Unplanned breast-conserving surgery after systemic therapy in locally advanced breast cancer: The results of level II oncoplastic techniques.

BACKGROUND: In patients with breast cancer for whom neoadjuvant chemotherapy (NAC) is planned, it is recommended to mark the primary tumour before treatment (planned surgery). However, surgeons may have to perform breast-conserving surgery on patients whose tumours are not marked (unplanned surgery). This study focused on the results obtained with planned and unplanned level II oncoplastic surgery (OPS) techniques applied to patients after NAC. METHODS: Patient groups who underwent planned, unplanned OPS and mastectomy after NAC were compared. Surgical margin status, re-operation and re-excision requirements, ipsilateral breast tumour recurrence (IBTR) and axillary recurrence rates recorded. Long-term local recurrence-free survival (LRFS), disease-free survival and overall survival were evaluated. RESULTS: There was no significant difference between the planned and unplanned OPS groups in terms of surgical margin status, re-excision requirement, and mastectomy rates. During an average follow-up period of 43 months, 5.3% and 4% of the patients in the planned OPS group developed IBTR and axillary recurrence, respectively, whereas these rates were 6.6% and 5.3% in the unplanned OPS group. In the mastectomy group, the rates of IBTR and axillary recurrence were found to be 4.1% and 3.8%, respectively. There was no significant difference between the three groups in terms of IBTR (P: .06) and axillary recurrence (P: .08) rates. CONCLUSION: Breast conserving surgery can be applied using level II OPS techniques with the post-NAC radiological examination and marking even if primary tumour marking is not done in the pre-NAC period.

Glucan improves impaired wound healing in diabetic rats .

UNLABELLED:  Purpose. Diabetes mellitus (DM) is a contributing factor to impaired wound healing in humans. A large body of evidence indicates that the diabetic state is associated with delayed or reduced wound repair capacity. The present study was designed to evaluate the efficacy of glucan on improving abdominal wall wound healing in rats with DM. METHODS: Ninety-six female, Sprague-Dawley rats that weighed between 250 g and 300 g were used. A laparotomy was performed on all of the rats on the 14th day. Twenty-four healthy rats (group 1) served as the control. Streptozotocin was used to induce DM in groups 2 and 3 (n = 48). Rats in group 3 received glucan (n = 24). Rats in group 4 were not rendered with DM but received glucan (n = 24). The sutures were removed and abdominal bursting pressure was measured and recorded on the seventh postoperative day for all of the groups. Tissue samples were taken from the incision line for histopathological evaluation and hydroxyproline measurement. RESULTS: In group 2, the bursting pressure was significantly lower than in groups 1, 3, and 4; the hydroxyproline content and histopathological evaluations also supported these findings. CONCLUSION: These results demonstrate that glucan improves impaired wound healing in rats with DM. .

Completion Thyroidectomy: Safer than Thought.

BACKGROUND: The aim of this study was to find out whether a substantial difference in terms of complication rates exists between primary and completion thyroidectomies following initial bilateral subtotal thyroidectomy in the light of current literature and our series. PATIENTS AND METHODS: Total number of 696 patients who received completion thyroidectomy (Group 1, n = 289) and total thyroidectomy for differentiated thyroid cancer (Group 2, n = 407) and their data were reviewed and postoperative complications were compared between the groups and with the literature. RESULTS: Transient and permanent hypocalcaemia rates were 20% and 5.8% in Group 1 and 10.5% and 5.1% for Group 2 respectively. Unilateral transient, bilateral transient and unilateral permanent recurrent laryngeal nerve palsy rates were 6.2%, 1.3% and 4.4% for patients in Group 1 whereas same complications were seen in 4.6%, 0.7% and 3.6% of patients in Group 2. When groups were compared for complications; temporary hypocalcaemia, unilateral temporary nerve palsy, and minor wound infection rates were statistically higher in Group 1, with no significant difference in permanent complications. CONCLUSION: When complication rates of re-operation after bilateral subtotal thyroidectomy and primary total thyroidectomy for differentiated thyroid cancer were compared in an unbiased fashion, completion thyroidectomy was shown to be as safe as a primary operation with regard to permanent complications.

Malignancy in Solitary Thyroid Nodules: Evaluation of Risk Factors.

BACKGROUND: The aim of the present study was to evaluate patients with suspicious solitary nodules undergoing bilateral total thyroidectomy for the presence of malignancy. PATIENTS AND METHODS: 141 patients with true solitary thyroid nodules who underwent bilateral total thyroidectomy at the Dr. Abdurrahman Yurtaslan Ankara Oncology Hospital between 2008 and 2013 were retrospectively evaluated. Parameters including demographics, ultrasonographic findings, and laboratory values were analyzed. RESULTS: When the final pathology results were evaluated, malignancy was found in 52/141 (36.9%) patients. 49 (94.2%) of these lesions were papillary carcinoma. Colloidal nodules accounted for 30.3% of all benign cases. Nodular irregularity, increased vascularity, microcalcification, and central/lateral lymphadenopathy significantly increased the risk of malignancy. Among these factors, increased vascularity was the most important risk factor and microcalcification the second. Nodule size did not affect the risk of malignancy. CONCLUSION: Irregular borders, microcalcification, increased vascularity, and detection of cervical lymphadenopathy were found to be correlated with malignancy in solitary nodules.

