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Objective:To analyze locoregional recurrence (LRR) pattern of patients with pT 1-2N 1 breast cancer after modified radical mastectomy, with and without adjuvant radiotherapy (RT). Methods:A total of 5442 eligible patients with breast cancer from 12 Chinese centers were included. The LRR sites and the effect of RT at different sites on recurrence in patients with and without RT were analyzed. The Kaplan-Meier method was used to calculate the cumulative LRR rate, and the difference was compared by the log-rank test.Results:With a median follow-up time of 63.8 months for the entire cohort, 395 patients developed LRR. The chest wall and supraclavicular fossa were the most common LRR sites, regardless of RT or molecular subtypes. The 5-year chest wall recurrence rates for patients with and without chest wall irradiation were 2.5% and 3.8%( P=0.003); the 5-year supraclavicular lymph nodal recurrence rates for patients with and without supraclavicular fossa irradiation were 1.3% and 4.1%( P<0.001); the 5-year axillary recurrence-free rates for patients with and without axillary irradiation were 0.8% and 1.5%( HR=0.31, 95% CI: 0.04-2.23, P=0.219); and the 5-year internal mammary nodal recurrence-free rates for patients with and without internal mammary nodal irradiation were 0.8% and 1.5%( HR=0.45, 95% CI: 0.11-1.90, P=0.268). Conclusions:The chest wall and supraclavicular fossa are the most common LRR sites of patients with pT 1-2N 1 breast cancer after modified radical mastectomy, which is not affected by adjuvant RT or molecular subtypes. The chest wall and supraclavicular fossa irradiation significantly reduce the risk of recurrence in the corresponding area. However, axillary and internal mammary nodal irradiation has no impact on the risk of recurrence in the corresponding area.
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ObjectiveTo investigate the clinical effect of Shipiyin combined with diosmin in the treatment of lymphedema with spleen Yang deficiency syndrome（SYDS）after modified radical mastectomy and the specific effect on the function of the affected limb. MethodEighty-two patients with lymphedema with SYDS after modified radical mastectomy from outpatient and inpatient department of breast department and oncology department of the First Affiliated Hospital of Hunan University of Chinese Medicine were randomly divided into an observation group（41 cases） and a control group（41 cases）. The control group was given diosmin tablets（0.9 g per time， two times per day）on the basis of conventional treatment，and the observation group was given Shipiyin（one dose per day）on the basis of the control group. The course of treatment was 14 days. The clinical symptoms were observed and the limb circumference，traditional Chinese medicine（TCM） syndrome score，functional assessment of cancer therapy-breast cancer（FACT-B） score，disability of arm， shoulder and hand questionnaire（DASH） score，and joint range of motion were measured to analyze the TCM syndrome therapeutic effect and clinical efficacy. ResultAfter 14 days of treatment， the total effective rate of the observation group was 85.37% （35/41） and that of the control group was 63.41% （26/41） in the TCM symptoms， showing a statistically significant difference （Z=-2.212， P<0.05）. In terms of the clinical efficacy， the total effective rate in the observation group was 82.93% （34/41） and that in the control group was 75.61% （31/41）， indicating a statistically significant difference （Z=-2.061， P<0.05）. Compared with the situations before treatment， the scores of clinical symptoms such as the swelling of the upper limb， pain， sense of heaviness， stuffiness， fatigue， fullness， tightness， and skin keratosis and pruritus in the two groups were significantly lowered （P<0.01） after treatment. Compared with the control group， the observation group could better improve the swelling and fullness（P<0.01），as well as the feeling of pain，heaviness，stuffiness，fatigue，tightness，skin keratosis and pruritus （P<0.05）of the upper limbs of patients. The affected limb circumference， TCM syndrome score， and DASH score decreased significantly， while the FACT-B score and upper limb joint range of motion increased significantly in the two groups after treatment （P<0.01）. Compared with the control group， the observation group showed significantly reduced limb circumference at 10 cm proximal to the elbow striae， lowered TCM syndrome score， elevated FACT-B score（P<0.05）， decreased DASH score and improved range of motion of the upper limb joint （P<0.01） after treatment. ConclusionShipiyin combined with diosmin has better clinical efficacy in the treatment of lymphedema with SYDS after modified radical mastectomy than diosmin alone，which can better improve the clinical symptoms，signs，quality of life and limb functional activity of patients. This provides a new clinical program for the treatment of lymphedema after breast cancer surgery with integrated Chinese and western medicine.
