A Quantitative Evaluation of the Effects of Radiation Therapy on the Post-Surgical Breast.

BACKGROUND: Radiation (RT) effects on breast volume may impact breast-conserving therapy (BCT) outcomes, but quantitative information is lacking regarding the extent/timing of volume loss. This study aimed to quantify volume loss by assessing changes in irradiated breasts. METHODS: Breast volume changes were calculated for 113 patients (115 breasts) following T1 tumor lumpectomies. From preoperative baseline to seven years post-radiation, volumes were calculated from mammograms using π/3* height*radius2. Paired t-tests assessed change over time, with subset analyses of tumor/breast volumes of ≤ 10% (n=67) and > 10% (n=48). Multivariable regression assessed volume change as a function of age, smoking history, diabetes, radiation dosage, fractions, technique, treatment length, boost dose, chemotherapy (hormonal or cytotoxic), baseline breast volume, and time since treatment. RESULTS: Patients lost 8.3% of breast volume during surgery. One year following BCT/RT, volume loss was 19.3%. By year five, total volume loss was 26.6%.Subset analyses demonstrated that in addition to lumpectomy defects, five-year volume loss was 21.7% for tumor/ breast volume > 10% and 29.5 % for tumor/ breast volume ≤ 10%. Volume loss between subgroups was not significantly different (p=0.37). Larger breast volume was a significant predictor of greater volume loss for all five years (p<0.001), followed by diabetes and smoking history. CONCLUSION: Patients with T1 tumors undergoing BCT/RT may lose approximately 20% of breast volume (beyond specimens) within a year, with continued loss for five years. Volume change did not differ significantly according to baseline breast volume, although larger breasts may experience comparatively larger volume changes.

Immediate and delayed flap reconstruction have equivalent outcomes and associated costs following soft tissue sarcoma surgery.

BACKGROUND AND OBJECTIVES: Surgical treatment of soft tissue sarcoma (STS) involves wide resection of the tumor, which can necessitate soft tissue reconstruction with local or free tissue flaps. This retrospective study compares cost, surgical and oncologic outcomes between patients undergoing reconstruction with immediate versus delayed flap coverage following STS resection. METHODS: Thirty-four patients who underwent planned flap reconstruction following resection of primary STS were identified retrospectively. Twenty-four (71%) received immediate reconstruction during the index surgery and 10 (29%) underwent planned delayed reconstruction. Preoperative patient-specific metrics, tumor characteristics, and surgical and patient outcomes were collected. Total hospital charges associated with every encounter during the perioperative period were obtained. RESULTS: Patient demographics, comorbidities, tumor metrics, and surgical characteristics were equivalent between groups. Postoperative wound complications, reoperations, readmissions, and disease-specific survival did not differ between cohorts. Costs associated with each reconstruction strategy were equivalent on bivariate and multivariate testing, when accounting for operating room time, hospital length of stay, and reoperation rate. CONCLUSIONS: Our study identifies no significant difference in patient outcome measures or cost between planned immediate and delayed flap reconstruction following STS resection. These results support the implementation of either treatment strategy in keeping with patient-centered, multidisciplinary care principles.

Surgical tele-mentoring using a robotic platform: initial experience in a military institution.

BACKGROUND: Surgical tele-mentoring leverages technology by projecting surgical expertise to improve access to care and patient outcomes. We postulate that tele-mentoring will improve surgeon satisfaction, procedural competence, the timeliness of operative intervention, surgical procedure efficiency, and key intra-operative decision-making. As a first step, we performed a pilot study utilizing a proof-of-concept tele-mentoring process during robotic-assisted surgery to determine the effects on the perceptions of all members of the surgical team. METHODS: An IRB-approved prospective feasibility study to determine the safety and efficacy of remote surgical consultation to local surgeons utilizing robotic surgery technology in the fields of general, urology, gynecology and thoracic surgery was performed. Surgical teams were provided a pre-operative face-to-face orientation. During the operation, the mentoring surgeon was located at the same institution in a separate tele-mentoring room. An evaluation was completed pre- and post-operatively by the operative team members and mentor. RESULTS: Fifteen operative cases were enrolled including seven general surgery, four urology, one gynecology and three thoracic surgery operations. Surveys were collected from 67 paired survey respondents and 15 non-paired mentor respondents. Participation in the operation had a positive effect on participant responses regarding all questions surveyed (p < 0.05) indicating value to tele-mentoring integration. Connectivity remained uninterrupted with clear delivery of audio and visual components and no perceived latency. Participant perception of leadership/administrative support was varied. CONCLUSIONS: Surgical tele-mentoring is safe and efficacious in providing remote surgical consultation to local surgeons utilizing robotic surgery technology in a military institution. Operative teams overwhelmingly perceived this capability as beneficial with reliable audio-visual connectivity demonstrated between the main operative room and the Virtual Medical Center. Further study is needed to develop surgical tele-mentoring to improve patient care without geographic limitations during times of peace, war and pandemic outbreaks.