Prospective Study on Avoiding Seroma Formation by Flap Fixation After Modified Radical Mastectomy.

INTRODUCTION: Seroma development after mastectomy is a common complication. Continued seroma causes increased outpatient visits, repeated aspirations, infection, delayed healing, delayed adjuvant therapy, and increased cost. Various treatments are being attempted to prevent and reduce seroma development. We examined the effects of flap fixation on seroma using absorbable sutures after modified radical mastectomy (MRM). METHODS: The prospectively recorded data of patients who underwent surgery for breast cancer were analyzed retrospectively. 72 consecutive patients who underwent MRM were included in the study. Patients who underwent MRM in the same way by the same surgeon were divided into two groups: the group whose wound was closed by fixing the flap to the chest wall with an absorbable suture (group A), and the group whose wound was closed with the classical method (group B). The groups were compared in terms of seroma development, clinicopathological data, and early complications. RESULTS: Drain removal time and the total amount of drained fluid in group A patients were significantly lower than drain removal time and the total amount of drained fluid in group B patients (P < .001). Similarly, the amount of aspirated seroma in the control examinations of group A patients was significantly lower than that in group B (P < .05). Group B needed re-aspiration significantly more than group A (P < .05). CONCLUSIONS: Flap fixation with suture after MRM is a method that reduces seroma formation and the amount of drained fluid, enables early removal of the drain, prevents delay in starting adjuvant treatment, is more comfortable for the patient and physician, and is also inexpensive.

Prognostic value of KI-67 proliferation index in luminal breast cancers.

AIM: This study aimed to examine the prognostic significance of the KI-67 proliferation index, especially in breast cancer (BC) patients without HER-2 expression and no nodal involvement. MATERIAL AND METHODS: The database of hormone-receptor-positive patients who underwent surgery for BC in our Surgical Oncology Clinic between 2008 and 2020 was retrospectively reviewed and recorded. Patients were categorized based on their KI-67 level, considering the cutoff value of 20%. RESULTS: Our study revealed that tumors with high KI-67 levels were more likely to have a more advanced histological grade (p = 0.00) and size (p = 0.038). In the univariant analysis, KI-67 level was effective on overall survival (p = 0.044) and disease-free survival (p = 0.048). However, we found that there was no independent prognostic factor in the multivariant analysis. CONCLUSION: Although the Ki-67 proliferation index does not yet have an agreed threshold value and scoring methodology, it can also be used to determine prognosis and evaluate treatment response in some patients.

OBJETIVO: Este estudio tuvo como objetivo examinar la importancia pronóstica del índice de proliferación KI-67, especialmente en pacientes con cáncer de mama sin expresión de HER-2 y sin compromiso ganglionar. MATERIAL Y MÉTODOS: Se revisó y registró retrospectivamente la base de datos de pacientes con receptores hormonales positivos intervenidas de cáncer de mama en nuestra Clínica de Oncología Quirúrgica entre 2008 y 2020. Las pacientes fueron categorizadas de acuerdo con su nivel de KI-67, considerando el valor de corte del 20%. RESULTADOS: Nuestro estudio reveló que los tumores con valores elevados de KI-67 eran más propensos a tener un grado histológico (p = 0.00) y un tamaño (p = 0.038) más avanzados. En el análisis univariado, el nivel de KI-67 fue efectivo sobre la supervivencia global (p = 0.044) y la supervivencia libre de enfermedad (p = 0.048). Sin embargo, encontramos que no había ningún factor pronóstico independiente en el análisis multivariante. CONCLUSIONES: Aunque el índice de proliferación Ki-67 aún no tiene un valor de umbral acordado ni una metodología de puntuación, también se puede utilizar para determinar el pronóstico y evaluar la respuesta al tratamiento en algunas pacientes.

Management of Aberrant Left Hepatic Artery During Laparoscopic Gastrectomy and Consequences.

Introduction: Aberrant left hepatic artery (ALHA) can exist in up to 25% of the population. The presence of ALHA during lymph node (LN) dissection in gastric cancer may complicate the process. In this study, we aimed to evaluate the existence rate, management, and consequences of ALHA in our laparoscopic gastrectomy series. Patients and Methods: Demographical and clinical data of laparoscopically operated 158 consecutive gastric cancer patients were collected retrospectively. Study patients were divided into three groups according to absence, existence and preservation, and existence and sacrification of ALHA. Harvested LN numbers, operation time, and postoperative alanine aminotransferase (ALT), aspartate aminotransferase (AST), and lactate dehydrogenase values on consecutive days were analyzed using Kruskal-Wallis and Mann-Whitney U tests. P < .05 is accepted as significant. Results: The median AST and ALT values of the ALHA-sacrificed group were higher than those of the group without ALHA and the ALHA-preserved group on the 1st, 3rd, and 5th postoperative days (P < .05). On the 10th day, liver enzymes returned to normal values. Conclusion: Adequate and appropriate dissection of LNs while preserving ALHA can be performed without prolonging the operation time. Sacrification of ALHA causes an increase in liver enzymes, with spontaneous recovery in most cases.

Migration of two swallowed foreign bodies to different locations in the same case.

Foreign body ingestion can be seen at all ages, especially in childhood. Most swallowed foreign objects are disposed from the body without any health problems through defecation. It is rare that a foreign object perforates the intestine and migrates into the liver or peritoneum. In our case two unintentionally swallowed needles pierced the intestine and were located in the left lobe of the liver and small intestine mesentery. Foreign objects were detected in the abdomen of a 20-year-old female patient during examination performed for abdominal pain that lasted for three months. After a follow up period of three weeks the patient's complaints continued. She underwent laparotomy and both needles were removed in one session. It should be kept in mind that swallowed foreign objects can sometimes perforate the gastrointestinal system and may be located in different organs in the abdomen.