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Patients undergoing modified radical mastectomy (MRM) experience lot of pain and require higher doses of analgesics. The modified pectoral nerves (m-PEC 2) block for post-operative analgesia for patients undergoing MRM has proven highly efficacious and best alternative to avoid high dose opioid induced side effects. The m -PEC 2 block was given to 5 patients undergoing modified radical mastectomy for post operative analgesia, decrease in the VAS score was noted and decrease need of rescue analgesia was seen
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Objective To analyze the dosimetric features of chest wall radiotherapy after modified radical mastectomy for left breast cancer using the beam’s eye view (BEV) in intensity-modulated radiation therapy (B-IMRT). Methods A total of 13 patients treated with modified radical mastectomy for left breast cancer in the Liaocheng People’s Hospital from May 2020 to November 2020 were recruited. They were treated with postoperative radiotherapy using the plans of B-IMRT or tangential fields in intensity-modulated radiation therapy (T-IMRT). The mean dose, conformity index and homogeneity index of the target field, and dose volume parameters of left lung and heart were compared between two groups. Results Compared with those of T-IMRT group, B-IMRT significantly improved the conformity and homogeneity of the target field (P < 0.05), and their mean dose of target field was similar. In addition, V5, V10, V20, V30 and Dmean of the left-side lung, and V5, V10, V30 and Dmean of the heart in B-IMRT group were significantly reduced compared with those of T-IMRT group (P < 0.05). In comparison to those of T-IMRT, B-IMRT decreases V5, V10, V20, V30 and Dmean of the left-side lung by 9.23%, 13.29%, 9.54%, 8.28% and 10.35%, respectively, which decreases V5, V10, V30 and Dmean of the heart by 27.62%, 29.72%, 21.45% and 24.88%, respectively. Conclusion Compared with T-IMRT planning, B-IMRT presents dosimetric advantages in the conformity and homogeneity of the target field in the postoperative radiotherapy of patients treated with modified radical mastectomy for left breast cancer, especially in reducing the radiation dose and volume of the heart and lungs.
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Objective:To investigate the radiation field and dose selection of patients with isolated chest wall recurrence (ICWR) after modified radical mastectomy, and analyze the prognostic factors related to subsequent chest wall recurrence.Methods:Clinical data of 201 patients with ICWR after mastectomy admitted to the Fifth Medical Center, Chinese PLA General Hospital from 1998 to 2018 were retrospectively analyzed. None of the patients received postoperative adjuvant radiotherapy. After ICWR, 48 patients (73.6%) underwent surgery and 155 patients (77.1%) received radiotherapy. Kaplan-Meier method was used to calculate the post-recurrence progression-free survival (PFS) rates and the difference was compared by log-rank test. Multivariate analysis was performed using Cox regression model. Competing risk model was adopted to estimate the subsequent local recurrence (sLR) rates after ICWR and the difference was compared with Gray test. Multivariate analysis was conducted using F&G analysis. Results:With a median follow up of 92.8 months after ICWR, the 5-year PFS rate was 23.2%, and the 5-year sLR rate was 35.7%. Multivariate analysis showed that patients with surgery plus radiotherapy and recurrence interval o F>12 months had a lower sLR rate. Patients with recurrence interval o F>48 months, local plus systemic treatment and surgery plus radiotherapy had a higher PFS rate. Among the 155 patients who received chest wall radiotherapy after ICWR, total chest wall irradiation plus local boost could improve the 5-year PFS rate compared with total chest wall irradiation alone (34.0% vs. 15.4%, P=0.004). Chest wall radiation dose (≤60 Gy vs.>60 Gy) exerted no significant effect upon the sLR and PFS rates (both P>0.05). In the 53 patients without surgery, the 5-year PFS rates were 9.1% and 20.5%( P=0.061) with tumor bed dose ≤60 Gy and>60 Gy, respectively. Conclusions:Local radiotherapy is recommended for patients with ICWR after modified radical mastectomy of breast cancer, including total chest wall radiation plus local boost. The radiation dose for recurrence should be increased to 60 Gy, and it should be above 60 Gy for those who have not undergone surgical resection. In addition, patients with ICWR still have a high risk of sLR, and more effective treatments need to be explored.
