'PartBreCon' study. A UK multicentre retrospective cohort study to assess outcomes following PARTial BREast reCONstruction with chest wall perforator flaps.

BACKGROUND: Partial breast reconstruction with a pedicled chest wall perforator flap (CWPF) enables breast conservation in a higher tumour: breast volume ratio scenario. Since there is limited evidence, this retrospective cohort study aimed to ascertain immediate (30-days) and medium-term (follow-up duration) surgical outcomes. METHODS: STROBE-compliant protocol ascertained CWPF outcomes between March 2011-March 2021. UK centres known to perform CWPF were invited to participate if they performed at least 10 cases. Data were retrospectively collected, including patient demographics, tumour and treatment characteristics, and surgical and oncological outcomes. Statistical analysis (R™) included multivariable logistic regression and sensitivity analysis. RESULTS: Across 15 centres, 507 patients with median age (54 years, IQR; 48-62), body mass index (25.4 kg/m2, IQR; 22.5-29), tumour size (26 mm, IQR; 18-35), and specimen weight (62 g, IQR; 40-92) had following flap types: LiCAP (54.1%, n = 273), MiCAP/AiCAP (19.6%, n = 99), LiCAP + LTAP (19.8%, n = 100) and TDAP (2.2%, n = 11). 30-days complication rates were in 12%: haematoma (4.3%, n = 22), wound infection (4.3%, n = 22), delayed wound healing (2.8%, n = 14) and flap loss (0.6%, n = 3; 1 full) leading to readmissions (2.6%, n = 13) and re-operations (2.6%, n = 13). Positive margins (n = 88, 17.7%) led to 15.9% (n = 79) re-excisions, including 7.5% (n = 37) at the planned 2nd of 2-stage surgery and 1.8% (n = 9) mastectomy. At median 23 months (IQR; 11-39) follow-up, there were 1.2% (n = 6) symmetrisations; recurrences: local (1%), regional/nodal (0.6%) and distant (3.2%). CONCLUSIONS: This large multicentre cohort study demonstrates acceptable complication and margin re-excision rates. CWPF extends the range of breast conservation techniques. Further studies are required for long-term oncological outcomes.

Percutaneous sentinel node removal using a vacuum-assisted needle biopsy in women with breast cancer: a feasibility and acceptability study.

AIMS: To assess the feasibility and acceptability of large-gauge percutaneous removal of the axillary sentinel lymph node (SLN) using dual gamma probe and ultrasound guidance. MATERIALS AND METHODS: Technetium nanocolloid was administered the day before surgery. On the day of surgery, potential SLNs were identified with gamma probe and ultrasound scanning. A 7 G vacuum-assisted biopsy (VAB) device was inserted percutaneously deep to the target node and the node(s) removed. The gamma probe was used to confirm removal of radiolabelled tissue. At surgery, any residual radiolabelled or blue nodes were removed. Morbidity was assessed via (1) a pain questionnaire immediately after the percutaneous procedure, (2) relevant items from the FACT B+4 questionnaire 7-10 days after surgery, and (3) case note review 1 month after surgery. RESULTS: Twenty-two patients consented and 20 patients underwent the procedure. Radiolabelled nodal tissue was obtained in 18/20 (90%). The mean procedure time was 11 minutes. Four of 18 patients had metastatic disease identified in the VAB excision tissue with 100% sensitivity for axillary metastasis. At axillary surgery, additional intact SLN or fragments were found in 14 patients. No additional metastatic disease was found at surgery. One patient suffered a pneumothorax during instillation of local anaesthetic. The median pain score was 10/100 by visual analogue scale. Immediate post-procedure haematoma was common (14 of 20) and prolonged manual compression frequent. CONCLUSION: VAB removal of sentinel nodes using dual scanning is feasible. Although preliminary sensitivity and specificity levels are encouraging, complications may discourage widespread implementation.

Measuring performance in clinical breast examination.

