Economic impact of outpatient follow-up using telemedicine vs in-person visits for patients in general surgery: A secondary analysis of a randomized clinical trial.

INTRODUCTION: Innovation in internet connectivity and the Covid 19 pandemic have caused a dramatic change in the management of patients in the medical field, boosting the use of telemedicine. A comparison of clinical outcomes and satisfaction between conventional face-to-face and telemedicine follow-up in general surgery, an economic evaluation is mandatory. The aim of the present study was to compare the differences in economic costs between these two outpatient approaches in a designed randomized controlled trial (RCT). METHODS: A RCT was conducted enrolling 200 patients to compare conventional in-person vs. digital health follow-up using telemedicine in the outpatient clinics in patients of General Surgery Department after their planned discharge. After a demonstration that no differences were found in clinical outcomes and patient satisfaction, we analyzed the medical costs, including staff wages, initial investment, patent's transportation and impact on social costs. RESULTS: After an initial investment of 7527.53€, the costs for the Medical institution of in-person conventional follow-up were higher (8180.4€) than those using telemedicine (4630.06€). In relation to social costs, loss of productivity was also increased in the conventional follow-up. CONCLUSION: The use of digital Health telemedicine is a cost-effective approach compared to conventional face-to-face follow-up in patients of General Surgery after hospital discharge.

Influence of surgical technique on complications, readmissions and clinical progress of breast cancer in women participating in screening programs / Influencia de la técnica quirúrgica en las complicaciones, reingresos y evolución clínica del cáncer de mama en mujeres participantes en programas de cribado poblacional

Introduction: Complications and readmissions derived from surgical treatment of breast cancer have been less evaluated than recurrence and mortality. The aim of this study was to analyze the results of surgical treatment and prognosis in a screening population with known high surgical variability.Methods: This multicenter study included 1086 women diagnosed with breast cancer from the CaMISS cohort study of women aged between 50 and 69years participating in four breast cancer screening programs in Spain between 2000 and 2009 with a follow-up until 2014. Multivariate models were used to estimate the adjusted odds ratio of breast surgery (mastectomy vs conservative treatment) for complications and readmissions and hazard ratios for recurrences and mortality.Results: Primary breast surgical treatment consisted of conservative treatment in 821 women (80.1%) and mastectomy in 204 (19.9%). Mastectomy was associated with readmissions, recurrences and mortality but this association was not statistically significant on multivariate adjusted analysis (ORa=1.51 [95%CI 0.89–2.57], HRa=1.37 [95%CI 0.85–2.19] and HRa=1.52 [95%CI 0.95–2.43] respectively). In our sample, the variables with greatest impact on complications, recurrences and mortality were stages III and IV (ORa=4.4[95%CI 1.22–16.16], HRa=7.96 [95%CI 3.32–19.06] and HRa=3.92[95%CI 1.77–8.67]).Conclusion: Complications, readmissions, recurrence and mortality were similar in both surgical techniques. These results support that surgical treatment for breast cancer can be adapted to professional and health system circumstances, and to the surgical needs and desires of each patient. At a time when screening programs are being questioned the variable with the greatest impact on mortality was stage III and IV. (AU)

Introducción: Las complicaciones y los reingresos derivados del tratamiento quirúrgico del cáncer de mama han sido menos evaluados que la recidiva y la mortalidad. El objetivo de este estudio ha sido analizar los resultados y el pronóstico del cáncer de mama en función del tipo de cirugía recibida en una población con elevada variabilidad quirúrgica.Métodos: En este estudio multicéntrico se incluyeron 1086 mujeres diagnosticadas de cáncer de mama de la cohorte CaMISS, con mujeres de entre 50 y 69 años participantes en 4 programas de cribado Españoles entre 2000 y 2009, con seguimiento hasta 2014. Se utilizó la regresión logística multivariada para estimar la odds ratio de complicaciones y reingresos. También modelos Cox para estimar hazard ratios de recidivas y mortalidad.Resultados: Se realizó cirugía conservadora en 821 mujeres (80,1%) y mastectomía en 204 (19,9%). La mastectomía se asoció con reingresos, recidivas y mortalidad, pero esta asociación no fue estadísticamente significativa en el análisis multivariado ajustado (ORa=1,51[IC95% 0,89-2,57], HRa=1,37[IC95% 0,85-2,19] y HRa=1,52[IC95% 0,95-2,43] respectivamente). La variable con mayor impacto sobre complicaciones, recidivas y mortalidad fue el estadio III/IV (ORa=4,4[IC 95%: 1,22-16,16], HRa=7,96[IC 95%: 3,32-19,06] y HRa=3,92[IC 95%: 1,77-8,67]).Conclusión: Las complicaciones, reingresos, recidiva y mortalidad fueron estadísticamente equivalentes en ambas técnicas quirúrgicas. El tratamiento quirúrgico del cáncer de mama puede adaptarse a las circunstancias profesionales, del sistema sanitario además de necesidades y deseos quirúrgicos de cada paciente. En un momento en que se cuestionan los programas de cribado, la variable con mayor impacto en mortalidad fue el estadio.