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Background: Seroma, a clinically evident subcutaneous collection of serous fluid after breast cancer surgery, developing in approximately 30% of cases. To prevent seroma formation, it is important to estimate individual risk of seroma formation, i.e., the identification of predictive variables will be helpful in designing future trials aimed at reducing the incidence of this seroma. This study intends to find out the association between certain pre-operative, intra-operative, and post-operative factors related to MRM and incidence of seroma formation.Methods: It was an observational prospective on 100 females undergoing MRM at Department of Gandhi Medical College Bhopal, Madhya Pradesh, India. Patients were observed postoperatively for seroma formation and factors affecting it.Results: patients with seroma formation in this study tended to be older age (age, 62.60±10.40 years versus 56.13±10.31 years; p<0.001) and more obese (BMI, 26.95±4.2 versus 24.61±3.61; p<0.001). Higher amount of initial drain volume was directly related to seroma formation. Initiation of arm physiotherapy after surgery (3.14±0.23 days versus 2.17±0.74 days; p=0.043).Conclusions: The incidence of seroma is higher in older and in more obese patients. The incidence is decreased by flap fixation under muscles and early physiotherapy. Furthermore, few interventions in the operative period can help minimize the chances of seroma formation.
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Background: Most of the complications are developed after modified radical mastectomy in breast cancer patients, hence to avoid and reduces the postoperative complications, this study is performed to identify the frequency of early post-operative complications of modified Radical Mastectomy within the period of four weeks.Methods: Cross-sectional case series using non-probability convenient sampling technique was conducted in surgical unit I of Tertiary care hospital, for 1 year from 15 January 2018 to 14 January 2019. 89 patients FNAC proved breast cancer were included, patients that received neoadjuvant chemo or radiotherapy or with inflammatory breast cancer, metastasis and with co-morbid were excluded. After taking consent patients were operated by senior consultant. Follow up was taken daily 7th post-operative day and then followed in OPD on weekly basis fourth week and final outcome was noted. SPSS version 23 was used for data analysis. Quantitative data was reported as frequency in percentages.Results: Total 31 patients developed complications during the study, accounts 34% of total patients. The most common complication was breast seroma in 12(13.48%) of cases with an increased risk in cases of age >50 yr, size of tumor >8 cm, weight >70 kg and increased number of lymph nodes [3 or above] palpable after wards hematoma in 6(6.74%), lymphedema in 5(5.62%), wound infection 4(4.49%) and shoulder dysfunction in 4(4.49%) patients, no patient was found scar hypertrophy.Conclusions: Seroma formation, hematoma were found most common early complications after modified radical mastectomy, lymphedema, wound infection and shoulder dysfunction were observed in small number of patients.
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Thoracic epidural anaesthesia is one of the safe and good alternative to general anaesthesia in high risk patients of chronic obstructive pulmonary disease and asthma where general anaesthesia is contraindicated. A 55 years old female patient was scheduled for modified radical mastectomy on account of advanced carcinoma of right breast. The patient was known case of bronchial asthma since 5 years with frequent attacks per week for which she was taking nebulisation with salbutamol and budesonide two times per day. In the pre-operative evaluation, her vitals were within normal limit but on auscultation air entry was reduced all over the chest with bilateral crepts and rhochi present. We did this patient in plaine thoracic epidural anaesthesia without haemodynamic instability. Thoracic epidural anaesthesia and analgesia for mastectomy is feasible, and it offers additional benefits in high-risk patients.
