Intraoperative and postoperative outcomes of Harmonic Focus versus monopolar electrocautery after neoadjuvant chemotherapy in breast conservative surgery: a comparative study.

BACKGROUND: Surgical devices are commonly used during breast conservative surgery (BCS) to provide better hemostasis. The Harmonic scalpel has recently gained momentum as an effective tool for intraoperative bleeding reduction. This comparative study was designed to determine the efficacy of Harmonic Focus in reducing postoperative complications of BCS after neoadjuvant chemotherapy (CTH) compared to the conventional method using monopolar diathermy. RESULTS: A prospective, nonrandomized, comparative study was conducted on patients scheduled to undergo BCS with axillary dissection after neoadjuvant CTH. Patients in the Harmonic Focus group had significantly shorter operative times than the monopolar electrocautery group (101.32 ± 27.3 vs. 139.3 ± 31.9 min, respectively; p < 0.001). Besides, blood loss was significantly lower in the Harmonic Focus group (117.14 ± 35.6 vs. 187 ± 49.8 mL, respectively; p < 0.001). Postoperatively, patients in the Harmonic Focus group had a significantly lower volume of chest wall drain (p < 0.001) and shorter time until drain removal (p < 0.001). Likewise, patients in the Harmonic Focus group had a significantly lower volume of axillary drain and shorter time until drain removal than monopolar electrocautery (p < 0.001). The incidence of postoperative complications was comparable between both groups (p = 0.128). CONCLUSIONS: This study confirmed the superiority of Harmonic Focus compared to monopolar electrocautery among patients receiving neoadjuvant CTH before BCS.

Minimally invasive inguinal lymph node dissection: initial experience and reproducibility in a limited resource setting-with technique video.

BACKGROUND: Conventional inguinal lymph node dissection comes with a high wound complication rate which increases hospital stay and may delay adjuvant treatment. Minimally invasive lymph node dissection (MILND) is a novel endoscopic technique which aims to minimize complications of lymphadenectomy. Herein we present our technique and experience with MILND to examine safety, feasibility and reproducibility in a setting of limited resources. METHODS: All patients undergoing MILND in the National Cancer Institute, Cairo were prospectively included following informed consent, IRB and ethical committee approval. Demographics, clinical, pathological data and postoperative complications according to Clavien-Dindo classification were recorded. Footage collected was used to create a step-by-step video demonstrating the technique. RESULTS: Twenty-seven procedures were included in the study. The most common indications were vulval cancer (44%) and skin melanoma (19%). There were 5 (18%) conversions to open procedure, all of them in the first 10 cases of the learning curve. The median (range) operative time was 120 (45-240) min and there was a trend towards shorter operative time after the first 5 cases. Wound dehiscence occurred in 4 cases (15%). Three of them (11%) required reoperation (grade III). Grade I/II complications in the form of seroma and wound infection occurred in 34%. The median (range) postoperative hospital stay was 2 (1-14). The median (range) number of retrieved lymph nodes was 12 (3-19). No grade III/IV lymphedema was recorded at 90 days after surgery. CONCLUSION: MILND is a safe, feasible technique associated with relatively low postoperative wound complications even when performed in a centre with relatively limited resources.

Challenging the Contraindications of Minimally Invasive Inguinal Lymph Node Dissection: Report of 2 Cases.

BACKGROUND: Endoscopic inguinal dissection is an emerging procedure utilizing minimally invasive technology to perform inguinal dissections aiming to avoid skin complications. Despite numerous reports there seems to be no consensus on inclusion and exclusion criteria, raising the question of when and when not to choose the minimally invasive technique. We compare the inclusion and exclusion criteria in published literature, and present our experience with 2 challenging cases; 1 with skin infiltration and the other with a previous lymphadenectomy scar. MATERIALS AND METHODS: We present 2 cases where this procedure was performed, despite limited nodal skin infiltration in the first case, and presence of a fresh scar of a previous biopsy and recent history of chemotherapy treatment in the second case. RESULTS: Despite skin infiltration by inguinal nodes, endoscopic inguinal dissection was performed and the attached skin was excised and delivered with the lymph nodes through the incision in the first case. Presence of a fresh scar and history of chemotherapy did not affect the outcomes in the second case, albeit fibrosis and adhesions. CONCLUSIONS: Skin infiltration, previous lymphadenectomy, and previous groin therapy might not represent absolute contraindications in selected cases and in the hands of experienced surgeons.

Cardiotoxicity with immune system targeting drugs: a meta-analysis of anti-PD/PD-L1 immunotherapy randomized clinical trials.

Background: With antiprogrammed death receptor-1 (anti-PD-L1) therapy, a recent meta-analysis reported higher incidence of cutaneous, endocrine and gastrointestinal complications especially with dual anti-PD-L1 immunotherapy (IMM). Methods: Our primary outcome was assessment of all cardiotoxicity grades in IMM compared with different treatments, thus a systemic review and a meta-analysis on randomized clinical trials (RCTs) were done. Results: We included 11 RCTs with 6574 patients (3234 patients in IMM arm vs 3340 patients in the other arm). Three non-small-cell lung cancer RCTs, seven melanoma RCTs and only one prostatic cancer RCT met the inclusion criteria. There were five RCTs that compared monoimmunotherapy to chemotherapy "(n = 2631 patients)". No difference exists in all cardiotoxicity grades or high-grade cardiotoxicity (p > 0.05). Lung cancer exhibited a higher response rate and lower mortality in IMM. Conclusion: There was no reported statistically significant cardiotoxicity associated with anti-PD/PD-L1 use. Lung cancer subgroups showed better response and survival rates.