[Axillary lymph node dissection after breast reconstruction by pedicled Latissimus dorsi: Operative steps and outcomes]. / Curage axillaire après reconstruction mammaire par lambeau de grand dorsal: principes chirurgicaux et résultats.

OBJECTIVES: We retrospectively reviewed all the cases of axillary lymph node dissection (ALND) performed within a year after an immediate breast reconstruction procedure by a pedicled Latissimus dorsi, which is transferred to the anterior thoracic wall through an axillary funnel. Operative technical steps are described taking account of the new anatomical relationship of the axilla. METHODS: We assessed postoperative immediate complications and late sequelaes. RESULTS: From 1999 to 2013, 21 ALND were performed. Immediate postoperative period was free of complication in 85% of cases when following the operative steps described in this work. Partial or total necrosis of the reconstructed breast did not occur. With a median follow-up of 64 months, 6 patients (28% of the whole population) presented at least one sequelae like a feeling of heavy arm (n=2, 9%) or a lymphedema (n=3, 14%), a chronic neuropathic pain (n=4, 19%) or a limitation in the arm range of motion (n=2, 9%). CONCLUSION: ALND after immediate breast reconstruction by a pedicled Latissimus dorsi is feasible and safe, without any additional postoperative complication in comparison with a classic ALND.

[Satisfaction in ambulatory patients with breast-conserving surgery and sentinel node biopsy for breast cancer]. / Satisfaction des patientes opérées par tumorectomie-ganglion sentinelle pour cancer du sein en ambulatoire.

OBJECTIVE: The objective of this study was to evaluate outpatient satisfaction for breast cancer surgery and compare with inpatient satisfaction. PATIENTS AND METHODS: Our observational prospective study included all patients who underwent breast cancer surgical procedure (breast-conserving surgery and sentinel node biopsy) between July and December 2013 in a cancer center. Patients were asked to answer a questionnaire at discharge and 30 days after surgery. RESULTS: One hundred and fifty-five patients (exclusively women) were included; the outpatient group comprised 102 patients and the inpatient group 53. The study showed no statistical difference in patients' satisfaction betweeen the two groups at discharge (P=0.20) and 30 days after surgery (P=0.30); 101 (99%) outpatients and 44 (95.7%) inpatients had very good or excellent level of satisfaction at discharge and 88 (92,7%) and 49 (98%), respectively 30 days after surgery. The overall mean satisfaction score was 9.1±1.2 [3-10] at discharge and 8.7±1.3 [3-10] 30 days after surgery. DISCUSSION AND CONCLUSION: Our study found high degree of satisfaction after breast surgery for cancer both for outpatients and inpatients. This suggests that ambulatory surgery is possible and valid for this type of oncologic breast surgery.

[Postoperative morbidities after modified posterior pelvic exenteration for ovarian cancer]. / Complications après exentération pelvienne postérieure modifiée selon Hudson dans le cadre de tumeurs malignes ovariennes.

OBJECTIVE: Complication and survival analysis of cytoreduction surgery with modified posterior pelvic exenteration in the surgical treatment of the ovarian malignant tumor. METHODS: A retrospective monocentric study between 2000 and 2013 in Rhone-Alpes cancer treatment center. One hundred and fifty-two patients with ovarian cancer and treated by surgery with modified posterior pelvic exenteration were included. Complication in the 30 days after surgery was analysed by the Clavien-Dindo classification. RESULTS: In our study, rate of global complication was 62.5% with a morbidity rate of grave complication of 7.9%. Our rate of complete resection was 82.2%. Three fistulas (2.2%) were found. On average, there was 6.6±1.8 (2-11) surgery gesture associated with Hudson resection during surgery. In univariate analysis, there was a statistic significant association between complication from the rank II of Clavien-Dindo classification and supraradical surgery, post-chemotherapy surgery, recurrent surgery, the resection of a diaphragmatic dome, and the partial gastric resection. This association was also observed with the number of surgical gesture associated with Hudson resection. CONCLUSIONS: The main prognostic surgical factor in ovarian cancer is to obtain a no macroscopic residual disease. The modified posterior pelvic exenteration allowed to obtain it. Our study demonstrates a low rate of grave complication further to this type of surgery.