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Objective@#To analyze the failure patterns of locoregional recurrence (LRR) and investigate the range of radiotherapy in T1-2N1 breast cancer patients undergoing modified radical mastectomy.@*Methods@#From September 1997 to April 2015, 2472 women with T1-2N1 breast cancer after modified radical mastectomy without neoadjuvant systemic therapy were treated in our hospital. 1898 patients who did not undergo adjuvant radiotherapy were included in this study. The distribution of accumulated LRR was analyzed. The LR and RR rates were estimated by the Kaplan-Meier method, and the prognostic factors were identified in univariate analyses with Log-rank test. Multivariate analysis was performed using Cox logistic regression analysis.@*Results@#With a median follow-up of 71.3 months (range 1.1-194.6), 164 patients had LRR, including supraclavicular/infraclavicular lymph nodes in 106(65%), chest wall in 69(42%), axilla in 39(24%) and internal mammary lymph nodes (IMNs) in 19 patients (12%). In multivariate analysis, age (>45 years vs.≤45 years), tumor location (other quadrants vs. inner quadrant), T stage (T1 vs. T2), the number of positive axillary lymph nodes (1 vs. 2-3), hormone receptor status (positive vs. negative) were significant prognostic factors for both LR and RR.@*Conclusions@#In patients with T1-2N1 breast cancer after modified radical mastectomy, the most common LRR site is supraclavicular/infraclavicular nodal region, followed by chest wall. The axillary or IMN recurrence is rare. The prognostic factors for LR and RR are similar, which indicates that supraclavicular/infraclavicular and chest wall irradiation should be considered for postmastectomy radiotherapy.
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Objective To analyze the failure patterns of locoregional recurrence (LRR) and investigate the range of radiotherapy in T1-2N1 breast cancer patients undergoing modified radical mastectomy.Methods From September 1997 to April 2015,2472 women with T1-2N1 breast cancer after modified radical mastectomy without neoadjuvant systemic therapy were treated in our hospital.1898 patients who did not undergo adjuvant radiotherapy were included in this study.The distribution of accumulated LRR was analyzed.The LR and RR rates were estimated by the Kaplan-Meier method,and the prognostic factors were identified in univariate analyses with Log-rank test.Multivariate analysis was performed using Cox logistic regression analysis.Results With a median follow-up of 71.3 months (range 1.1-194.6),164 patients had LRR,including supraclavicular/infraclavicular lymph nodes in 106(65％),chest wall in 69(42％),axilla in 39(24％) and internal mammary lymph nodes (IMNs) in 19 patients (12％).In multivariate analysis,age (＞45 years vs.≤45 years),tumor location (other quadrants vs.inner quadrant),T stage (T1 vs.T2),the number of positive axillary lymph nodes (1 vs.2-3),hormone receptor status (positive vs.negative) were significant prognostic factors for both LR and RR.Conclusions In patients with T1-2N1 breast cancer after modified radical mastectomy,the most common LRR site is supraclavicular/infraclavicular nodal region,followed by chest wall.The axillary or IMN recurrence is rare.The prognostic factors for LR and RR are similar,which indicates that supraclavicular/infraclavicular and chest wall irradiation should be considered for postmastectomy radiotherapy.
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Objective To assess the intervention effect of upper limb rehabilitation exercise video on life quality in patients after modified radical mastectomy. Methods A total of 160 breast cancer patients received modified radical mastectomy were from Shanghai Jiading District Maternal and Child Health Hospital from June 2017 to June 2019.They were randomly divided into control group and observation group with 80 cases in each group.The patients in the control group were trained with routine upper limb rehabilitation exercise, and the patients in the observation group were given video training for upper limb rehabilitation exercise.Quality of life (QOL), anxiety scale and depression scale were used for corresponding evaluations.Satisfaction and compliance scales were also used for evaluation. Results Before intervention, there was no significant difference in each index between the two groups (P>0.05).After intervention, the quality of life in the observation group was better than that in the control group, including life status (21.43±4.83), functional status (19.69±4.72), emotional status (19.83±4.36), social/family status (19.59±3.62) and additional attention (24.73±3.27).There was no statistically significant difference in these parameters before and after intervention in the control group (P>0.05).The scores of anxiety (36.37±5.64) and depression (37.28±4.47) in the observation group were lower than those in the control group, and the differences were statistically significant.The nursing satisfaction of patients in the observation group was much higher than that in the control group (91.25% vs 77.50%), and the proportion of compliance was higher than that in the control group (97.50% vs 68.75%). Conclusion In breast cancer patients received radical mastectomy, video-guided rehabilitation training can improve the quality of life and nursing satisfaction, compliance of rehabilitation, and condition of anxiety and depression.
