RESUMO
BACKGROUND: Patients with locally advanced endocrine positive tumors who will not benefit from chemotherapy can be treated by either primary surgery or neoadjuvant endocrine therapy (NET). How often does NET result in breast-conserving surgery (BCS)? METHODS: We conducted a literature search in PubMed and Embase, to identify articles on surgical treatment after NET. RESULTS: In 19 studies the pathological complete response (pCR) rate was reported after NET; an overall pCR rate of 1% was found. Compared with neoadjuvant chemotherapy (NCT), the BCS rate was significantly higher after NET (OR 0.60; 95% CI, 0.51-0.69; P < 0.00001). The surgical conversion rate was reported in eight studies [4-75.9%], with a mean of 30.2%. CONCLUSION: This review found that one out of three patients becomes eligible for BCS after treatment with NET.
Assuntos
Antineoplásicos Hormonais , Neoplasias da Mama , Mastectomia Segmentar , Terapia Neoadjuvante , Feminino , Humanos , Antineoplásicos Hormonais/uso terapêutico , Neoplasias da Mama/cirurgia , Neoplasias da Mama/tratamento farmacológico , Neoplasias da Mama/patologia , Neoplasias da Mama/metabolismo , Quimioterapia Adjuvante/métodos , Mastectomia Segmentar/métodos , Terapia Neoadjuvante/métodos , Receptores de Estrogênio/metabolismo , Receptores de Progesterona/metabolismo , Resultado do TratamentoRESUMO
BACKGROUND: Cholecystectomy is considered the standard treatment for acute cholecystitis and symptomatic gallstones. An increasing number of frail elderly patients are being referred for this surgical treatment. A better understanding of surgical outcome in the elderly is needed to improve quality of care. METHODS: A retrospective analysis of 565 patients who underwent cholecystectomy was performed. Focus of the analyses was on postoperative complications and its predictors. RESULTS: The study population was divided in two cohorts; aged <70. More complications were found in patients aged ≥70 years. More elderly patients were admitted to the intensive care, respectively 4.0% and 14.1% (Pâ¯=â¯0.045). Hospital mortality was 6% in patients aged ≥70 years vs 0.6% in patients <70. CONCLUSION: In elderly patients, the complication and mortality rate following cholecystectomy is higher than previously reported. For high-risk patients aged ≥70 with cholecystitis, alternative therapies should be considered as a bridge to surgery or definite treatment.