Safety and efficacy of selumetinib in pediatric and adult patients with neurofibromatosis type 1 and plexiform neurofibroma.

BACKGROUND: The MEK inhibitor, selumetinib, reduces plexiform neurofibroma (PN) in pediatric patients with neurofibromatosis type 1 (NF1). Its safety and efficacy in adults with PN and effectiveness in other NF1manifestations (e.g., neurocognitive function, growth reduction, and café-au-lait spots) are unknown. METHODS: This open-label, phase 2 trial enrolled 90 pediatric or adult NF1 patients with inoperable, symptomatic, or potentially morbid, measurable PN (≥ 3 cm). Selumetinib was administered at doses of 20 or 25 mg/m2 or 50 mg q 12 hrs for 2 years. Pharmacokinetics, PN volume, growth parameters, neurocognitive function, café-au-lait spots, and quality of life (QoL) were evaluated. RESULTS: Fifty-nine children and 30 adults (median age, 16 years; range, 3-47) received an average of 22±5 (4-26) cycles of selumetinib. Eighty-eight (98.9%) out of 89 per-protocol patients showed volume reduction in the target PN (median, 40.8%; 4.2%-92.2%), and 81 (91%) patients showed partial response (≥ 20% volume reduction). The response lasted until cycle 26. Scores of neurocognitive functions (verbal comprehension, perceptual reasoning, processing speed, and full-scale IQ) significantly improved in both pediatric and adult patients (P <0.05). Prepubertal patients showed increases in height score and growth velocity (P <0.05). Café-au-lait spot intensity decreased significantly (P <0.05). Improvements in QoL and pain scores were observed in both children and adults. All adverse events were CTCAE grade 1 or 2 and were successfully managed without drug discontinuation. CONCLUSION: Selumetinib decrease PN volume in the majority of pediatric and adult NF1 patients while also showing efficacy in non-malignant diverse NF1 manifestations.

The effect of preoperative botulinum toxin a injection on traction force during hernia repair: a prospective, single-blind study, intra-patient comparison using contralateral side as a control.

PURPOSE: Ventral hernias are a common complication of laparotomy, posing challenges particularly when primary fascial closure is unattainable. Although chemical component separation using preoperative botulinum toxin A (BTX) injections has emerged as a promising adjunct, objective evidence of its efficacy remains limited. This study aimed to objectively assess the effect of preoperative BTX on traction force during ventral hernia repair. METHODS: A prospective, single-blind study was conducted on patients with midline incisional hernias following liver transplantation. BTX was administered unilaterally, and the traction force required to medially advance the anterior rectus sheath was measured intraoperatively. Pre- and post-injection CT scans were analyzed for changes in hernia size and LAW muscle measurements. Statistical analyses were performed to evaluate traction force differences between BTX-injected and uninjected sides. RESULTS: Ten patients underwent hernia repair with primary fascial closure achieved in all cases. Comparison of pre- and post-injection CT scans showed no significant changes in hernia size. LAW muscle length increased by 1.8 cm, while thickness decreased by 0.2 cm. Intraoperative traction force measurements revealed a significant reduction on the BTX-injected side compared to the uninjected side (p < 0.0001). The traction force ratio on the BTX-injected to the uninjected side averaged 57%, indicating the efficacy of BTX in reducing tension. CONCLUSION: Preoperative BTX significantly reduces traction force during ventral hernia repair, highlighting its potential as an adjunctive therapy in complex cases. While challenges remain in patient selection and outcome assessment, BTX offers a promising avenue for enhancing abdominal wall reconstruction outcomes and reducing surgical complications.

Factors influencing the decision-making process in breast reconstruction from the perspective of reconstructive surgeons: A qualitative study involving Korean plastic surgeons.