Valoración geriátrica integral: influencia en los resultados clínicos de la cirugía colorrectal en pacientes de edad muy avanzada / Comprehensive geriatric assessment: Influence on clinical results after colorectal surgery in advanced age patients

Introducción: El objetivo de este trabajo fue analizar los resultados clínicos postoperatorios de los pacientes tratados quirúrgicamente por cáncer colorrectal en relación con los resultados de la valoración geriátrica integral preoperatoria. Métodos: Estudio observacional en el que se analizó la morbimortalidad postoperatoria a los 30 y 90 días en una cohorte de pacientes intervenidos por cáncer colorrectal según grupos de edad: grupo 1) edad entre 75 y 79 años; grupo 2) entre los 80 y los 84 años, y grupo 3) ≥85 años. Además de la evaluación del riesgo anestésico, se evaluó a los pacientes con los índices de Karnofsky, Barthel y Pfeiffer. Se analizó la mortalidad a los 30 y 90 días de la cirugía en relación con los resultados de la evaluación integral. Resultados: Se incluyeron 227 pacientes afectados de cáncer colorrectal en el periodo de estudio: 91 del grupo 1, 89 del grupo 2 y 47 del grupo 3. Hubo diferencias estadísticamente significativas en la mortalidad a los 30 días (p=0,029), pero no a los 90 días de la cirugía, según los grupos de edad. La mortalidad a los 90 días fue significativamente superior en los pacientes con peores puntuaciones en las escalas de Karnofsky y Barthel. Conclusiones: La valoración geriátrica integral mediante distintas escalas es una buena herramienta para evaluar la mortalidad postoperatoria en el postoperatorio a medio plazo.(AU)

Introduction: The objective of this work was to analyse the postoperative clinical results of patients surgically treated for colorectal cancer in relation to the results of the preoperative comprehensive geriatric evaluation. Methods: Observational study in which postoperative morbidity and mortality at 30 and 90 days were analysed in a cohort of patients surgically treated for colorectal cancer according to age groups: group 1) between 75 and 79 years old; group 2) between 80 and 84 years old, and group 3) ≥85 years old. In addition to the anaesthetic risk assessment, patients were assessed with the Karnofsky, Barthel and Pfeiffer indexes. Mortality at 30 and 90 days after surgery was analysed in relation to the results of the comprehensive evaluation. Results: A total of 227 patients with colorectal cancer were included in the study period: 91 in group 1, 89 in group 2 and 47 in group 3. There were statistically significant differences in mortality at 30 days (p=0,029) but not at 90 days after surgery, according to age groups. Mortality at 90 days was significantly higher in patients with worse scores on the Karnofsky and Barthel scales. Conclusions: Comprehensive geriatric assessment using different scales is a good tool to assess postoperative mortality in the mid-term postoperative period.(AU)

Unravelling the Encapsulation of DNA and Other Biomolecules in HAp Microcalcifications of Human Breast Cancer Tissues by Raman Imaging.

Microcalcifications are detected through mammography screening and, depending on their morphology and distribution (BI-RADS classification), they can be considered one of the first indicators of suspicious cancer lesions. However, the formation of hydroxyapatite (HAp) calcifications and their relationship with malignancy remains unknown. In this work, we report the most detailed three-dimensional biochemical analysis of breast cancer microcalcifications to date, combining 3D Raman spectroscopy imaging and advanced multivariate analysis in order to investigate in depth the molecular composition of HAp calcifications found in 26 breast cancer tissue biopsies. We demonstrate that DNA has been naturally adsorbed and encapsulated inside HAp microcalcifications. Furthermore, we also show the encapsulation of other relevant biomolecules in HAp calcifications, such as lipids, proteins, cytochrome C and polysaccharides. The demonstration of natural DNA biomineralization, particularly in the tumor microenvironment, represents an unprecedented advance in the field, as it can pave the way to understanding the role of HAp in malignant tissues.

