RESUMO
Conservative breast cancer surgery is facing a new problem: the potential tumour involvement of resection margins. This eventuality has been closely and negatively associated with disease-free survival. Various factors may influence the likelihood of margins being affected, mostly related to the characteristics of the tumour, patient or surgical technique. In the last decade, many studies have attempted to find predictive factors for margin involvement. However, it is currently the new techniques used in the study of margins and tumour localisation that are significantly reducing reoperations in conservative breast cancer surgery.
Assuntos
Neoplasias da Mama/cirurgia , Mastectomia/métodos , Neoplasias da Mama/patologia , Feminino , Humanos , Cuidados Intraoperatórios , Neoplasia ResidualRESUMO
INTRODUCTION: The objective of our study was to assess recurrence after negative sentinel lymph node biopsy (SLNB) and to determine the risk factors related to local and distant recurrence in this group of patients. MATERIALS AND METHODS: We conducted a prospective observational study from 2006 to 2011. It included 607 patients with early-stage breast cancer and negative SLNB with a 5-year follow-up period. RESULTS: The disease-free survival rate was 98.5% and 96.5% at 2 and 5 years, respectively. Multivariate analysis identified the following prognostic factors for disease recurrence: tumor necrosis (hazard ratio [HR], 4.89; 95% confidence interval [CI], 1.61-14.89; P = .005), lymphovascular invasion (HR, 3.46; 95% CI, 1.14-10.55; P = .029), T2 tumor size (HR, 4.35; 95% CI, 1.40-13.52; P = .011), and moderate to severe lymphoplasmacytic stromal infiltration (HR, 3.06; 95% CI, 1.18-7.96; P = .022). CONCLUSION: Recurrence in patients with negative SLNB was satisfactorily low. Nevertheless, determining the prognostic factors related to a greater recurrence rate could help identify high-risk patients and influence systemic adjuvant therapy.
Assuntos
Neoplasias da Mama/epidemiologia , Neoplasias da Mama/patologia , Recidiva Local de Neoplasia/epidemiologia , Recidiva Local de Neoplasia/patologia , Biópsia de Linfonodo Sentinela , Adulto , Idoso , Idoso de 80 Anos ou mais , Axila , Neoplasias da Mama/terapia , Terapia Combinada , Intervalo Livre de Doença , Feminino , Seguimentos , Humanos , Metástase Linfática , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/terapia , Estadiamento de Neoplasias , Prognóstico , Estudos Prospectivos , Fatores de Risco , Linfonodo Sentinela/patologia , Taxa de Sobrevida , Adulto JovemRESUMO
BACKGROUND: This study evaluated the use of TachoSil as an adjunctive therapy for reducing axillary lymphocele formation. METHODS: Eighty-six patients diagnosed with breast cancer N+ and treated with axillary lymphadenectomy received a TachoSil patch in the axillary wound. Using a database of patients without placing a hemostatic patch, we applied a matched case-control in a 1-to-2 fashion. Multiple and logistic regression analyses were used to evaluate postoperative results. RESULTS: Patient group with TachoSil showed a significantly lower drainage volume (P < .001) and the length of stay was significantly shorter (P < .001). The number of patients with evacuative punctures was 24.5% in the group with patch versus 51.2% in the control group (P < .001). In multivariate analysis, the use of TachoSil was a significant predictor of reducing axillary drainage volume (P < .001), mean length of hospital stay (P = .001), and number of evacuative punctures of lymphocele (odds ratio .264, 95% confidence interval .144 to .484, P < .001). CONCLUSION: The use of TachoSil in axillary lymphadenectomy may be a safe and useful treatment option for reducing axillary drainage volume, incidence of symptomatic lymphocele, and hospital stay.