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Introducción.La tasa de incidencia de infecciones del sitio operatorio asociadas a cirugías mamarias varía desde el 6 hasta el 38 %. Se presentan la incidencia local y el perfil microbiológico de las infecciones en una clínica oncológica.Métodos.Se trata de un estudio de cohorte, prospectivo, descriptivo, durante un periodo de un año en el Instituto Médico de Alta Tecnología, IMAT Oncomédica, de mujeres con diagnóstico de cáncer de mama, que presentaron infecciones del sitio operatorio después de la mastectomía. Resultados.Se encontraron 335 cirugías registradas y la incidencia de infecciones del sitio operatorio fue del 3,38 %, todas en mastectomías radicales con reconstrucción. Se obtuvo crecimiento bacteriano en el 77 % de los cultivos, principalmente de cocos Gram positivos, con predominio de Staphylococcus aureus sensible a la meticilina (SAMS). Los bacilos Gram negativos representaron el 40 %. Se administraron cefalosporinas de primera generación como profilaxis antibiótica prequirúrgica, la cual fue correcta en el 31 % de los casos. En el 50 % de las pacientes infectadas se practicó el baño prequirúrgico y se cumplió el protocolo institucional. Conclusiones. La incidencia encontrada de infecciones del sitio operatorio es menor que la reportada en otras series. Staphylococcus aureus sensible a la meticilina fue el microorganismo responsable más frecuente. El cum-plimiento de la profilaxis con cefalosporina y baño prequirúrgico es fundamental para disminuir la incidencia de infecciones del sitio operatorio
Introduction.The incidence rate of surgical site infection associated with breast surgeries ranges from 6% to 38%. We present the local incidence and microbiological profile of infections in an oncology clinic.Methods. Prospective, descriptive cohort study over a one-year period of women diagnosed with breast cancer at Instituto Médico de Alta Tecnología, IMAT Oncomédica, and have developed surgical site infection after mastectomy.Results. 335 registered surgeries were found. The incidence of surgical site infection was 3.38%, all of them in radical mastectomies with reconstruction. Bacterial growth was obtained in 77% of crops. Gram-positive were the main microorganisms responsible, predominantly methicillin-sensitive Staphylococcus aureus (SAMS). Gram-Negative bacilli accounted for 40%. First generation cephalosporins were administered as presurgical antibiotic prophylaxis, which was correct in 31% of cases. In 50% of infected patients, the pre-surgical bath was performed and the institutional protocol was complied with.Conclusion. Our incidence of surgical site infection was lower than reported in other series. SAMS was the most common responsible microorganism. Compliance with cephalosporin and pre-surgical bath prophylaxis is critical to reducing the incidence of operative site infections.
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Humans , Breast Neoplasms , Surgical Wound Infection , Mastectomy, Modified Radical , MicrobiologyABSTRACT
Introduction: Modified radical mastectomy (MRM) isassociated with extensive tissue dissection and substantialpostoperative pain. Various modes of postoperative analgesiahave been used to alleviate the suffering of these patients.One of that is wound instillation, in our study we comparedthe effects of bupivacaine and ropivacaine for post-operativeanalgesia when instilled through the surgical drains in patientsundergoing MRM.Material and methods: After obtaining the InstitutionalEthics Committee approval and written informed consent,60 female patients aged between 18 and 60 years withAmerican Society of Anaesthesiologist status I/II scheduledto undergo MRM were enrolled for the study. Patients wererandomised into two groups (30 each), a total of 40 cc of eitherbupivacaine (0.125%) or ropivacaine (0.2%) instilled throughsurgical drains. Visual analogue score and hemodynamicswere compared in the postoperative period every 2 hourlytill 12 hours. Quantitative data were compared by usingunpaired t-test and qualitative data by using Chi-Square testand Fisher’s Exact test.Results: Duration of analgesia was found to be significantlylonger in bupivacaine group (512.37±63.06 minutes) ascompared to ropivacaine (427.97±43.26 minutes) (p<0.0001). Systolic and diastolic blood pressure were high andstatistically significant in bupivacaine group as compared toropivacaine but clinically not significant.Conclusion: Both local anaesthetics, bupivacaine andropivacaine showed near similar pharmacological effectshowever the duration of analgesia was observed more withbupivacaine when instilled through the surgical drains. Woundinstillation, being a non-invasive technique is an effectivemode of providing postoperative analgesia in MRM ascompare to other invasive modalities.