Preoperative Assessment of Geriatric Surgical Patients: Update on Clinical Scales Used for Elective General and Digestive Surgery.

BACKGROUND: Higher life expectancy in the general population entails a growing interest in the surgical management of diseases affecting elderly patients. Preoperative assessment when planning surgery needs to carefully evaluate physical and functional status of the patient. This review aims to describe the most commonly used scales in the evaluation of elderly patients scheduled for surgery and provides a useful tool to decide the scales that would be better to assess these specific patients. METHODS: According to the PRISMA statement of publications published, we have carried out a systematic review focused on elderly patients who underwent surgical procedures in General and Surgery. Using Medline, Embase, and Cochrane library, a systematic search of the literature from 1992 to 2018 was performed. This enabled us to retrieve information from the selected articles on scales to evaluate medical fitness, functional status, or both, in the elderly or frail patients. RESULTS: We reviewed 102 articles and selected the most frequently used assessment scales or indexes. After this extensive analysis, we selected 4 functional scales (Katz Index, Barthel Scale, Karnofsky Performance Score, and Vulnerable Elders Survey), 4 clinical scales (American Society of Anaesthesiologists Index, Charlson Comorbidity Index, Pfeiffer Test, and Physiological and Operative Severity Score for the enumeration of Mortality and Morbidity Scale) and finally, 2 mixed scales (American College of Surgeons National Surgical Quality Improvement Program Surgical Risk Calculator and Edmonton Frail Scale). CONCLUSIONS: No consensus on the use of a unified assessment scale for elderly patients exists. However, with this review, we provide a brief guideline about the most useful and used scales to perform a comprehensive assessment of geriatric patients undergoing surgery.

Comprehensive geriatric assessment: Influence on clinical results after colorectal surgery in advanced age patients. / Valoración geriátrica integral: influencia en los resultados clínicos de la cirugía colorrectal en pacientes de edad muy avanzada.

INTRODUCTION: The objective of this work was to analyse the postoperative clinical results of patients surgically treated for colorectal cancer in relation to the results of the preoperative comprehensive geriatric evaluation. METHODS: Observational study in which postoperative morbidity and mortality at 30 and 90 days were analysed in a cohort of patients surgically treated for colorectal cancer according to age groups: group 1) between 75 and 79 years old; group 2) between 80 and 84 years old, and group 3) ≥85 years old. In addition to the anaesthetic risk assessment, patients were assessed with the Karnofsky, Barthel and Pfeiffer indexes. Mortality at 30 and 90 days after surgery was analysed in relation to the results of the comprehensive evaluation. RESULTS: A total of 227 patients with colorectal cancer were included in the study period: 91 in group 1, 89 in group 2 and 47 in group 3. There were statistically significant differences in mortality at 30 days (p=0,029) but not at 90 days after surgery, according to age groups. Mortality at 90 days was significantly higher in patients with worse scores on the Karnofsky and Barthel scales. CONCLUSIONS: Comprehensive geriatric assessment using different scales is a good tool to assess postoperative mortality in the mid-term postoperative period.

Telemedicine to follow patients in a general surgery department. A randomized controlled trial.

BACKGROUND: Telemedicine is becoming more popular in many medical specialties but few studies have been conducted in General Surgery. This study aims to evaluate the feasibility of its introduction in this specialty. METHODS: A prospective randomized clinical trial (RCT) was conducted in 200 patients to compare conventional vs telemedicine follow-up in the outpatient clinics. The primary outcome was the feasibility of telemedicine follow-up and the secondary outcomes were its clinical impact and patient satisfaction. RESULTS: Patients were enrolled between March 2017 and April 2018 and there were no statistically significant differences between the groups' characteristics. The primary outcome was achieved in 90% of the conventional follow-up group and in 74% of the telemedicine group (P = 0.003). No differences were found in clinical outcomes (P = 0.832) or patient satisfaction (P = 0.099). CONCLUSION: Telemedicine is a good complementary service to facilitate follow-up management in selected patients from a General Surgery department.

