our experience adds evidence that NSM is safe, if the retro-areolar resection margin is clear and maximal surgical clearance is performed.

Functional results after mesorectal excision for rectal cancer: comparative study among surgical approaches.

BACKGROUND: We analyzed the evolution of genitourinary dysfunctions in patients undergoing surgical treatment for rectal cancer, and compared open surgery, laparoscopy, robotic and TaTME. METHODS: Functional outcomes were evaluate using standardized questionnaires, compiled at the start of treatment, after the end of Radiotherapy, at 1 and 6 months after surgery. RESULTS: In 72 patients 37.5% had low, 27.8% middle, and 34.7% high rectal cancers. Open technique was performed in 25% of cases, while 29.2% underwent laparoscopy, 20.8% TaTME and 25% robotic. We noted a deterioration in urogenital function: surgical technique can influence the result both in urinary and male sexual function but not ejaculation. Robotics and laparoscopy bring better outcomes than open surgery and TaTME. Female sexuality worsening seems not influenced by the technique. In general age, stage, complications, and anastomotic leakage appear to be predictive factors for functional dysfunctions. As reported in literature rectal cancer treatment leads to urogenital worsening: this seems to be progressive in male sexuality only, while female one and urinary function show a slight improvement in the first months, although a full recovery possibility is discussed. Is also reported how robotic and laparoscopy have a lower functional impact. TaTME has gained consensus thank to the excellent oncological and function outcomes, but in our study leads to worse results. CONCLUSIONS: Mini-invasive techniques guarantee the same oncological result than more invasive ones, but with better functional outcomes and tolerability; robotic surgery seems to be slight superior to laparoscopy, but with longer operative time.

Recent advances in the surgical care of breast cancer patients.

A tremendous improvement in every aspect of breast cancer management has occurred in the last two decades. Surgeons, once solely interested in the extipartion of the primary tumor, are now faced with the need to incorporate a great deal of information, and to manage increasingly complex tasks. As a comprehensive assessment of all aspects of breast cancer care is beyond the scope of the present paper, the current review will point out some of these innovations, evidence some controversies, and stress the need for the surgeon to specialize in the various aspects of treatment and to be integrated into the multidisciplinary breast unit team.