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Background: Triple-negative breast cancers (TNBCs) form a heterogeneous group of cancers typically exhibiting an aggressive behavior resulting in increased risk of locoregional relapse (LRR) and distant metastases. The effect of radiotherapy on LRR risk and overall survival (OS) in women treated with mastectomy alone for early-stage TNBC remains unclear. Aim: The aim of this study is to compare the locoregional recurrence rate, disease-free survival (DFS), and OS following breast conservation therapy (BCT) or modified radical mastectomy (MRM) alone in women with stage I and IIA TNBC and to assess the impact of tumor and treatment-related factors. Materials and Methods: Patients with early-stage (pT1-2, N0) TNBC-treated between January 1, 2010, and December 31, 2011, were identified from the hospital-based registry records. The mean age was 48 years. Forty-nine patients underwent BCT, and 121 underwent MRM. The majority of the patients in both groups had T2 and grade 3 disease. None of the patients had margin positive status after surgery. Five patients had lymphovascular invasion (LVI). Results: At a median follow-up of 50 months (range: 4–83 months), there was no locoregional recurrence (LRR) in either arm. Eight patients relapsed, six developed distant metastases, and one patient each had a new primary in the contralateral breast and ovary. Two patients died of disseminated cancer, one each in the BCT and MRM groups. The five-year DFS was 95.8% and 91.1% for the BCT group and MRM group, respectively, (P = 0.83). The corresponding 5-year OS was 98% and 97.5% (P = 0.527). There was no statistically significant difference in outcome based on age, grade, LVI, or margin status between both groups. Conclusion: This retrospective analysis identified no statistically significant difference in outcome regarding LRR, DFS, or OS in patients treated without adjuvant radiation for women with pT1-T2N0 TNBC who underwent MRM in comparison to BCT
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RESUMEN El Cáncer de mama Bilateral, es una entidad clínico patológica especial de presentación del cáncer de mama. Por lo que realizamos la presentación de un paciente con esta rara afección así como una revisión del estado actual de esta enfermedad.
ABSTRACT Bilateral breast cancer is a special pathological clinical entity presenting breast cancer. So we made the presentation of a patient with this rare condition as well as a review of the current status of this disease.
RESUMO O câncer de mama bilateral é uma entidade clínica patológica especial que apresenta câncer de mama. Por isso, fizemos a apresentação de um paciente com esta condição rara, bem como uma revisão do estado atual desta doença.
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Context: Individuals who have been diagnosed with cancer usually suffer from various psychosocial impairments. Psychosocial impairments affect the well-being of the individual, causing risk to the individual in various ways. With rise in awareness about cancer and its effects on an individual, people are increasingly seeking out various complementary therapies to cope with their illness. Hence this study aimed to compare the effect of Group Based Mindful Based Stress Reduction and Progressive Muscle Relaxation on stress in post Modified Radical Mastectomy patients.Methods and Material: 60 post MRM patients (30-60 yrs) were selected as per eligibility criteria. Pre-intervention scores were taken using DASS-42 (Marathi version). Both the groups intervention was given for ten minutes for five days, for one week and post-intervention assessment was done, and scores noted.Results: Unpaired t test of baseline characteristics (BMI, AGE, pre-interventional DASS) done for both the groups showed that the groups were comparable.Pre and Post interventional data collected in MBSR (group 1) (t= 2.94, p<0.001) and PMR (group 2) (t=1.67, p<0.05) showed that there was significant difference in DASS scores. However, between group analysis by Unpaired t test of both the groups showed no significant difference (t=0.98, p>0.05) hence, both the interventions were effective in decreasing DASS scores.Conclusions:The study concluded that both the interventions were effective in decreasing symptoms of stress in the post MRM patients.