Survival and quality of life after surgery for colorectal cancer in the elderly: a comparative study

Background: the aim of this study was to analyze the clinical results of the multidisciplinary management of elderly patients with colorectal cancer in a single center and to describe postoperative quality of life. Methods: a comparative study was designed to compare the results and quality of life of patients treated in our center for colon cancer, aged from 80 to 84 years (study group) compared to a control group (aged form 75 to 79 years of age). Morbidity, mortality, oncological results and quality of life were analyzed. Results: eighty-seven patients aged between 80 and 84 years of age (study group) were compared to a control group, which was formed by 91 patients aged from 75 to 79 years of age. There were no significant differences in technique and morbidity. Survival at 30 days, 90 days and at the end of follow-up (median 48 months) were similar in both groups. There were no differences in quality of life except for one item with regard to physical function (p = 0.0138). Conclusion: similar clinical results and quality of life were achieved after treating elderly patients with colon cancer with a multidisciplinary management approach

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Survival and quality of life after surgery for colorectal cancer in the elderly: a comparative study.

BACKGROUND: the aim of this study was to analyze the clinical results of the multidisciplinary management of elderly patients with colorectal cancer in a single center and to describe postoperative quality of life. METHODS: a comparative study was designed to compare the results and quality of life of patients treated in our center for colon cancer, aged from 80 to 84 years (study group) compared to a control group (aged form 75 to 79 years of age). Morbidity, mortality, oncological results and quality of life were analyzed. RESULTS: eighty-seven patients aged between 80 and 84 years of age (study group) were compared to a control group, which was formed by 91 patients aged from 75 to 79 years of age. There were no significant differences in technique and morbidity. Survival at 30 days, 90 days and at the end of follow-up (median 48 months) were similar in both groups. There were no differences in quality of life except for one item with regard to physical function (p = 0.0138). CONCLUSION: similar clinical results and quality of life were achieved after treating elderly patients with colon cancer with a multidisciplinary management approach.

Resultados del tratamiento quirúrgico de la fístula anal en pacientes con enfermedad de Crohn mediante técnica de colgajo de avance endorrectal: revisión sistemática de la literatura / Advancement Flap Technique for Anal Fistula in Patients With Crohn's Disease: A Systematic Review of the Literature

Introducción: La técnica de colgajo de avance endorrectal es una de las alternativas en el tratamiento de la fístula anal en pacientes con enfermedad de Crohn. Métodos: Diseñamos una revisión sistemática de la literatura, seleccionando estudios que incluyeron a pacientes afectos de enfermedad de Crohn y fístula anal tratados mediante esta técnica. De esos estudios solo se seleccionaron los pacientes seguidos durante al menos 6 meses. Resultados: Se seleccionaron 11 estudios con un total de 135 pacientes. Los resultados, con seguimientos de 8,4 a 82 meses, indicaron una curación del 66% y una tasa de recurrencia de alrededor del 30%. Sin embargo, se observó importante heterogeneidad en los resultados de las series revisadas. Conclusiones: El colgajo de avance endorrectal es una alternativa adecuada en los pacientes con fístula anal y enfermedad de Crohn. Sin embargo, es necesario desarrollar nuevos estudios que aporten un mayor nivel de evidencia científica (AU)

Introduction: Treatment for anal fistulas in patients with Crohn's disease is still challenging, even for the expert surgeon. The advancement flap technique is characterized by the preservation of the anal sphincter complex. Methods: A systematic review of the literature, selecting series of patients affected by Crohn's disease and anal fistulas and treated using advancement flap technique was performed. Patients followed during at least 6 months have been included. Results: From 128 initial studies, 11 studies were selected, including overall 135 patients. Those studies show low- level evidence. Results in a series with follow-up from 8,4 to 82 months, stated a clinical success of 66% and recurrence rate around 30%. However there was an evident heterogeneity of results. Conclusion: The review concludes that the advancement flap technique to treat anal fistulas in patients with Crohn's disease is an adequate alternative. New studies are necessary to provide higher-level evidence (AU)

Ganglio secundario como indicador de linfadenectomía axilar en pacientes afectas de cáncer de mama / Secondary node analysis as an indicator for axillary lymphadenectomy in breast cancer patients

