RÉSUMÉ
PURPOSE: There has been a UK national directive to ensure that patients are offered reconstructive surgical options. We aimed to assess any change in oncoplastic practice over a 10-year period. METHODS: The surgical management of 7019 breast cancers was retrospectively assessed at Nightingale Breast Centre, Manchester University UK, from 2010 to 2019. The procedures were categorised into breast conservative surgery (BCS) and mastectomy ± immediate reconstruction. The data were analysed using inclusion and exclusion criteria. RESULTS: The overall rates of BCS and mastectomy were 60.1% and 39.9% respectively. No statistically significant change in the overall rates of BCS or mastectomy was observed over the last decade (p = 0.08). The rate of simple wide local excision (WLE) decreased from 98.7% to 89.3% (p < 0.001), whilst the rate of therapeutic mammoplasty (TM) increased from 1.3% to 8% (p < 0.01). The rate of chest wall perforator flaps (CWPF) changed from zero to account for 2.7% of all BCS by 2019. The overall rate of immediate breast reconstruction (IBR) did not significantly change over the study period, but it consistently remained above the national average of 27%. The rate of implant-based IBR increased from 61.3% to 76.5% (p = 0.012), whilst the rate of Latissimus Dorsi (LD) reconstruction decreased from 26.7% to 5.1% (p < 0.05). Additionally, the rate of nipple-sparing mastectomy significantly increased from 5.2% to 24%. CONCLUSION: No significant changes in the overall rates of BCS was observed, the rates of advanced breast conservation techniques, nipple-sparing mastectomy, and implant-based IBR all have increased, whilst the use of LD reconstruction decreased.
Sujet(s)
Tumeurs du sein , Mammoplastie , Mastectomie , Humains , Femelle , Mammoplastie/tendances , Mammoplastie/méthodes , Mammoplastie/statistiques et données numériques , Tumeurs du sein/chirurgie , Tumeurs du sein/anatomopathologie , Tumeurs du sein/épidémiologie , Études rétrospectives , Adulte d'âge moyen , Mastectomie/méthodes , Mastectomie/statistiques et données numériques , Mastectomie/tendances , Adulte , Sujet âgé , Mastectomie partielle/méthodes , Mastectomie partielle/statistiques et données numériques , Royaume-Uni/épidémiologieRÉSUMÉ
BACKGROUND: The effectiveness of paravertebral block in preventing chronic pain after breast surgery remains controversial. The primary hypothesis of this study was that paravertebral block reduces the incidence of chronic pain 3 months after breast cancer surgery. METHODS: In this prospective, multicenter, randomized, double-blind, parallel-group, placebo-controlled study, 380 women undergoing partial or complete mastectomy with or without lymph node dissection were randomized to receive preoperative paravertebral block with either 0.35 ml/kg 0.75% ropivacaine (paravertebral group) or saline (control group). Systemic multimodal analgesia was administered in both groups. The primary endpoint was the incidence of chronic pain with a visual analogue scale (VAS) score greater than or equal to 3 out of 10, 3 months after surgery. The secondary outcomes were acute pain, analgesic consumption, nausea and vomiting, chronic pain at 6 and 12 months, neuropathic pain, pain interference, anxiety, and depression. RESULTS: Overall, 178 patients received ropivacaine, and 174 received saline. At 3 months, chronic pain was reported in 93 of 178 (52.2%) and 83 of 174 (47.7%) patients in the paravertebral and control groups, respectively (odds ratio, 1.20 [95% CI, 0.79 to 1.82], P = 0.394). At 6 and 12 months, chronic pain occurred in 104 of 178 (58.4%) versus 79 of 174 (45.4%) and 105 of 178 (59.0%) versus 93 of 174 (53.4%) patients in the paravertebral and control groups, respectively. Greater acute postoperative pain was observed in the control group 0 to 2 h (area under the receiver operating characteristics curve at rest, 4.3 ± 2.8 vs. 2.9 ± 2.8 VAS score units × hours, P < 0.001) and when maximal in this interval (3.8 ± 2.1 vs. 2.5 ± 2.5, P < 0.001) but not during any other interval. Postoperative morphine use was 73% less in the paravertebral group (odds ratio, 0.272 [95% CI, 0.171 to 0.429]; P < 0.001). CONCLUSIONS: Paravertebral block did not reduce the incidence of chronic pain after breast surgery. Paravertebral block did result in less immediate postoperative pain, but there were no other significant differences in postoperative outcomes.