BACKGROUND: Little research has been conducted on factors influencing the decision-making process for immediate breast reconstruction (IBR) options from the perspective of reconstructive surgeons, despite its significant impact on doctor-patient communication and shared decision-making. This study aims to explore the multiple factors and the mechanisms by which they interact using a qualitative methodology. We also address potential barriers to shared decision-making in IBR. METHODS: Semistructured interviews were conducted with a purposive sample of reconstructive surgeons. Thematic analysis was used to identify key influences on IBR decision-making process from the perspective of reconstructive surgeons. RESULTS: Four major themes were identified: 1. Patient clinical scenarios; 2. Nonclinical practice environments; 3. Reconstructive surgeon preferences; and 4. Patient consultation. Reconstructive surgeons demonstrated diverse approaches to patient clinical scenarios. High-volume centers were significantly influenced by nonclinical factors such as scheduling and operating room allocation systems. Reconstructive surgeons often had strong personal preferences for specific IBR options, shaped by their expertise, experience, and clinical environment. Based on the preliminary decision, surgeons provided information with varying degrees of neutrality. Patients varied in their knowledge and participation, resulting in variation in the final decision authority among surgeons. CONCLUSIONS: This study highlights the need to address nonclinical environmental constraints to improve shared decision-making process in IBR. Surgeons should recognize power imbalances in the doctor-patient relationship and be aware of their biases.

Robot-Assisted Capsulectomy with Immediate Reimplantation in Breast Reconstruction.

SUMMARY: Recent reports have introduced robotic breast surgery for immediate breast reconstruction with an implant. However, relevant reports of robot-assisted breast reconstruction including capsulectomy are limited. Although capsulectomy lowers risk of capsular contracture and thus contributes to better aesthetic outcomes, total capsulectomy may have complications, such as injury to axillary structures or chest wall and overlying skin devascularization. To minimize the risk of injury, the authors used a robotic system with Da Vinci SP, which has freely movable arms and clear, magnified three-dimensional vision, for total capsulectomy. Compared with conventional procedures, robotic surgery has the critical advantage of minimal incision and concealed scars, contributing to positive aesthetic outcomes. This study suggests that robot-assisted capsulectomy is technically feasible and safe for patients undergoing breast reconstruction with immediate reimplantation.

A comparison of clinical outcomes of acellular dermal matrix with and without radiation sterilization process in immediate prepectoral direct-to-implant breast reconstruction.

BACKGROUND: Although there are many acellular dermal matrix (ADM) products, the sterilization process varies for each product. We compared the clinical outcomes of immediate prepectoral direct-to-implant (DTI) breast reconstruction with and without sterilization products. METHODS: This was a retrospective study of immediate prepectoral DTI breast reconstructions performed between 2018 and 2020. We classified patients depending on whether the used ADM products had undergone radiation sterilization and compared the patient demographics and surgical outcomes, including seroma, infection, mastectomy flap necrosis, capsular contracture, and implant failure. RESULTS: The study included 357 patients, 182 in the no-sterilization group and 179 in the sterilization group. The ADM size differed significantly between the no-sterilization and sterilization groups (122.7 cm2 vs. 145.4 cm2, respectively, P = 0.01). There were no significant differences in overall rates of complications between the two groups, including seroma (P = 0.28), infection (P = 0.63), mastectomy flap necrosis (P = 0.76), and capsular contracture (P = 0.76). However, implant failure from infection (0% vs. 3.4%, P = 0.01) and drainage amount (690.3 mL vs. 779.36 mL, P = 0.04) with similar removal days were significantly higher in the sterilization group. CONCLUSION: The authors demonstrated similar complication rates for seroma, infection, mastectomy flap necrosis, and capsular contracture. Whereas a bigger size of ADM was needed to cover a similar implant volume, and drain amount was higher in the sterilization group, the salvage rate from infection was higher in the no-sterilization group with a significant difference.

Specialty impact on residents' perceived quality of life, stress, and job satisfaction: a comparative study.

Purpose: Specialty choice in residency training has a significant impact on an individual's career and satisfaction, as well as the supply-demand imbalance in the healthcare system. The current study aimed to investigate the quality of life (QOL), stress, self-confidence, and job satisfaction of residents, and to explore factors associated with such variables, including postgraduate year, sex, and especially specialty, through a cross-sectional survey. Methods: An online survey was administered to residents at 2 affiliated teaching hospitals. The survey had a total of 46 items encompassing overall residency life such as workload, QOL, stress, confidence, relationship, harassment, and satisfaction. Related survey items were then reconstructed into 4 key categories through exploratory factor analysis for comparison according to group classification. Results: The weekly work hours of residents in vital and other specialties were similar, but residents in vital specialties had significantly more on-call days per month. Residents in vital specialties had significantly lower scores for QOL and satisfaction. Specifically, vital-surgical residents had significantly lower QOL scores and higher stress scores than the other specialty groups. Satisfaction scores were also lowest among vital-surgical residents, with a marginal difference from vital-medical, and a significant difference from other-surgical residents. Female residents had significantly lower satisfaction scores than their male counterparts. Conclusion: Residents in vital specialties, particularly vital-surgical specialties, experience significantly worse working conditions across multiple dimensions. It is necessary to improve not only the quantity but also the quality of the system in terms of resource allocation and prioritization.