Does CSE1L Overexpression Affect Distant Metastasis Development in Breast Cancer?

BACKGROUND: CSE1L (chromosome segregation 1-like) is the human homologue to the yeast gene CSE1, and is related to invasion and metastasis in cancer progression. The aim of this study was to investigate the potential role of CSE1L expression in distant metastasis of breast cancer. PATIENTS AND METHODS: A total of 71 breast cancer patients were included in this study. Clinical characteristics and CSE1L status were evaluated. Immunohistochemistry was performed on formalin-fixed, paraffin-embedded archival breast tumor tissue. The results of CSE1L staining were analyzed according to the percentage of immunoreactive cells. RESULTS: 34 patients had distant metastasis and 37 did not. The mean age of the patients was 50.5 ± 12.1 years. Age, tumor size, and hormone receptor status were similar in patients with distant metastasis and in those without. A statistically significant relationship was found between nuclear CSE1L expression and distant metastasis of breast cancer. Lymph node metastasis and nuclear grade were other factors affecting distant metastasis. CONCLUSION: There is a relationship between nuclear CSE1L overexpression and distant metastasis in breast cancer. CSE1L status may therefore become a valuable prognostic tool in the future.

Locally applied molgramostim improves wound healing at colonic anastomoses in rats after ligation of the common bile duct.

BACKGROUND: Several systemic factors, including jaundice, long-term corticosteroid therapy, diabetes and malnutrition, increase the risk of anastomotic dehiscence. The local application of molgramostim (recombinant human granulocyte-macrophage colony stimulating factor) has been reported to improve impaired dermal wound healing. Since jaundice, one of the systemic risk factors for anastomotic dehiscence, causes significant impairment of anastomotic healing, we hypothesized that locally injected molgramostim could improve the healing of bowel anastomoses in bile-duct-ligated rats used as an experimental model for jaundice. METHODS: Eighty-six Sprague-Dawley rats were randomized into 4 groups of 20-22 animals each as follows: group 1--colonic anastomosis only; group 2--laparotomy followed 7 days later by colonic anastomosis; group 3--common-bile-duct ligation (CBDL) followed 7 days later by colonic anastomosis (control group); group 4--CBDL followed by colonic anastomosis with locally applied molgramostim. Laparotomy was performed under anesthesia in group 2 rats. In groups 3 and 4, laparotomy was followed by ligation and dissection of the common bile duct. After 7 days, colonic anastomosis was performed; in group 4 rats, molgramostim (50 microg) was injected into the perianastomotic area. On postoperative day 3, rats were killed, and the bursting pressures and hydroxyproline levels measured. Two rats from each group were selected for histopathological examination. RESULTS: The mean bursting pressure in group 4 was significantly higher than that in group 3 (37.8 v. 30.5 mm Hg [p < 0.01]). The mean hydroxyproline level in group 3 was significantly lower than that of the other groups (2.7 v. 3.1-3.5 mg/g tissue [p < 0.01]). On histopathological examination, specimens from group 4 rats showed an increased mononuclear cell population and a smaller gap on the anastomotic line than those from group 3. CONCLUSION: The local injection of molgramostim improves healing of the impaired wound in rats subjected to CBDL.

Prognostic significance of apex axillary invasion for locoregional recurrence and effect of postmastectomy radiotherapy on overall survival in node-positive breast cancer patients.

Postmastectomy irradiation substantially reduces the risk of locoregional recurrences (LRR) of breast carcinoma. However, debates continue on the prognostic factors for radiotherapy and the effect of radiotherapy on overall survival. The present study was undertaken to investigate the prognostic significance of level III positive nodes, along with the other factors for LRR, and to evaluate the effect of postmastectomy radiotherapy on overall survival among node-positive breast carcinoma treated systemically. Data from 549 consecutive node-positive breast cancer patients who underwent modified radical mastectomy and received adjuvant systemic therapy were studied retrospectively. Prognostic factors for LRR and the effect of postmastectomy radiotherapy on overall survival were analyzed. Survival curves were generated by the Kaplan-Meier method, and multivariate analysis was performed by the Cox proportional hazard model. The 5-year locoregional recurrence rate is 7%. Apical invasion was found to be an independent prognostic factor for LRR (HR 2.6, CI 1.29-5.35) along with a finding of 4 or more positive nodes and T3 tumor. Adjuvant radiotherapy decreased LRR and improved survival significantly. Apical invasion, 4 or more positive axillary lymph nodes, and T3 tumor are the predictors of LRR, and patients with these adverse factors are candidates for adjuvant radiotherapy. Postmastectomy radiotherapy improves overall survival.