Introducción: En la actualidad no existe consenso en cuanto a la necesidad de realizar linfadenectomía axilar (LA) en los casos en que se detectan macrometástasis en el ganglio centinela (GC). En este estudio se presenta la utilidad del ganglio secundario (GS), una nueva técnica diagnóstica, como factor predictor de afectación axilar. Métodos: Se diseñó un estudio observacional, retrospectivo y multicéntrico con el objetivo de validar la técnica del GS, entendido como tal el siguiente ganglio a nivel anatómico y de difusión linfogammagráfica tras el GC, como predictor de la afectación axilar. Sobre un total de 2.273 pacientes afectas de cáncer de mama se obtuvo una muestra válida de 283 pacientes a las que se había analizado el estado del GS de forma adicional. Las variables principales del estudio fueron el estado histológico del GC, del GS y del vaciamiento axilar y se valoró la sensibilidad, especificidad y exactitud de la prueba. Resultados: La prueba del GS, con GC positivo, presenta una sensibilidad del 61,1%, una especificidad del 78,7%, un valor predictivo positivo del 45,8% y un valor predictivo negativo del 87,3%, con una exactitud del 74,7%. Conclusión: El estudio del GS junto con la técnica del GC permite realizar una estadificación más precisa del estado axilar, en pacientes con cáncer de mama, en comparación con el estudio único del GC (AU)

Introduction: Currently, there is no agreement regarding if it would be necessary to perform an axillary lymph node dissection (ALND) in patients who have macrometastases in the sentinel lymph node (SLN). We studied the utility of the secondary node analysis (SN), defined as the following node after the SLN in an anatomical and lymphatic pathway, as a sign of malignant axillary involvement. Methods: An observational, retrospective and multicentre study was designed to assess the utility of the SN as a sign of axillary involvement. Among 2273 patients with breast cancer, a valid sample of 283 was obtained representing those who had the SN studied. Main endpoints of our study were: the SLN, the SN and the ALND histological pattern. Sensitivity, specificity and precision of the test were also calculated. Results: SN test, in cases with positive SLN, has a sensitivity of 61.1%, a specificity of 78.7%, a positive predictive value of 45.8% and a negative predictive value of 87.3% with a precision of 74.7%. Conclusion: The study of the SN together with the technique of the SLN allows a more precise staging of the axillary involvement, in patients with breast cancer, than just the SLN technique (AU)

Advancement Flap Technique for Anal Fistula in Patients With Crohn's Disease: A Systematic Review of the Literature. / Resultados del tratamiento quirúrgico de la fístula anal en pacientes con enfermedad de Crohn mediante técnica de colgajo de avance endorrectal: revisión sistemática de la literatura.

INTRODUCTION: Treatment for anal fistulas in patients with Crohn's disease is still challenging, even for the expert surgeon. The advancement flap technique is characterized by the preservation of the anal sphincter complex. METHODS: A systematic review of the literature, selecting series of patients affected by Crohn's disease and anal fistulas and treated using advancement flap technique was performed. Patients followed during at least 6 months have been included. RESULTS: From 128 initial studies, 11 studies were selected, including overall 135 patients. Those studies show low- level evidence. Results in a series with follow-up from 8,4 to 82 months, stated a clinical success of 66% and recurrence rate around 30%. However there was an evident heterogeneity of results. CONCLUSION: The review concludes that the advancement flap technique to treat anal fistulas in patients with Crohn's disease is an adequate alternative. New studies are necessary to provide higher-level evidence.

Secondary node analysis as an indicator for axillary lymphadenectomy in breast cancer patients. / Ganglio secundario como indicador de linfadenectomía axilar en pacientes afectas de cáncer de mama.

INTRODUCTION: Currently, there is no agreement regarding if it would be necessary to perform an axillary lymph node dissection (ALND) in patients who have macrometastases in the sentinel lymph node (SLN). We studied the utility of the secondary node analysis (SN), defined as the following node after the SLN in an anatomical and lymphatic pathway, as a sign of malignant axillary involvement. METHODS: An observational, retrospective and multicentre study was designed to assess the utility of the SN as a sign of axillary involvement. Among 2273 patients with breast cancer, a valid sample of 283 was obtained representing those who had the SN studied. Main endpoints of our study were: the SLN, the SN and the ALND histological pattern. Sensitivity, specificity and precision of the test were also calculated. RESULTS: SN test, in cases with positive SLN, has a sensitivity of 61.1%, a specificity of 78.7%, a positive predictive value of 45.8% and a negative predictive value of 87.3% with a precision of 74.7%. CONCLUSION: The study of the SN together with the technique of the SLN allows a more precise staging of the axillary involvement, in patients with breast cancer, than just the SLN technique.