A comprehensive evaluation of ChatGPT consultation quality for augmentation mammoplasty: A comparative analysis between plastic surgeons and laypersons.

OBJECTIVES: ChatGPT has gained significant popularity as a source of healthcare information among the general population. Evaluating the quality of chatbot responses is crucial, requiring comprehensive and qualitative analysis. This study aims to assess the answers provided by ChatGPT during hypothetical breast augmentation consultations across various categories and depths. The evaluation involves the utilization of validated tools and a comparison of scores between plastic surgeons and laypersons. METHODS: A panel consisting of five plastic surgeons and five laypersons evaluated ChatGPT's responses to 25 questions spanning consultation, procedure, recovery, and sentiment categories. The DISCERN and PEMAT tools were employed to assess the responses, while emotional context was examined through ten specific questions. Additionally, readability was measured using the Flesch Reading Ease score. Qualitative analysis was performed to identify the overall strengths and weaknesses. RESULTS: Plastic surgeons generally scored lower than laypersons across most domains. Scores for each evaluation domain varied by category, with the consultation category demonstrating lower scores in terms of DISCERN reliability, information quality, and DISCERN score. Plastic surgeons assigned significantly lower overall quality ratings to the procedure category compared to other question categories. They also gave lower emotion scores in the procedure category compared to laypersons. The depth of the questions did not impact the scoring. CONCLUSIONS: Existing health information evaluation tools may not be entirely suitable for comprehensively evaluating the quality of individual responses generated by ChatGPT. Consequently, the development and implementation of appropriate evaluation tools to assess the appropriateness and quality of AI consultations are necessary.

Robot-assisted kidney transplantation in a morbidly obese patient with incisional hernia reconstruction and abdominoplasty: a case report.

Performing kidney transplantations in patients with morbid obesity presents unique challenges using the conventional retroperitoneal approach. Robot-assisted kidney transplantation (RAKT) offers several advantages, such as better access to hard-to-reach areas. A 56-year-old morbidly obese woman presented with end-stage renal disease due to diabetic nephropathy. The patient had a history of obesity for over 20 years, with a peak body mass index (BMI) of 46.9 kg/m2. Before transplantation, she successfully reduced her BMI to 28.9 kg/m2, but was left with excessive skin folds. The surgery began with the removal of the sac from the incisional hernia and umbilical hernia, which was then used as the site for the GelPOINT port. The da Vinci X robot system was utilized to perform RAKT. After completing RAKT, the plastic surgery team initiated abdominal reconstruction involving panniculectomy, followed by hernial reconstruction and abdominoplasty. The patient's postoperative course was uneventful, and she was discharged on postoperative day 7. Her creatinine level was 0.69 mg/dL, and she did not experience any episodes of rejection during the 16 months following RAKT. This case report describes the successful combination of RAKT with incisional hernia reconstruction and abdominoplasty in a patient with morbid obesity.

Analysis on the Difference between the Practical Brassiere Size and Real Breast Volume.

Background: Brassiere cup size is defined as the difference in chest circumference between the inframammary fold and the fullest part of the breast. However, a large number of women are not aware of the correct definition and are prone to wearing incorrectly-sized brassieres. In this report, the authors compared the cup size of worn brassieres and the actual measurement. Methods: This study was a retrospective review of patients who had undergone breast reconstruction operation between May 2020 and June 2021. All patients who visited the plastic surgery clinic for breast reconstruction were inquired about their cup size, and their breast circumferences were measured. The patient demographic information, ptosis grade, mastectomy specimen weight, measured breast circumference, and known cup size were analyzed. Results: Overall, 163 women were included. Notably, 92 of 163 patients (56.4%) were wearing a correctly-sized brassiere. Patients were more likely to wear a correctly-sized brassiere as the cup size became smaller. Moreover, patients with A-cup breasts tended to wear larger brassieres, whereas patients with B and C-cup breasts tended to wear smaller brassieres than their actual breast cup size. Conclusions: Approximately one in two women do not know their correct brassiere cup size. Women tend to wear a brassiere of the wrong size as their cup size becomes larger. Therefore, it is important for surgeons to be aware of their patient's brassiere wearing habit and their perception when a surgery, such as augmentation or reconstruction, is planned.