Sujet(s)
Bloc anesthésique du système nerveux autonome/méthodes , Tumeurs du sein/chirurgie , Douleur chronique/diagnostic , Mastectomie/effets indésirables , Douleur postopératoire/diagnostic , Soins préopératoires/méthodes , Adulte , Sujet âgé , Bloc anesthésique du système nerveux autonome/tendances , Douleur chronique/prévention et contrôle , Méthode en double aveugle , Femelle , Humains , Mastectomie/tendances , Adulte d'âge moyen , Douleur postopératoire/prévention et contrôle , Soins préopératoires/tendances , Études prospectivesRÉSUMÉ
PURPOSE: The COVID-19 pandemic has changed the way many health institutions approach their workload. Physicians managing patients with cancer now have to deal not only with the disease but also the restrictions and limitations imposed because of the global pandemic. We aimed to determine how surgical preferences in breast cancer management were affected globally using a questionnaire-based survey. METHODS: Under the auspices of the Turkish Senology Society (SENATURK) we asked 122 surgeons from 27 countries to reply to a 26-question survey designed to measure the impact of COVID-19 on their surgical practice when treating patients with breast cancer. RESULTS: The characteristics of participant surgeons were statistically similar when comparing the participants' answers from Turkey and other countries. From the responses given to our questionnaire, it was understood that breast cancer surgery decreased by 25% (p<0.05) in institutions all over the world, including Turkey, but there was no change in the approach technique to the axilla. CONCLUSIONS: Globally breast surgeons have adapted to the new normal due to the COVID-19 pandemic. Many surgical approaches and some follow up protocols have been changed, although the degree of change has varied from country to country. In addition, the availability of multidisciplinary case conferences has been reduced in some centers which may affect the quality of services provided to patients.
Sujet(s)
Tumeurs du sein/chirurgie , COVID-19 , Santé mondiale/tendances , Disparités d'accès aux soins/tendances , Mastectomie/tendances , Types de pratiques des médecins/tendances , Chirurgiens/tendances , Femelle , Enquêtes sur les soins de santé , Humains , Facteurs tempsRÉSUMÉ
BACKGROUND: Since April 2015, the Korean National Health Insurance (NHI) has reimbursed breast cancer patients, approximately 50% of the cost of the breast reconstruction (BR) procedure. We aimed to investigate NHI reimbursement policy influence on the rate of immediate BR (IBR) following total mastectomy (TM). METHODS: We retrospectively analyzed breast cancer data between April 2011 and June 2016. We divided patients who underwent IBR following TM for primary breast cancer into "uninsured" and "insured" groups using their NHI statuses at the time of surgery. Univariate analyses determined the insurance influence on the decision to undergo IBR. RESULTS: Of 2,897 breast cancer patients, fewer uninsured patients (n = 625) underwent IBR compared with those insured (n = 325) (30.0% vs. 39.8%, P < 0.001). Uninsured patients were younger than those insured (median age [range], 43 [38-48] vs. 45 [40-50] years; P < 0.001). Pathologic breast cancer stage did not differ between the groups (P = 0.383). More insured patients underwent neoadjuvant chemotherapy (P = 0.011), adjuvant radiotherapy (P < 0.001), and IBR with tissue expander insertion (P = 0.005) compared with those uninsured. CONCLUSION: IBR rate in patients undergoing TM increased after NHI reimbursement.