Regresión espontánea de carcinoma hepatocelular. A propósito de un caso / Spontaneous regression of hepatocellular carcinoma. A case report

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Reconstruccion de la mama con gel de plaquetas en la cirugia conservadora del cancer / Use of platelet gel in breast reconstruction after breast-conserving cancer surgery

Introducción: Con la finalidad de disminuir las deformidades de la mama después de la cirugía conservadora del cáncer, presentamos una nueva técnica de reconstrucción mamaria mediante la restitución del volumen mamario con gel de plaquetas. Pacientes y métodos Estudio piloto de 20 pacientes con cáncer de mama sometidas a tumorectomía a las que se aplicó en el espacio residual el gel obtenido por plaquetoaféresis de donante alogénico sano. A las pacientes se les realizó un seguimiento clínico, iconográfico e histológico, así como una valoración del resultado estético. Resultados La edad media fue de 50,5±8,65 años (rango 42-70 años) y la mediana del índice de comorbilidad de Charlson fue de 1,15±1,27 (rango 0-5). El volumen medio de la tumorectomía fue de 63,1±31,1ml (rango 30-160ml) y el volumen de restitución con el gel de plaquetas fue de 111,5±60,9ml (rango 40-250ml). Después de una mediana de seguimiento de medio de 17 meses, el 80% de las pacientes preservaron el volumen mamario y no fueron necesarias reintervenciones por afectación de los márgenes quirúrgicos ni se observaron recidivas. Conclusiones El gel de plaquetas permite restituir el volumen mamario ajustado al volumen de la tumorectomía, minimizando las retracciones y deformidades habituales de la cirugía conservadora, lo que permite realizar resecciones amplias con márgenes oncológicos de seguridad (AU)

Introduction: With the aim of decreasing breast defects after conservative cancer surgery, we present a new breast reconstruction technique using breast volume restitution with platelet gel. Patients and method: A pilot study was conducted on 20 breast cancer patients undergoing tumorectomy with placement a gel obtained by platelet pheresis of a healthy allogeneic donor in the surgical cavity. Patients had a clinical, photographic and histological follow-up, as well as an assessment of the aesthetic outcome. Results: The mean age was 50.5 8.6 years (range 42-70 years) and with a mean Charlson comorbidity index of 1.1 1.2 (range 0-5). The mean tumour volume was 63.1 31.1 ml(range 30-160 ml) and the mean restitution volume with platelet gel was 111.5 60.9 ml (range40-250 ml). After a mean follow-up of 17 months, 80% of the patients maintained the breast volume and no further operations were needed due to surgical margin involvement. No recurrences were observed in any patient. Conclusions: Platelet gel allows restitution of the breast volume adjusted to the tumorectomy volume, minimising the usual retractions and deformities after conservative surgery. It enables wide resections and safety margins (AU)

[Use of platelet gel in breast reconstruction after breast-conserving cancer surgery]. / Reconstrucción de la mama con gel de plaquetas en la cirugía conservadora del cáncer.

INTRODUCTION: With the aim of decreasing breast defects after conservative cancer surgery, we present a new breast reconstruction technique using breast volume restitution with platelet gel. PATIENTS AND METHOD: A pilot study was conducted on 20 breast cancer patients undergoing tumorectomy with placement a gel obtained by plateletpheresis of a healthy allogeneic donor in the surgical cavity. Patients had a clinical, photographic and histological follow-up, as well as an assessment of the aesthetic outcome. RESULTS: The mean age was 50.5±8.6 years (range 42-70 years) and with a mean Charlson comorbidity index of 1.1±1.2 (range 0-5). The mean tumour volume was 63.1±31.1 ml (range 30-160 ml) and the mean restitution volume with platelet gel was 111.5±60.9 ml (range 40-250 ml). After a mean follow-up of 17 months, 80% of the patients maintained the breast volume and no further operations were needed due to surgical margin involvement. No recurrences were observed in any patient. CONCLUSIONS: Platelet gel allows restitution of the breast volume adjusted to the tumorectomy volume, minimising the usual retractions and deformities after conservative surgery. It enables wide resections and safety margins.