Safety of Augmenting Breast Volume in Direct-to-Implant Breast Reconstruction With Contralateral Breast Augmentation: Comparison With 2-Stage Reconstruction.

BACKGROUND: Direct-to-implant breast reconstruction is a standard method of implant-based reconstruction; however, the risk of skin necrosis and implant failure exists. During simultaneous contralateral augmentation, an implant larger than the resected tissue must be inserted to balance both sides, which may increase the risk of complications. This study examined the differences in the incidence of complications between the single-stage direct-to-implant reconstruction and 2-stage reconstruction when contralateral augmentation was performed simultaneously. METHODS: This study included 99 patients who underwent implant-based breast reconstruction with contralateral augmentation between 2012 and 2020. A retrospective chart review was conducted and the patients were divided into 2 groups: the single-stage reconstruction (n = 61) and 2-stage reconstruction (TSR, n = 38) groups. Demographic data and surgical and oncological information were collected. Complications including skin necrosis and reconstruction failure were investigated as the primary outcome. RESULTS: Implant volume and contralateral implant volume were significantly greater in TSR group than in the single-stage reconstruction group. There were no significant differences in the incidence of complications and reconstruction failure rates between both groups. The nipple-sparing mastectomy was the risk factor for complications. Furthermore, the risk factors for mastectomy skin necrosis were implant volume and differences in the volume of both implants. CONCLUSIONS: Single-stage reconstruction did not increase the risk of complications compared with TSR when implants that were larger than the resected tissue were inserted after mastectomy. Proper patient selection and selection of implants that are not excessively large could satisfy patients' cosmetic needs in a single operation.

The effect of intraoperative immersion solutions on acellular dermal matrix: Biofilm formation and mechanical property.

BACKGROUND: Acellular dermal matrix (ADM) is generally used on implant-based breast operations; However, it can increase surgical site infection. Many immersion solutions are applied to ADM, however, the most effective solution is unknown. The purpose of this study is to determine the effect of different solutions on the biofilm formation and mechanical properties of ADM. METHODS: Aseptic porcine-derived ADMs were immersed in 5 different solutions for 30 min; sterile normal saline, 10% povidone-iodine, 0.5% chlorhexidine, antibiotics (cefazolin, gentamicin, and vancomycin), and taurolidine. They are transferred to 10 ml suspension of methicillin-sensitive/resistant Staphylococcus aureus (MSSA/MRSA) or Staphylococcus epidermidis and an overnight culture was performed. After rinsing and sonication to obtain the biofilm on ADM, colony forming unit (CFU) was measured. In addition, the maximum load before ADM deformation and the elongation length of ADM at the start of the maximum load was determined. RESULTS: Regardless of strains, povidone-iodine, chlorhexidine, and taurolidine group had lower CFUs than the saline group with statistical significance. Meanwhile, the antibiotics group did not show statistical difference from the saline group. Moreover, only taurolidine group showed higher tensile strength (MRSA, p = 0.0003; S. epidermidis, p = 0.0023) and elongation length (MSSA, p = 0.0015) than the saline group. The antibiotics and chlorhexidine group yielded lower tensile strength and elongation length than the povidone-iodine and taurolidine groups. CONCLUSIONS: It was suggested that the 10% povidone-iodine or taurolidine solution is effective. In contrast, the antibiotics solution could be considered as an effective intraoperative solution.

Pseudoangiomatous Stromal Hyperplasia of the Breast in a Female Adolescent Presenting as Bilateral Gigantomastia.

