De-escalation of complexity in oncoplastic breast surgery: Case series from a specialized breast center.

INTRODUCTION: Oncoplastic breast surgery has evolved the surgical treatment of breast cancer over the past two decades. This practice still lacks validation and poses several dilemmas in terms of safety, local and systemic control, timing of adjuvant treatments and cost-effectiveness. Our case series investigates the effects of a reduced surgical complexity on cosmetic results and quality of life. METHODS: We treated 76 consecutive patients affected by early stage breast cancer from January 2016 to April 2017. We employed a decision support system to assist the final shared decision making. The communication process before surgery included new specific information on recent evidence about local control of disease and outcomes after multimodality treatment. In order to estimate the oncoplastic complexity, we created a new score based on scars, bilateral procedures and type and timing of reconstructions. We compared the outcomes of this series to that of a previous one from the same institution. RESULTS: The medium complexity score (CS) in the current series was significantly lower compared to that of the previous series (medium CS cohort 1 = 3.1 vs medium CS cohort 2 = 1.51; p = 0.001). Complications according to Clavien-Dindo classification did not vary significantly between the two series (p = 0.7). The increased use of primary systemic treatment did not translate into a significantly lower mastectomy rate (cohort 1 = 20% vs cohort 2 = 16%; p = n.s.). There was no significant difference in breast deformities after breast conserving surgery (p = 0.2). The BCCT.Core demonstrated a 67.1% occurrence of "good" results. Quality of life in patients who underwent breast-conserving surgery measured using the Breast-Q demonstrated similar results in the pre-post-op assessment. CONCLUSIONS: This study hypothesizes that a proper information may impact on patient's decisions and may reduce surgical complexity. This reduction likely has no effects on the main surgical outcomes estimated using standard tools. More investigations should be performed on a larger multi-institutional scale to confirm these conclusions.

[Appendiceal mucoceles. A case report]. / Il mucocele appendicolare. Analisi di un caso.

A case of benign mucocele presenting as a subocclusive syndrome is reported; the surgical treatment consisted in a right colectomy. Appendiceal mucoceles are rare lesions of the appendix, characterized by a gross enlargement of the appendix from accumulation of mucoid substance within the lumen. It is a rare condition, encountered in only 0.1-0.4% of all appendectomies with a female predominance and an average age at the time of diagnosis over 50 years. Following careful review of the literature, the difficulties in differential diagnosis are underlined, especially between benign and malignant forms and the possibility of a pre-operative diagnosis is examined. Abdominal ultrasound and CT scan of the abdomen or colonoscopy may suggest the diagnosis. However, often the diagnosis is an incidental event. The pathogenesis, histologic aspect of the lesion and the different surgical strategies are discussed. A frozen section examination should be performed in all patients, while the abdomen is open, because it may be impossible to predict the underlying pathology merely by inspecting the serosal surface of a dilated appendix. If a simple retentional cyst is uncovered, without atypia, appendectomy should be curative; if cystadenoma or cystadenocarcinoma of the appendix are found, more extended resection was necessary. However if the operation is done as an emergency, a frozen section examination is not always available: in those patients a more extended resection is suggested.

[A proposed clinico-instrumental protocol for diagnostic guidance in breast lumps]. / Proposta di protocollo clinico-strumentale di orientamento diagnostico negli addensamenti mammari.

Women who practice self-examination of the breast often believe to identify lumps which produce much concern; in many cases differential diagnosis with cancer is therefore necessary. The authors propose a clinical-instrumental protocol as a guide to the right diagnosis in these patients.

[Toxic adenoma of the thyroid gland: personal experience]. / L'adenoma tossico della tiroide: esperienza personale.

The Authors analyzed the thyroid diseases series of the Institute of 1a Clinica Chirurgica of the University of Catania which includes 1022 patients over the last 17 years, reviewing clinical and laboratory tests usually used in a register of diagnosis for autonomous adenomas of the thyroid. The Authors discuss pathogenesis, likely etiology and epidemiology of Plummer's adenoma, taking into consideration the therapy and the complications related to the therapy itself. They conclude stating that the adenoma is a pathology where the surgical operation solves the dismetabolic condition in a lasting way.