Sujet(s)
Tumeurs du sein/chirurgie , Assurance maladie/tendances , Mammoplastie/économie , Mastectomie/économie , Adulte , Tumeurs du sein/épidémiologie , Femelle , Politique de santé , Humains , Remboursement par l'assurance maladie/économie , Remboursement par l'assurance maladie/tendances , Mammoplastie/statistiques et données numériques , Mammoplastie/tendances , Mastectomie/statistiques et données numériques , Mastectomie/tendances , Adulte d'âge moyen , République de Corée/épidémiologie , Études rétrospectivesRÉSUMÉ
OBJECTIVE: At the end of 1 year of the coronavirus disease (COVID-19) pandemic, we aimed to reveal the changes in breast cancer cases in the context of cause and effect based on the data of surgically treated patients in our institution. PATIENTS AND METHODS: Patients with breast cancer were divided into two groups. Group 1 consisted of patients who were operated in the year before the COVID-19 pandemic, and Group 2 consisted of patients who were operated within the first year of the pandemic. Tumor size, axillary lymph node positivity, distant organ metastasis status, neoadjuvant chemotherapy, and type of surgery performed were compared between the two groups. RESULTS: The tumor size, axillary lymph node positivity, and neoadjuvant chemotherapy were higher in Group 2 than in Group 1 (p = .005, p = .012, p = .042, respectively). In addition, the number of breast-conserving surgery + sentinel lymph node biopsy were lower, while the number of mastectomy and modified radical mastectomy were higher in Group 2 than in Group 1 (p = .034). CONCLUSION: Patients presented with larger breast tumors and increased axillary involvement during the pandemic. Moreover, distant organ metastases may increase in the future.
Sujet(s)
Tumeurs du sein/diagnostic , COVID-19 , Retard de diagnostic/tendances , Accessibilité des services de santé/tendances , Acceptation des soins par les patients/statistiques et données numériques , Adulte , Sujet âgé , Sujet âgé de 80 ans ou plus , Antinéoplasiques/usage thérapeutique , Tumeurs du sein/traitement médicamenteux , Tumeurs du sein/anatomopathologie , Tumeurs du sein/chirurgie , Traitement médicamenteux adjuvant , Femelle , Humains , Lymphadénectomie/tendances , Métastase lymphatique , Mastectomie/méthodes , Mastectomie/tendances , Adulte d'âge moyen , Traitement néoadjuvant , Études rétrospectives , Charge tumorale , TurquieRÉSUMÉ
OBJECTIVE: There are limited data concerning the use of mastectomy and associated factors in China in recent years. This study aimed to investigate the uptake of mastectomy and determine the associations between patients' characteristics and mastectomy among Chinese women with breast cancer. METHODS: A retrospective analysis of female breast cancer cases from 1st January 2015 to 31st December 2019 from a tertiary hospital was conducted. Socio-demographic data, clinical data, and surgery types were collected by reviewing the medical record system. Chi-squared test, Fisher's exact test and multivariate logistic regression analysis were used to determine any correlations of patients' characteristics with mastectomy. RESULTS: A total of 1,171 women with breast cancer were identified, and 76.60% of them underwent a mastectomy. The mastectomy rates showed an increase from 70.62% in 2015 to 86.87% in 2017 and then dropped to 71.91% in 2019. Women undergoing mastectomy were older and were more likely to be married and have at least one child. They had an advanced cancer stage, larger tumour size, and more lymph node invasion and were positive for HER-2 overexpression. Older age, larger tumour size (2-5 cm), higher cancer stages (stage 2- stage 3) and being positive for HER-2 were the four independent variables that significantly predicted the uptake of mastectomy. CONCLUSIONS: Our results showed a wide application of mastectomy in China and uncovered the factors associated with mastectomy uptake from a single-centre experience. Findings suggested the potential overuse of mastectomy among women with early-stage breast cancer, and highlighted the significance of promoting cancer screening in China. Findings could be also used to develop relevant provisions and interventions to facilitate breast cancer treatment decision-making and screening planning.
