RESUMEN
BACKGROUND: Delays in initiating adjuvant chemotherapy after breast cancer surgery seems to have an impact on patients' risk of relapse and their survival rate. The aim of this retrospective study was to identify factors delaying initiation of adjuvant chemotherapy after breast surgery. MATERIAL AND METHODS: All patients undergoing surgical treatment for mammary cancer between June 2014 and June 2015 and receiving adjuvant chemotherapy were selected retrospectively. RESULTS: In multivariate analysis, 3 factors significantly delay initiation of adjuvant chemotherapy: a secondary procedure (odds ratio [OR], 6.67; P = .00012), inclusion in a therapeutic trial (OR, 8.46; P = .0013), and a positive HER2 status (OR, 3.02; P = .063 [statistically significant]). DISCUSSION: This study provides a brief overview of the population most likely to experience a delay in the initiation of their adjuvant chemotherapy after cancer surgery. Our findings should assist interventions during initial management.
Asunto(s)
Antineoplásicos/uso terapéutico , Neoplasias de la Mama/tratamiento farmacológico , Quimioterapia Adyuvante/métodos , Tiempo de Tratamiento , Anciano , Neoplasias de la Mama/cirugía , Femenino , Humanos , Persona de Mediana Edad , Estadificación de Neoplasias , Selección de Paciente , Estudios Retrospectivos , Factores de Riesgo , Factores de Tiempo , Resultado del TratamientoRESUMEN
UNLABELLED: A prospective study was lead in order to analyze the accuracy of an X-ray device settled in the operating room for margin assessment, when performing breast-conserving surgery. PATIENTS AND METHODS: One hundred and seventy patients were included. All lesions were visible on the preoperative mammograms. An intraoperative X-ray of the lumpectomy specimen was systematically performed for margins assessment. Final histological data were collected and the accuracy of intraoperative specimen radiography (IOSR) for margin assessment was analyzed. RESULTS: IOSR allowed an evaluation of margins status in 155 cases (91.2%). After final histological examination, the positive margins rate would have been 6.5% if margin assessment had relied only on IOSR. CONCLUSION: Margin assessment with a two-dimensional X-ray device would have allowed the achievement of negative margins in 93.5% of the cases. Moreover, this procedure allows important time-saving and could have a substantial economical impact.
Asunto(s)
Neoplasias de la Mama/diagnóstico por imagen , Neoplasias de la Mama/patología , Mastectomía Segmentaria , Neoplasia Residual/diagnóstico por imagen , Adulto , Anciano , Neoplasias de la Mama/cirugía , Carcinoma Ductal de Mama/diagnóstico por imagen , Carcinoma Ductal de Mama/patología , Carcinoma Ductal de Mama/cirugía , Carcinoma Lobular/diagnóstico por imagen , Carcinoma Lobular/patología , Carcinoma Lobular/cirugía , Femenino , Humanos , Periodo Intraoperatorio , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Estudios Prospectivos , RadiografíaRESUMEN
At the R. Adams Cowley Shock Trauma Center, participation of anesthesiologists in the care of thoracic trauma victims begins with the initial assessment of patients on arrival by helicopter or ambulance. It continues with management of the airway, stabilization of hemodynamics, intraoperative management, patient care in the PACU and critical care setting, and acute pain management. By using a team approach involving anesthesia, surgery, and critical care, the care of trauma victims with thoracic injury continues to be enhanced.