BACKGROUND: Clinical breast examination (CBE) remains an essential part of triple assessment of breast lumps, but to date there are no performance measures for clinicians using this technique. The aim of this retrospective audit was to compare the performance and accuracy of CBE to identify key indicators that could be used to monitor performance prospectively. METHODS: Clinical examination findings (E1, normal, to E5, malignant) for 16,585 patients who had CBE as part of triple assessment were obtained from electronic medical records. The performance of CBE, by age group, mammographic density and clinician, was assessed by calculating the sensitivity, specificity and area under the receiver operating characteristic (ROC) curve. RESULTS: There was marked variation in sensitivity between clinicians (range 44.6-65.9 per cent). There was a strong downward trend in the percentage classified as E5 as sensitivity for breast cancer detection decreased, and a corresponding strong downward trend in the proportion of E4 and E5 cancers classified as E5. Both of these measures could be used as indicators to monitor CBE performance. CONCLUSION: The performance measures outlined here could help to identify clinicians who have a lower sensitivity for CBE and who may therefore require feedback and further training.

Complete pathological response following down-staging chemoradiation in locally advanced pancreatic cancer: challenging the boundaries.

Pancreatic cancer is an aggressive malignancy, relatively resistant to chemotherapy and radiotherapy, which usually presents late. Disease specific mortality approaches unity despite advances in adjuvant therapy. We present the first reported case of complete pathological response following neoadjuvant therapy in a locally advanced pancreatic adenocarcinoma.

Refining the technique of hepatic parenchymal transection: combined saline-linked radiofrequency precoagulation and ultrasonic aspiration.

BACKGROUND/AIMS: With recognition of its benefits, there has been a trend towards minimizing blood loss during hepatic parenchymal transection but no one technique has been shown to be superior to another. We analyzed our experience with using a novel combined technique of saline-linked radiofrequency precoagulation and ultrasonic aspiration for hepatic parenchymal transection. METHODOLOGY: This combined technique was used in 12 patients for parenchymal transection for metastatic hepatic disease and data was collected prospectively. Total blood loss, bile leaks, parenchymal transection time, hepatic pedicle clamp requirement and 30-day mortality were used as outcome measures. RESULTS: Four minor and 8 major hepatic resections were performed in twelve patients of who two underwent a synchronous resection of the rectum. The median blood loss was 525 mL (IQR 312.5-1150) in these patients who had a median postoperative stay of 7 days (IQR 7-14). The median parenchymal transection time was 120 minutes (IQR 100-153.75). No patient required portal triad clamping at anytime and there was no mortality. CONCLUSIONS: Combined technique of saline-link radiofrequency ablation and ultrasonic aspiration appears to be comparable to other techniques and should be considered as an alternative.

Single center experience of laparoscopic vs. open resection for gastrointestinal stromal tumors of the stomach.

BACKGROUND/AIMS: With better understanding of disease biology and technological advances, an increasing number of gastric gastrointestinal stromal tumors (GISTs) are being resected laparoscopically. We assessed our management of gastric GISTs in our institution. METHODOLOGY: Prospectively collected data from 13 patients who underwent surgery for gastric gastrointestinal stromal tumors over an 18-month period were analyzed with respect to operative and oncological outcomes. Seven patients underwent open resection and 6 patients had laparoscopic resection. RESULTS: The tumors were evenly distributed in both groups in whom the median age was 68 years in the open group vs. 70 years in the laparoscopic group. The median operating time was 132 min in the open group and 110 min in the laparoscopic group and patients who had a laparoscopic resection had a shorter hospital stay (4 days versus 11 days). Patients in the open group had a larger tumor the patients in the laparoscopic group (11.5 x 6 x 4 cm vs. 5 x 4 x 3 cm). No patient had evidence of recurrence at median follow-up of 9 months. CONCLUSIONS: Patients with small gastric GISTs can be safely resected with a laparoscopic approach, offering a quicker operation and shorter hospital stay. A laparoscopic approach does not alter risk of early local or distant recurrence.