.
Sujet(s)
Tumeurs du sein/chirurgie , Mastectomie/statistiques et données numériques , Mastectomie/tendances , Adulte , Sujet âgé , Sujet âgé de 80 ans ou plus , Tumeurs du sein/anatomopathologie , Tumeurs du sein/psychologie , Études transversales , Femelle , Études de suivi , Humains , Mastectomie/psychologie , Adulte d'âge moyen , Pronostic , Études rétrospectives , Jeune adulteRÉSUMÉ
PURPOSE: This study aimed to evaluate national trends in utilization, resource use, and predictors of immediate breast reconstruction (IR) after mastectomy. METHODS: The 2005-2014 National Inpatient Sample database was used to identify adult women undergoing mastectomy. IR was defined as any reconstruction during the same inpatient stay. Multivariable regression models were utilized to identify factors associated with IR. RESULTS: Of 729,340 patients undergoing mastectomy, 41.3% received IR. Rates of IR increased from 28.2% in 2005 to 58.2% in 2014 (NP-trend<0.001). Compared to mastectomy alone, IR was associated with increased length of stay (2.5 vs. 2.1 days, P < 0.001) and hospitalization costs ($17,628 vs. $8,643, P < 0.001), which increased over time (P < 0.001). Predictors of IR included younger age, fewer comorbidities, White race, private insurance, top income quartile, teaching hospital designation, high mastectomy volume, and performance of bilateral mastectomy. CONCLUSION: Mastectomy with IR is increasingly performed with resource utilization rising at a steady pace. Our study points to persistent sociodemographic and hospital level disparities associated with the under-utilization of IR. Efforts are needed to alleviate disparities in IR.
Sujet(s)
Tumeurs du sein/chirurgie , Mammoplastie/économie , Mammoplastie/tendances , Mastectomie/tendances , Adulte , Sujet âgé , Femelle , Coûts hospitaliers , Humains , Durée du séjour/économie , Adulte d'âge moyen , États-UnisRÉSUMÉ
BACKGROUND: Compared to general anesthesia, regional anesthesia confers several benefits including improved pain control and decreased postoperative opioid consumption. While the benefits of peripheral nerve blocks (PNB) have been well studied, there are little epidemiological data on PNB usage in mastectomy and lumpectomy procedures. The primary objective of our study was to assess national trends of the annual proportion of PNB use in breast surgery from 2010 to 2018. We also identified factors associated with PNB use for breast surgery. METHODS: We identified lumpectomy and mastectomy surgical cases with and without PNB between 2010 and 2018 using the Anesthesia Quality Institute National Anesthesia Clinical Outcomes Registry (AQI NACOR). We modeled the nonlinear association between year of procedure and PNB use with segmented mixed-effects logistic regression clustered on facility identifier. The association between PNB use and year of procedure, age, sex, American Society of Anesthesiologists physical status (ASA PS), facility type, facility region, weekday, and tissue expander use was also modeled using mixed-effects logistic regression. RESULTS: Of the 189,854 surgical cases from 2010 to 2018 that met criteria, 86.2% were lumpectomy cases and 13.8% were mastectomy cases. The proportion of lumpectomy cases with PNB was <0.1% in 2010 and increased each subsequent year to 1.9% in 2018 (trend P < .0001). The proportion of mastectomy cases with PNB was 0.5% in 2010 and 13% in 2018 (trend P < .0001). The year 2014 was the breakpoint selected for segmented regression. Before 2014, the odds of PNB among the mastectomy cases was not significantly different from year to year. After 2014, the odds of PNB increased by 2.24-fold each year (95% confidence interval [CI], 2.00-2.49; P < .001); interaction test for pre-2014 versus post-2014 was P < .001. Similar trends were seen in the lumpectomy cases, where after 2014, the odds of PNB increased by 2.03-fold (95% CI, 1.81-2.27; P < .001); interaction test for pre-2014 versus post-2014 was P < .001. In the mastectomy cohort, year of procedure ≥2014, female sex, facility region, and tissue expander use were associated with higher odds of PNB. For lumpectomy cases, year of procedure ≥2014 and facility region were associated with higher odds of PNB use. CONCLUSIONS: We found increased annual utilization of PNB for mastectomy and lumpectomy since 2010, although absolute prevalence is low. PNB use was associated with year of procedure for both lumpectomy and mastectomy, particularly post-2014.
