Cirugía conservadora en el cáncer de mama / Conservative surgery for breast cancer

Para poder apreciar la importancia de la cirugía conservadora en el cáncer de mama se realizó una revisión exhaustiva de diferentes estudios sobre este procedimiento -tanto nacionales como extranjeros-, que tuvieran buena casuística y estuvieran metodológicamente bien confeccionados. Esta enfermedad, que cada vez tiene mayor carácter crónico, es un problema de salud frecuente que produce alteraciones corporales significativas y que tiene además una importante connotación psicosocial pues influye de forma negativa en la autoestima de las mujeres. Tras la revisión se pudo concluir que la cirugía conservadora es el tratamiento de elección en las pacientes con cáncer de mama en estadios I y II, pues permite conseguir un control local satisfactorio con una menor mutilación, sin modificar la supervivencia ni el índice de metástasis a distancia. Por tanto, hay que generalizar esta modalidad de tratamiento para que con ello se beneficie un mayor número de mujeres(AU)

With the objective of assessing the importance of the conservative surgery to treat breast cancer, an extensive review was made on the various studies about this procedure, both national and international; they must have good casuistry and be well designed from a methodological viewpoint. This disease with an increasing chronic nature is a frequent health problem that brings about significant body alterations and psychosocial effect, since it has a negative impact on the female self-esteem. After this review, it was concluded that the conservative surgery is the treatment of choice for the I and II stage breast cancer patients because it allows satisfactory local control with smaller mutilation, without changing either the survival rate or the distant metastasis index. Therefore, conservative surgery must be generalized so that a higher number of females can benefit from it(AU)

Results from Over One Year of Follow-Up for Absorbable Mesh Insertion in Partial Mastectomy

PURPOSE: Recently, several clinicians have reported the advantages of simplicity and cosmetic satisfaction of absorbable mesh insertion. However, there is insufficient evidence regardint its long-term outcomes. We have investigated the surgical complications and postoperative examination from the oncologic viewpoint. MATERIALS AND METHODS: From February 2008 to March 2009, 34 breast cancer patients underwent curative surgery with absorbable mesh insertion in Samsung Medical Center. Patient characteristics and follow up results including complications, clinical and radiological findings were retrospectively investigated. RESULTS: The mean age of the study population was 50.1+/-8.9 years old (range 31-82) with a mean tumor size of 3+/-1.8 cm (range 0.8-10.5), and the excised breast tissue showed a mean volume of 156.1+/-99.8 mL (range 27-550). Over the median follow-up period of 18+/-4.6 months (range 3-25), mesh associated complications, including severe pain or discomfort, edema, and recurrent fluid collection, occurred in nine patients (26.5%). In three cases (8.8%), recurrent mastitis resulted in mesh removal or surgical intervention. In the postoperative radiologic survey, the most common finding was fluid collection, which occurred in five patients (16.1%), including one case with organizing hematoma. Fat necrosis and microcalcifications were found in three patients (9.7%). CONCLUSION: Absorbable mesh insertion has been established as a technically feasible, time-saving procedure after breast excision. However, the follow-up results showed some noticeable side effects and the oncologic safety of the procedure is unconfirmed. Therefore, we suggest that mesh insertion should be considered only in select cases and should be followed-up carefully.

Solitary Drain-Site Recurrence after Lumpectomy for Breast Cancer

Locoregional recurrence after breast conservative surgery is not a rare event. However, a metastatic nodule solely at the surgical drain site seems to be extremely unusual. In this report, we present a patient who received a lumpectomy for breast cancer but a metastatic nodule developed at the drain site more than two years after her surgery.

Morbidity and mortality in breast conservation surgery in early carcinoma breast

To study the mortality and morbidity after breast conservation surgery [BCS] in patients with early breast cancer and comparison with local and international literature. An Interventional descriptive study. Place and Fauji Foundation Hospital, Rawalpindi from Jan 2002 to Dec 2003. Thirty diagnosed cases of early breast cancer in clinical stage I and II were included. Patients with solitary lump with size up to 4 cm in biggest diameter, 5 cm with large sized breasts and patients with lump in one breast were included. Patients with multicentric diseases, lump larger than 4 cm in size in greatest dimension, lump situated beneath areola, lumps fixed to skin or deeper structures were excluded. There were 2 [6.67%]cases of seroma formation and 1 [3.33%] case of wound infection, 8 [26.67%]patients suffered persistent painful shoulder movements and arm pain, 4 [13.33%] patients suffered breast disfigurement. 3 [10%] cases of loco-regional recurrence. 1 [3.33%] patient underwent mastectomy and 2 [6.66%] patients underwent further local excision,. Percentage of ductal carcinoma in post-menopausal women was also high. There was no mortality. Breast conservation surgery is equally effective as mastectomy in the treatment of early breast cancer as there is no statistically significant difference in disease-free survival and overall survival

Carcinoma residual de mama / Residual breast carcinoma

Antecedentes: Siguiendo la amplia resección local de los cánceres de mama, 1 de cada 4 pacientes tiene enfermedad residual en la retumorrectomía o en la pieza de mastectomía. Objetivos: Determinar si el carcinoma residual de mama se correlaciona con mayor recidiva local o distinta supervivencia global. Lugar de aplicación: División de Cirugía General y práctica privada. Diseño: Estudio retrospectivo y descriptivo. Población: 139 pacientes consecutivos con mastectomía o tratamiento conservador luego de una biopsia diferida del tumor. Método: Revisión de las historias clínicas. Luego de la resección de carcinomas de mama palpables o no palpables en los que existen bordes comprometidos en la pieza de resección o sospecha mamográfica de carcinoma residual, se estudia el especímen de la retumorrectomía o la pieza de mastectomía. Los pacientes fueron seguidos una media de 63 meses y fueron documentadas las recidivas locales y la supervivencia. Resultados: El estudio retrospectivo de los 139 pacientes tratados con cirugía conservadora o mastectomía identificó 53 (38,1 por ciento) de carcinomas residuales, 42,5 por ciento para los carcinomas invasores (43/101) y 26,3 por ciento para los no invasores (10/38). De los 52 pacientes con tratamiento conservador, 15 (28,8 por ciento) tenían carcinoma residual. No hubo diferencia estadísticamente significativa ni para las recidivas locales (p = 0,56) o supervivencia entre los pacientes con o sin carcinoma residual. No fue demostrada ninguna relación de acuerdo a la edad los pacientes, el componente intraductal extensivo o el compromiso axilar. Conclusiones: El hallazgo de carcinoma residual de mama luego de amplia biopsia diferida no afecta la recidiva local o la supervivencia en pacientes con tratamiento conservador o mastectomía. Para minimizar el riesgo del carcinoma residual, se debe considerar la amplia excisión de las lesiones o la mastectomía en el manejo del carcinoma multifocal y de los no palpables radiológicamente multicéntricos