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Objective To study the application value of radiotherapy optimization after modified radical mastectomy.Methods From January 2012 to January 2015,one hundred and twelve patients treated with modified radical mastectomy in Taizhou Cancer Hospital were enrolled and divided randomly into group A,B and C.40 patients in group A received modulated radiation therapy(MRT) with 2.0Gy/f,25 times,DT50Gy for 33-35d;35 cases in group B received concurrent chemoradiotherapy with MRT and 37 cases in group C received concurrent chemoradiotherapy with large segmentation scheme of 2.66Gy/f,16 times,DT42.56Gy for 22-24d.The recurrence rate,survival rate and the incidence of acute and chronic radiation injury of the 3 groups were compared.The parameters of V5,V10,V20 and V30 of ipsilateral lung was recorded by dose volume histogram(DVH).Results The total recurrence rate in group C was significantly lower than that of the other two groups (16.2％(6/37) vs.28.6％(10/35) vs.42.5％(17/40),x2 =6.409,P=0.041),while the total survival rate was significantly higher than that of the other two groups (89.2％ (33/37) vs.77.1％ (27/35) vs.65.0％ (26/40),x2 =6.313,P =0.043),and there was no significant difference in the local recurrence and distant metastasis rate in the 3 groups (P＞0.05).The incidence of total radiation injury in group C was lower than that of the other two groups (21.6％ (8/37) vs.42.9％ (15/35) vs.50％ (20/40),x2 =6.973,P =0.031),and there was no significant difference in the incidence of acute and chronic injury and the grade of injury in the 3 groups (P＞0.05).The values of VS,V10,V20 and V30 increased gradually in the 3 groups.The V5 and V10 in group C were significantly higher than those of the other two groups ((32.9 ± 7.4) ％ vs.(17.5 ± 5.9) ％ vs.(16.8 ± 6.4) ％,F =18.625,P=0.000,(42.4±7.3)％ vs.(39.3±5.8)％ vs.(35.5±6.0)％,F=15.624,P=0.000),and there was no significant difference in V20 and V30 among the three groups (P＞ 0.05).Conclusion The combination of concurrent chemoradiotherapy and breast cancer after modified radical mastectomy is of great value in improving prognosis and reducing radiation damage.
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Objective To evaluate the efficacy of anterior cutaneous branch of the intercostal nerve block combined with pectoral nerves (Pecs) block type Ⅱ for early postoperative analgesia by comparing with Pecs block type Ⅱ in the patients undergoing modified radical mastectomy.Methods Sixty-eight patients,aged 18-64 yr,with American Society of Anesthesiologists physical status Ⅰ-Ⅲ,scheduled for elective modified radical mastectomy under general anesthesia,were divided into 2 groups (n=34 each) using a random number table method:Pecs block type Ⅱ plus anterior cutaneous branch of intercostal nerve block group (P+A group) and Pecs block type Ⅱ group (P group).Anesthesia was induced with fentanyl,propofol and cisatracurium besilate,the patients were then tracheally intubated,and anesthesia was maintained with sevoflurane combined with nitrous oxide in both groups.In both groups,0.25％ levobupivacaine 10 ml was injected into the space between pectoralis major and pectoralis minor under ultrasound guidance,and then 0.25％ levobupivacaine 10 ml was injected into the surface of the serratus anterior muscle at the level of 3rd rib for Pecs block type Ⅱ before operation.In group P+A,0.25％ ropivacaine 10 ml (20 ml in total) was injected into the interspace between the transverse thoracic and intercostal muscles in the junction area at the level of 4th and 5th ribs to perform anterior cutaneous branch of the intercostal nerve block.The equal volume of normal saline was given instead in group P.Morphine was given for analgesia when visual analogue scale score＞3 or when the patients required.The cumulative amount of morphine administered at 24 h after surgery was recorded.The development of postoperative nausea and vomiting was observed.Results Compared with group P,the cumulative amount of morphine administered at 24 h after surgery was significantly decreased,and the postoperative analgesia time was prolonged in group P+A (P＜0.05).There was no significant difference in the incidence of postoperative nausea and vomiting between the two groups (P＞0.05).Conclusion Combination of anterior cutaneous branch of the intercostal nerve block and Pecs block type Ⅱ provides better analgesic efficacy for early postoperative analgesia than Pecs block type Ⅱ alone in the patients undergoing modified radical mastectomy.