Sujet(s)
Bloc anesthésique du système nerveux autonome/tendances , Interprétation statistique de données , Bases de données factuelles/tendances , Mastectomie partielle/tendances , Mastectomie/tendances , Adulte , Études de cohortes , Femelle , Humains , Mâle , Adulte d'âge moyen , Nerfs périphériques/physiologie , EnregistrementsRÉSUMÉ
INTRODUCTION: The rapid spread of COVID-19 across the globe is forcing surgical oncologists to change their daily practice. We sought to evaluate how breast surgeons are adapting their surgical activity to limit viral spread and spare hospital resources. METHODS: A panel of 12 breast surgeons from the most affected regions of the world convened a virtual meeting on April 7, 2020, to discuss the changes in their local surgical practice during the COVID-19 pandemic. Similarly, a Web-based poll based was created to evaluate changes in surgical practice among breast surgeons from several countries. RESULTS: The virtual meeting showed that distinct countries and regions were experiencing different phases of the pandemic. Surgical priority was given to patients with aggressive disease not candidate for primary systemic therapy, those with progressive disease under neoadjuvant systemic therapy, and patients who have finished neoadjuvant therapy. One hundred breast surgeons filled out the poll. The trend showed reductions in operating room schedules, indications for surgery, and consultations, with an increasingly restrictive approach to elective surgery with worsening of the pandemic. CONCLUSION: The COVID-19 emergency should not compromise treatment of a potentially lethal disease such as breast cancer. Our results reveal that physicians are instinctively reluctant to abandon conventional standards of care when possible. However, as the situation deteriorates, alternative strategies of de-escalation are being adopted. IMPLICATIONS FOR PRACTICE: This study aimed to characterize how the COVID-19 pandemic is affecting breast cancer surgery and which strategies are being adopted to cope with the situation.
Sujet(s)
Tumeurs du sein/thérapie , COVID-19/prévention et contrôle , Mastectomie/tendances , Pandémies/prévention et contrôle , Types de pratiques des médecins/tendances , Rendez-vous et plannings , Tumeurs du sein/anatomopathologie , COVID-19/épidémiologie , COVID-19/transmission , COVID-19/virologie , Contrôle des maladies transmissibles/organisation et administration , Contrôle des maladies transmissibles/normes , Évolution de la maladie , Interventions chirurgicales non urgentes/normes , Interventions chirurgicales non urgentes/statistiques et données numériques , Interventions chirurgicales non urgentes/tendances , Femelle , Charge mondiale de morbidité , Rationnement des services de santé/normes , Rationnement des services de santé/statistiques et données numériques , Rationnement des services de santé/tendances , Humains , Mastectomie/économie , Mastectomie/normes , Mastectomie/statistiques et données numériques , Traitement néoadjuvant/statistiques et données numériques , Blocs opératoires/économie , Blocs opératoires/statistiques et données numériques , Blocs opératoires/tendances , Sélection de patients , Affectation du personnel et organisation du temps de travail/économie , Affectation du personnel et organisation du temps de travail/statistiques et données numériques , Affectation du personnel et organisation du temps de travail/tendances , Types de pratiques des médecins/économie , Types de pratiques des médecins/organisation et administration , Types de pratiques des médecins/statistiques et données numériques , Orientation vers un spécialiste/statistiques et données numériques , Orientation vers un spécialiste/tendances , SARS-CoV-2/pathogénicité , Chirurgiens/statistiques et données numériques , Enquêtes et questionnaires/statistiques et données numériques , Délai jusqu'au traitementRÉSUMÉ