Pseudoangiomatous stromal hyperplasia (PASH) is a rare idiopathic proliferative mesenchymal breast disease related to hormonal imbalance, and thus extremely rare in children and adolescents. In addition, PASH manifests as a bilateral gigantomastia in some cases with no established cause or treatment. Here, we report a case of a rapidly developed PASH presenting with bilateral gigantomastia in a 14-year-old premenarchial female patient. Considering the patient's age and emotions and the need for nipple-areolar complex repositioning, we performed reduction mammoplasty rather than total mastectomy despite the possibility of recurrence. Although some masses could not be completely removed, no complications, such as infection, wound dehiscence, or hematoma occurred postoperatively. The patient was stable during the 18-month follow-up period, although an evidence of recurrent and residual disease was noted upon ultrasonography.

A Comparative Study of Wraparound versus Anterior Coverage Placement of Acellular Dermal Matrix in Prepectoral Breast Reconstruction.

BACKGROUND: Prepectoral direct-to-implant insertion (DTI) with acellular dermal matrix (ADM) is the currently preferred operation for breast reconstruction. There are different placements of ADM, which are largely classified as wraparound placement or anterior coverage placement. Because there are limited data comparing these two placements, this study aimed to compare the outcomes of these two methods. METHODS: This was a retrospective study of immediate prepectoral DTI breast reconstructions performed by a single surgeon between 2018 and 2020. Patients were classified depending on the ADM placement type used. Surgical outcomes and breast shape changes using nipple position during follow-up were compared. RESULTS: A total of 159 patients were included in the study, with 87 in the wraparound group and 72 in the anterior coverage group. Demographics were similar between the two groups, excluding ADM amount used (154.1 cm 2 versus 137.8 cm 2 ; P = 0.01). There were no significant differences in the overall rate of complications between the two groups, including seroma (6.90% versus 5.56%; P = 1.0), total drainage amount (762.1 mL versus 805.9 mL; P = 0.45), and capsular contracture (4.6% versus 1.39%; P = 0.38). The wraparound group had a significantly longer distance change than that of the anterior coverage group in the sternal notch-to-nipple distance (4.44% versus 2.08%; P = 0.03) and midclavicle-to-nipple distance (4.94% versus 2.64%; P = 0.04). CONCLUSIONS: Wraparound and anterior coverage placement of ADM in prepectoral DTI breast reconstruction showed similar complication rates, including seroma, drainage amount, and capsular contracture. However, wraparound placement can make the breast more ptotic in shape compared with anterior coverage placement. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

Development of Three-Dimensional Breast Scan and Measurement Application Using Laser Imaging Detection and Ranging Sensor on iPhone.

SUMMARY: Laser imaging detection and ranging (LiDAR) is a modern three-dimensional (3D) technology that uses a time-of-flight method based on the round-trip time of an infrared laser beam to detect the presence and features of objects. The iPhone 12 Pro is the first smart mobile device with built-in LiDAR sensors. The authors' team developed a software application based on iOS devices with built-in LiDAR sensors for 3D breast scanning and automatically analyzing the breast's geometric measurement. Breast geometry, including midclavicle-to-nipple distance, sternal notch-to-nipple distance, nipple-to-inframammary fold (IMF) distance, distance between nipples, and body circumference on nipple and IMF level were measured using the software application and tapeline. The relative technical error of measurement (rTEM) value was used to calculate the error ratios between the measurements acquired by the software application and those of the tapeline. Good rTEM values ranging from 2.99% to 5.19% were found in the midclavicle-to-nipple distance, sternal notch-to-nipple distance, distance between nipples, nipple-level circumference, and IMF-level circumference. However, there was a poor rTEM value greater than 10% in the nipple-to-IMF distance. The proposed software application using current iOS devices with built-in LiDAR sensors can provide an ideal 3D scanning system that has a low cost burden, good accuracy, portability, and ease of use.

Analysis of Perfusion in the DIEP Flap: Role of the Location of the Perforator, Umbilicus, and Midline Crossing-Over Vessel.