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Background: Carcinoma of the breast is the most common of non-skin malignancies in women and is second to lung cancer is a cause of cancer deaths. A woman who lives to age 90 has a one in eight chance of developing breast cancer. It is as ironic and tragic that a neoplasm arising in an exposed organ, readily accessible to self-examination and clinical surveillance, continues to exact such a heavy toll. The aim of the study: To determine, if differences in the extent of axillary node dissection would alter the number of reported positive nodes, to emphasize the presence and importance of dissecting the inter pectoral node (Rotter’s Node) in Modified Radical Mastectomy. Materials and methods: This study was conducted in the Department of General Surgery, Government Stanley Medical College, Chennai in 2018. Patients were evaluated according to NCCN guidelines and were subjected to Modified Radical Mastectomy for whomsoever it was needed. 32 cases underwent Modified Radical Mastectomy with complete axillary dissection (level I/II/III and inter pectoral node) according to the identical procedure. The dissection was carried out in all patients, irrespective of whether they had palpable nodes or not clinically. Results: An average of 13 lymph nodes was examined per case (range: 8−20). Axillary lymph node involvement was found in 56% of the cases (18/32). Of the 18 cases, 83% (n = 15) had involvement of level I/II nodes only, and 16% (n = 3) had positive ALN in levels III and, or, inter pectoral nodes, in addition to the level I/II. Involvement of lymph nodes in level III and inter pectoral nodes without a level I metastasis was not found. By the inclusion of level III to a level I/II dissection, two cases (11%) was converted from one to three positive nodes (pN1) to ≥4 positive nodes (pN2). Involvement Rosy Adhaline Selvi, Manimegalai. Scrutiny of extent of axillary node dissection for patients with primary breast cancer. IAIM, 2019; 6(3): 212-216. Page 213 of lymph nodes in level III was found in 3 cases (16%) 10/32 cases (31%) had ≥4 positive nodes who required adjuvant therapy. Conclusion: Variations in the level of axillary node dissection for breast cancer which includes the inter pectoral and level III nodes can result in significant changes in the number of positive axillary nodes stepping up the pathologic nodal status from pN1 to pN2. This can potentially bias adjuvant therapy recommendations if treatment decisions are based on this prognostic factor.
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Objective To investigate the efficacy of the single-injection technique of PECS Ⅰ and Ⅱ blocks for postoperative analgesia in patients undergoing modified radical mastectomy. Methods Sixty female patients who would undergo elective unilateral modified radical mastectomy, aged 30-65 years, falling into ASA physical status Ⅰ or Ⅱ, were selected and randomly divided into PECS group (group P) or control group (group C), 30 cases in each. After induction, patients in group P underwent ultrasound-guided combined PECS Ⅰ and Ⅱ blocks in a single-injection technique before surgery, 30 ml of 0.5％ ropivacaine was given to these patients. Patients in group C received general anesthesia alone. Anesthesia maintenance was performed by total intravenous anesthesia. The dosage of intraoperative propofol and remifentanil, postoperative recovery time, the requirement of sufentanil at 48 h after operation and the first time pressing the analgesic pump button, rescue analgesic requirements at 48 h after operation and the pressing frequency of analgesic pump were recorded in the two groups. Results The usage of propofol and remifentanil in group P were significantly less than those in group C (P ＜ 0.05). The recovery time after operation was significantly shorter than that in group C (P ＜ 0.05). The total consumption of sufentanil after 48 h was significantly less than that in group C (P ＜ 0.05). The first pressing time of the analgesic pump in group P was significantly later than that in group C (P ＜ 0.05).The rescue analgesic requirements in group P at 48 h were lower than those in group C (P ＜ 0.05).The pressing frequencies of analgesic pump in group P at 24 h were less than those in group C (P ＜ 0.05). Conclusion For patients undergoing modified radical mastectomy, ultrasound-guided combined PECS Ⅰ and Ⅱ blocks in a single-injection technique can reduce the dosage of opioid drugs in the perioperative period, and can provide better analgesic effect after operation.