Trends in utilization of sentinel node biopsy and adjuvant radiation in women ≥ 70.

BACKGROUND AND OBJECTIVES: Omission of routine axillary staging and adjuvant radiation (XRT) in women ≥ 70 years old with early stage, hormone receptor-positive, clinically node-negative breast cancer has been endorsed based on several landmark studies. We sought to determine how much omission of axillary staging/XRT has been adopted. METHODS: Using the National Cancer Data Base, we selected malignant breast cancer cases in women ≥ 70 with ER + tumors, ≤2 cm with clinically negative lymph nodes who underwent breast conservation and had known XRT status in 2005-2015. The use of sentinel lymph node biopsy (SNB) and XRT status was summarized by year to determine trends over time. RESULTS: In total, 57 230/69 982 patients underwent SNB. Of the 12 752 patients in whom SNB was omitted, 6296 were treated at comprehensive community cancer programs. Regarding XRT, 33 891/70 114 received adjuvant XRT. There were no significant trends with regards to patients receiving SNB or those receiving XRT. CONCLUSION: Since 2005, there has been no change in SNB or XRT for early stage ER + breast tumors. However, there was a difference in omission of SNB based on facility type and setting. Future monitoring is needed to determine if these trends persist following the recently released Choosing Wisely® recommendations.

Is metastasectomy a worthy option?-the role of surgery in metastatic colon cancer to liver and lungs.

BACKGROUND: The role of surgery and metastasectomy is controversial in the treatment of stage IV colon cancer (CC). The aim of this study was to investigate the relationship between primary tumor resection (PTR) with metastasectomy and survival in patients diagnosed with metastatic CC. METHODS: The National Cancer Data Base (NCDB) was retrospectively queried for patients diagnosed with colon adenocarcinoma from 2004 to 2013. Patient demographics, clinical characteristics, and short-term outcomes were collected. Groups were generated based on if surgery was performed and, if so, was metastasectomy involved. Associations between groups were evaluated using Kruskal-Wallis and Pearson Chi-square tests. Overall survival (OS) was summarized using standard Kaplan-Meier methods. The association between surgical group and OS was evaluated using the log-rank test. RESULTS: Of 31,172 patients, 13,214 (42.4%) had surgery while 17,958 (57.6%) did not. Among these, 81.3% of patients had liver metastases only, while 18.7% of patients had both liver and lung metastases. Median OS was 15.1 months (95% CI: 14.8 to 15.5 months) for the entire cohort. However, median OS was significantly better for those who had surgery (either PTR alone or PTR with metastasectomy) compared to those who did not (21.8 vs. 7.5 months, P<0.001). Patients who received PTR with metastasectomy had worse median OS (20.5 vs. 21.8 months, P=0.035) compared to those who only received PTR (P=0.211). CONCLUSIONS: PTR in select patients diagnosed with metastatic CC provides a remarkable improvement to survival rate. The role of metastasectomy remains controversial as no difference in survival outcomes exists between patients who received it and who did not.

Comparing morbidity rates between wise pattern and standard horizontal elliptical mastectomy incisions in patients undergoing immediate breast reconstruction.

BACKGROUND: Breast cancer patients with ptotic breasts pursuing mastectomy with immediate reconstruction can present challenges. A wise pattern (inverted-T) mastectomy incision (WPM) has been suggested as an alternative to the standard horizontal elliptical mastectomy (EM) to reduce redundant skin and correct ptosis. Herein, we sought to examine the differences in morbidity between the two techniques. METHODS: We performed a retrospective review of women undergoing mastectomy with immediate reconstruction at our institution from June 2007 to January 2016. We compared those undergoing WPM to a control population undergoing EM. Statistical analysis was performed evaluating clinical, pathological, and surgical outcome variables according to patient and per breast. All tests were two-sided with alpha level set at 0.05 for statistical significance. RESULTS: A total of 241 women underwent mastectomy and reconstruction in 421 breasts; 78/241 (32%) had WPM (149 breasts), 163/241 (68%) had EM (272 breasts). Both groups were similar in age, smoking status, diabetes, race, tumor type, and pathologic stage (all P > 0.07). Skin flap necrosis was the most frequently encountered complication, occurring in 58/149 (38.9%) of WPM breasts and in 24/272 (8.9%) of EM breasts (P < 0.0001). There was no difference in the need for revisional procedures between the groups (WPM: 24.1% vs EM: 17.6%, P = 0.207). CONCLUSION: Patients should be counseled WPM is associated with higher rates of skin flap necrosis. However, this does not translate into higher rates of revisional procedures or return to OR.

Symptomatic Axillary Seroma after Sentinel Lymph Node Biopsy: Incidence and Treatment.

BACKGROUND: Postoperative seroma is a nuisance for patients and surgeons. Few studies investigate predisposing factors for axillary seroma after sentinel lymph node biopsy (SLNB). We sought to quantitate the risk of symptomatic seroma and characterize interventions. METHODS: We performed a retrospective review of 667 women undergoing breast-conserving surgery and SLNB at our institution between July 2007 and January 2015. Surgeons dissected sharply or with standard electrocautery. We correlated patient and tumor characteristics with symptomatic seroma using logistic regression models for univariate and multivariate predictors. All statistical tests were two sided, with p < 0.05 considered significant. RESULTS: Overall, 127 (19 %) of 667 women had axillary seromas and 98 (77 %) of 127 required further intervention for symptom relief. Seroma patients were similar in age, BMI, race, tumor type, T and N stage, and number of nodes removed as those without (all p > 0.07). Seroma rates did not vary according to surgeon, nodal mapping technique, or axillary closure technique (p = 0.8789). Multivariate analysis identified diabetes, smoking, and SSI as predictors of symptomatic axillary seroma with odds ratio of 1.97, 1.98, and 37.19 (all p < 0.017), respectively. Among the 98 of 127 patients with seroma, most (81 of 98, 83 %) resolved with a mean of 1.3 aspirations. The remainder resolved after axillary drain (13 of 98, 13 %) or additional surgery (4 of 98, 4 %). CONCLUSIONS: Symptomatic axillary seroma occurs in 14 % patients undergoing breast-conserving surgery with SLNB and is not influenced by tumor, nodal mapping, or surgeon characteristics. Management infrequently requires more than simple aspiration. Drain placement at initial surgery may be considered in smokers or patients with diabetes.