BACKGROUND: During breast reconstruction, predicting contralateral perfusion of the deep inferior epigastric artery perforator flap can help minimize tissue necrosis. This study aimed to quantify the area of contralateral perfusion and identify the factors affecting it. METHODS: A retrospective study was conducted on unilateral breast reconstructions with a single perforator-based deep inferior epigastric artery perforator flap, for the period of 2017 to 2019. Data on the distance between the perforator and the umbilicus, and the grade of the midline crossing-over vessel (G0, no vessel; G1, suspicious vessel; G2, definite vessel), were collected. Contralateral perfusion was estimated using intraoperative indocyanine green angiography, and the degree of contralateral circulation based on perforator location was assessed using a response surface methodology analysis. RESULTS: The study included 143 patients (G0, 62; G1, 45; and G2, 36). The average length of transverse contralateral flap perfusion (contralateral circulation area/vertical height of the flap) increased as the crossing-over vessel grade increased (G0, 62.96 ± 20.33 mm; G1, 71.69 ± 20.66 mm; and G2, 81.1 ± 19.32 mm; P = 0.0002). In the response surface methodology analysis, contralateral perfusion was the least when the perforator was located near the umbilicus (G0, within a 10-mm radius; G1, <10-mm transverse distance and 16- to 22-mm vertical distance; and G2, within a 20-mm radius). CONCLUSIONS: The umbilicus can interfere with contralateral perfusion; thus, a definite presence of a midline crossing-over vessel ensures robust contralateral perfusion. The results of this study can help surgeons select the optimal single perforator before surgery. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.

Loss to follow-up after direct-to-implant breast reconstruction.

Loss to follow-up is inevitable in retrospective cohort studies, and patients are lost to follow-up after direct-to-implant reconstruction despite annual follow-up recommendation. We analyzed more than 500 patients to analyze the rate of loss to follow-up to plastic surgery and to investigate the factors affecting it. A retrospective review of patients who underwent direct-to-implant reconstruction between July 2008 and August 2016 was performed. Loss to follow-up to plastic surgery was defined as a difference of ≥24 months between the total and plastic surgery follow-up. The rate of loss to follow-up and associated factors including patients' demographics, surgery-related variables, oncological data, and early and late complications were analyzed. Of 631 patients who underwent direct-to-implant reconstruction, 551 patients continued visiting the hospital for breast cancer-related treatment. Of the 527 patients who were eligible for the study, 157 patients (29.8%) were lost to plastic surgery follow-up. Surgery-related variables, early complications, cancer stage, and adjuvant therapies were not significantly different. Younger age was significantly associated with loss to follow-up in univariate analysis. However, logistic regression revealed that a long total follow-up period, distant metastasis, and absence of late elective complications were significant factors contributing to follow-up loss. Late elective complications such as malposition, capsular contracture, and mastectomy flap thinning were more common in the follow-up group (48%) than in the loss to follow-up group (22%). Follow-up loss after direct-to-implant reconstruction was not associated with specific demographic or surgery-related variables, and postoperative courses significantly affected the loss to follow-up.

Outcomes of smooth round implant-based immediate breast reconstruction: Long-term follow-up results.

The issue of breast implant-associated anaplastic large cell lymphoma in 2019 has resulted in the discontinuation of textured breast implants and resumption in the use of smooth round implants. However, in the field of breast reconstruction, long-term follow-up data for direct-to-implant reconstruction using smooth round implants is insufficient. This retrospective study aimed to evaluate the long-term outcomes of breast reconstruction using smooth round implants. This study included 185 patients (208 breasts) who underwent smooth round implant-based immediate breast reconstruction between 2007 and 2018. Their demographic information and surgical and oncological data were collected. Early (within 90 days) and late (after 90 days) complications, reoperations, implant maintenance, and the survival rate were analyzed to evaluate the long-term outcomes and identify the related factors. The mean follow-up period was 112.08 months. The most common early complications were skin necrosis (9.13%) and infection (3.85%). The factors influencing the development of early complications were the mastectomy specimen weight (237.14 ± 114.84 cc and 298.04 ± 141.53 cc for no complication and any complication, respectively; p = 0.0123) and implant volume (222.79 ± 77.76 cc and 264.48 ± 89.03 cc for no complication and any complication, respectively; p = 0.0082). The most common late complication was capsular contracture (13.46%). Approximately 91.35% of the implants were maintained during the follow-up period. The factors affecting the development of early complications and implant maintenance were the mastectomy specimen weight and implant volume. This study provides information on long-term follow-up results useful in cases where only smooth round implants are available, which can then serve as a basis for future related studies.

Surgical outcomes of oro-intestinal continuity reconstruction after total esophagectomy in patients with cervicothoracic malignancy: a thoracic surgeon's perspective.

