Clinical significance of HER2 status in T1bN0 breast cancer: a nationwide study from the Korean Breast Cancer Society.

PURPOSE: The prognosis of patients with node-negative T1b tumors according to human epidermal growth factor receptor 2 (HER2) status is not known. This group of patients has not been studied in the available randomized trials. The objective of this study was to evaluate the survival of patients in a monoethnic group diagnosed with T1b lymph node-negative breast cancer depending on HER2 status. METHODS: We analyzed 3110 patients with T1bN0M0 breast cancer whose data were deposited into the Korean Breast Cancer Society Registry database between 2000 and 2009. Overall survival (OS) and breast cancer-specific survival (BCSS) were compared according to HER2 status. RESULTS: Among all patients, 494 (15.9%) had HER2-positive breast cancer. At a mean follow-up of 93 months, 108 deaths and 86 breast cancer-specific deaths were noted among all patients. There was no significant difference in OS between the HER2-negative and HER2-positive groups (p = 0.103). The same result was observed for BCSS. However, in the subgroup of estrogen receptor (ER)-positive women, HER2-negative patients had a better BCSS prognosis than HER2-positive patients (p = 0.025). Multivariate analysis also indicated a significant difference in BCSS in the ER-positive subgroup (HR 2.60; 95% CI 1.15-5.87; p = 0.021). CONCLUSION: This study analyzed a large nationwide and monoethnic cohort and found a significant difference only in BCSS in the ER-positive subgroup according to HER2 status. Anti-HER2 therapy may be considered in HER2-positive and ER-positive patients with small, node-negative breast cancer.

Viscum album extract (Helixor-M) treatment for thoracic duct injury after modified radical neck dissection: a case report.

Chyle leakage after modified radical neck dissection is a rare condition that could be occasionally life-threatening if untreated. We report the first case of successful management of a thoracic duct injury using Viscum album extract (Helixor-M). A 54-year-old woman diagnosed with papillary thyroid cancer of the right lobe of the thyroid with metastasis to cervical lymph node levels II-VI, bilaterally, underwent total thyroidectomy and modified radical neck dissection. Three days postoperatively, the surgical team identified a thoracic duct injury due to drainage of chyle from the Jackson-Pratt drain inserted in the right side of the patient`s neck. Various medical treatments (octreotide, withdrawal of enteral feeding, and total parenteral nutrition) and surgical treatments [lymphatic ligation of cervical lymph node level IV and negative pressure wound therapy (vacuum-assisted closure)] were performed, but the drainage persisted. Viscum album extract (Helixor-M) was then injected through the drain. The dose of Viscum album extract was increased while being cautious of its adverse effects, such as nausea, vomiting, erythema, induration at the injection site, and flu-like symptoms. The injection was effective in stopping the drainage and the patient's condition improved, without recurrence. The patient was discharged on the 64th postoperative day without any further complications. Our results suggest that treatment of thoracic duct injury after neck surgery with Viscum album extract (Helixor-M) may be a novel, less invasive alternative approach to treat cases resistant to standard treatments.

A Comparative Study of Needlescopic Grasper Assisted Single Incision versus Three-Port versus Pure Single Incision Laparoscopic Cholecystectomy.

Purpose: Single incision laparoscopic cholecystectomy (SILC) is a surgical method to treat gallbladder disease designed to reduce postoperative pain and improve cosmetic results. However, pure SILC (pSILC) has several inherent limitations. In this study, we report the surgical outcomes of SILC with needlescopic grasper (nSILC) compared with those of pSILC and conventional three-port laparoscopic cholecystectomy (TPLC). Methods: This retrospective study enrolled 103 patients who underwent laparoscopic cholecystectomy for benign gallbladder disease in our hospital between January 2013 and January 2015. Among them, 33 patients underwent pSILC, 35 underwent nSILC, and 35 underwent TPLC. We collected demographic characteristics and operative data to analyze outcomes between groups. Results: All procedures were done by laparoscopy and the gallbladder of each patient was completely removed. Women and younger patients were more to undergo SILC than TPLC. Analysis showed that the operation time of the nSILC group was longer than that of the TPLC group, but shorter than that of the pSILC group (skin to skin operation time [pSILC: 65.2±19.1 min, nSILC: 49.7±12.9 min, and TPLC: 43.4±14.7 min, p<0.001], and major procedure time [pSILC: 42.2±18.7 min, nSILC: 25.9±8.9 min, and TPLC: 23.4±12.7 min, p<0.001]). There were no significant differences between the groups for patient visual analogue scale score, length of hospital stay, or intraoperative blood loss. Conclusion: nSILC is feasible surgical method in patients with benign gallbladder disease compared to TPLC, and that is an effective procedure to overcome the disadvantage of pSILC.