Programa de cirugía mayor ambulatoria para cáncer de mama: experiencia en el Hospital de Mataró / Major ambulatory surgery programme for breast cancer: experience in Hospital de Mataró (Spain)

Objetivos. Estudiar los resultados obtenidos desde el pleno funcionamiento del programa de cirugía mayor ambulatoria para cáncer de mama en nuestro centro. Métodos. Análisis retrospectivo de las pacientes intervenidas de cáncer de mama dentro del programa desde enero del 2012 hasta diciembre del 2014. Se han estudiado el número de pacientes tratadas en el programa, el tipo de procedimientos quirúrgicos realizados, la evolución del índice de sustitución del tratamiento quirúrgico para el cáncer de mama, la tasa y las causas de conversión a ingreso y los motivos de no inclusión en el programa. Resultados. Durante este período 369 pacientes fueron intervenidas de cáncer de mama, de las cuales 161 fueron incluidas en el programa. El índice de sustitución global fue del 44%. Del 2012 al 2014, la tasa de conversión al ingreso fue del 10% (18 pacientes) siendo las 2 primeras causas la linfadenectomía axilar por positividad del ganglio centinela (12 pacientes) y las complicaciones postoperatorias inmediatas médicas o anestésicas (5 pacientes); 31 pacientes no fueron incluidas en el programa: 19 (61%) por comorbilidades médicas, 5 (16%) por motivos sociales y 7 (23%) por decisión del cirujano responsable. Conclusiones. La cirugía ambulatoria para el tratamiento del cáncer de mama se muestra factible y segura. Desde el inicio del programa el índice de sustitución ha aumentado de forma progresiva, presentando una buena tasa de satisfacción por parte de las pacientes tratadas (AU)

Objectives. To study the results obtained after the full implementation of a major ambulatory surgery programme for breast cancer in our centre. Methods. A retrospective review was conducted of all patients undergoing breast cancer surgery within a major ambulatory surgery programme from January 2012 to December 2014. We studied the number of patients treated in the major ambulatory surgery programme, the trend in the substitution rate of breast cancer surgical treatment, the surgical procedures performed, the satisfaction rate, the inpatient rate and its causes, and the reasons for not including patients in the ambulatory programme. Results. During this period, 369 patients underwent breast cancer surgery, of which 161 were included in the major ambulatory surgery programme. The overall substitution rate was 44%. From 2012 to 2014, the inpatient rate was 10% (18 patients), the two main causes being axillary lymph node dissection due to a positive result of sentinel lymph node biopsy (12 patients) and medical and anaesthetic postoperative complications (5 patients). A total of 31 patients were not included in the program: 19 (61%) due to medical comorbidities, 5 (16%) due to social reasons and 7 (23%) due to the decision of the treating surgeon. Conclusions. Outpatient surgery programmes for breast cancer are feasible and safe. Since the start of the programme, the substitution rate in our centre has improved progressively, resulting in a good satisfaction rate among treated patients (AU)

Sentinel Node Biopsy in Special Histologic Types of Invasive Breast Cancer.

OBJECTIVE: To assess the feasibility of sentinel node biopsy (SNB) in ductal and lobular invasive breast cancer, a group of tumors known as special histologic type (SHT) of breast cancer. MATERIALS AND METHODS: Between January 1997 and July 2008, 2253 patients from 6 affiliated hospitals underwent SNB who had early breast cancer and clinically negative axilla. The patients' data were collected in a multicenter database. For lymphatic mapping, all patients received an intralesional dose of radiocolloid Tc-99m (4mCi in 0.4 mL saline), at least two hours before the surgical procedure. SNB was performed by physicians from the same nuclear medicine department in all cases. RESULTS: Of the 2253 patients in the database, the SN identification rate was 94.5% (no radiotracer migration in 123 patients), and positive sentinel node prevalence was 22%. SHT was reported in 144 patients (6.4%) of the whole series. In this subgroup, migration of radiotracer was unsuccessful in 8 patients (identification rate was 94.4%) and SNs were positive in 7.4%. SN positivity prevalence in these tumors was variable across the subtypes. Higher probability of lymphatic spread seemed to be related to tumor invasiveness (20% of positivity in micropapillary, 15% in cribriform subtypes, and 0% in adenoid-cystic). CONCLUSION: Sentinel node biopsy is feasible in special histologic subtypes of breast carcinoma with a good identification rate. Lower migration rates, however, might be associated with special histologic features (colloid subtype). Complete axillary dissection after a positive sentinel node cannot be omitted in patients with SHT breast cancer because they can be associated with further axillary disease; the reported very low incidence of axillary metastases would justify avoiding axillary dissection only in the adenoid-cystic subtype.