Background: Oro-intestinal continuity reconstruction following total esophagectomy in patients with head-neck or esophageal cancer is rare and results in high operative morbidity and mortality. This case series aimed to investigate the perioperative surgical outcomes of oro-intestinal continuity reconstruction after total esophagectomy in selected patients with advanced head/neck or esophageal cancer. Methods: From 2011 to 2018, 14 patients who underwent oro-intestinal reconstruction after total esophagectomy were assessed. We analyzed perioperative mortality, postoperative complications, oncologic outcomes, and recovery of dietary function. Results: The median age of the patients was 61 (range, 42-72) years old and median follow-up time was 18.6 (range, 0-52.9) months. For conduit selection, 11 cases of oro-gastrostomy (78.6%), 2 of oro-colo-gastrostomy (14.3%), and 1 of oro-jejuno-gastrostomy (7.1%) were performed. Complete resection was pathologically confirmed in 10 patients (71.4%). Anastomosis site leakage was observed in three patients (21.4%) and conduit necrosis in two (14.3%). Postoperative mortality within 30 days, 90 days, and 1 year was 7.1%, 28.6%, and 42.8%, respectively. Conclusions: Oro-intestinal continuity reconstruction following total esophagectomy showed acceptable morbidity and mortality in selected patients with advanced head/neck cancer or esophageal cancer. Careful selection of surgical candidates and multidisciplinary collaboration of experienced surgical teams are essential to minimize the surgical risk.

Is There a Difference in the Diagnosis and Prognosis of Local Recurrence between Autologous Tissue and Implant-Based Breast Reconstruction?

Introduction: Breast reconstruction has become common after total mastectomy; however, certain types of breast reconstruction may be associated with delayed local recurrence or poor survival. Here, we investigated whether there are differences in the diagnosis and prognosis of local recurrence between autologous reconstruction and implant reconstruction. Materials and Methods: A retrospective analysis was performed on patients undergoing breast cancer surgery with autologous tissue or immediate implant reconstruction in a single center (January 2003-December 2017). Patient data including the period from cancer surgery to local recurrence diagnosis, tumor size at the time of recurrence, and survival time after cancer surgery and recurrence detection were analyzed. Results: There was a significant difference (p = 0.021) in the time from surgery to recurrence between the autologous tissue (1,246 days) and implant (909 days) groups. Recurrence tumor size did not differ (autologous: 1.00 cm2 vs. implant: 0.90 cm2; p = 0.813). Survival time after surgery (p = 0.63) and recurrence detection (p = 0.74) did not statistically significant. Conclusions: Statistical difference in the detection time was observed between autologous tissue and implant group. On the other hand, there is no difference in recurrence tumor size or survival time. A further study is necessary to identify the different detection time of local recurrence.

Outcome Analysis Depending on the Different Types of Incision following Immediate Breast Reconstruction.

Background: Immediate breast reconstruction following nipple-sparing mastectomy (NSM) is widely used for its cosmetic benefits. Due to the lack of guidelines, the types of incisions in NSM vary and which method is superior remains a debate. In this study, we hypothesized that the periareolar incision has a higher risk of complications, such as nipple-areolar complex (NAC) necrosis, than other incisions. Methods: A retrospective chart review was conducted and divided into three groups: the periareolar, radial, and lateral incision groups. The reconstruction method and complications of NAC necrosis, wound dehiscence, seroma, hematoma, infection, and reconstruction failure were investigated. Results: A total of 103 patients (periareolar incision (33%, n = 34), radial incision (39.8%, n = 41), and lateral incision (27.2%, n = 28)) who underwent NSM and immediate breast reconstruction from 2018 to 2020 were included. The reconstruction methods were direct-to-implant, DIEP flap, LD flap, and PAP flap, and there was all of which had no statistically significant difference between the groups regarding the reconstruction method (p=0.257). In terms of complications, there was no significant difference in NAC necrosis (29.4%, 19.5%, and 21.4%, in the periareolar, radial, and lateral groups, respectively; p=0.578), wound dehiscence, seroma or hematoma, infection, and reconstruction failure. Conclusion: Breast reconstruction following NSM through periareolar incision does not increase the incidence of complications, including NAC necrosis. However, since only Asian patients with low BMI were included, if an appropriate patient group is selected for immediate reconstruction after NSM, reconstruction can be safely performed through the periareolar incision, and good cosmetic results can be obtained.