In breast cancer surgery, there has been a major shift toward less invasive local treatment. Although axillary lymph node dissection (ALND) was an integral part of surgical treatment for breast cancer, sentinel lymph node (SLN) biopsy was developed as an accurate method for axillary staging. ALND can be avoided not only in patients with negative SLNs but also in those with one or two positive SLNs receiving breast and/or axillary radiation. On the other hand, ALND has remained the standard treatment for patients with clinically positive nodes. However, axillary reverse mapping (ARM) was developed to map and preserve arm lymphatic drainage during ALND and/or SLN biopsy. This procedure allowed reduction of the rate of arm lymphedema without increasing axillary recurrence, although patients receive postoperative chemotherapy and high-risk patients undergo axillary radiation. Standard ALND may not be necessary even for patients with clinically positive nodes who receive axillary radiation and systemic therapy. Thus, the extent of axillary surgery in breast cancer has been decreased with increased use of systemic and radiation therapy.
Sujet(s)
Tumeurs du sein/thérapie , Lymphadénectomie/tendances , Métastase lymphatique/thérapie , Mastectomie/tendances , Récidive tumorale locale/épidémiologie , Aisselle , Tumeurs du sein/diagnostic , Tumeurs du sein/anatomopathologie , Chimioradiothérapie adjuvante/histoire , Chimioradiothérapie adjuvante/méthodes , Chimioradiothérapie adjuvante/statistiques et données numériques , Chimioradiothérapie adjuvante/tendances , Femelle , Histoire du 20ème siècle , Histoire du 21ème siècle , Humains , Lymphadénectomie/effets indésirables , Lymphadénectomie/histoire , Lymphadénectomie/statistiques et données numériques , Métastase lymphatique/diagnostic , Métastase lymphatique/anatomopathologie , Lymphoedème/épidémiologie , Lymphoedème/étiologie , Lymphoedème/prévention et contrôle , Mastectomie/effets indésirables , Mastectomie/histoire , Mastectomie/statistiques et données numériques , Récidive tumorale locale/anatomopathologie , Récidive tumorale locale/prévention et contrôle , Stadification tumorale , Complications postopératoires/épidémiologie , Complications postopératoires/étiologie , Complications postopératoires/prévention et contrôle , Noeud lymphatique sentinelle/effets des médicaments et des substances chimiques , Noeud lymphatique sentinelle/anatomopathologie , Noeud lymphatique sentinelle/effets des radiations , Noeud lymphatique sentinelle/chirurgie , Biopsie de noeud lymphatique sentinelle/effets indésirables , Biopsie de noeud lymphatique sentinelle/histoire , Biopsie de noeud lymphatique sentinelle/statistiques et données numériques , Biopsie de noeud lymphatique sentinelle/tendancesRÉSUMÉ
PURPOSE: As part of the implementation of quality registration in Iceland we used retrospective data to compare diagnosis and treatment of invasive breast cancer between Iceland and Sweden. MATERIALS AND METHODS: Information on all patients diagnosed with invasive breast cancer in Iceland 2016-2017 was obtained from the Icelandic Cancer Registry. Hospital records were used to register variables in an electronic form adapted from the Swedish quality registration, and compared with data from Sweden for the same period. A chi-square test was used to compare ratios. RESULTS: A total of 486 cases of breast cancer were diagnosed in Iceland and 15.325 in Sweden. A lower proportion of 40-69 year old women were diagnosed within the screening programme in Iceland (46%) compared to Sweden (60%) (p<0.01). Multidisciplinary tumor board meetings held before and after surgery were less frequent in Iceland (92% vs. 96%) compared to Sweden (98% vs. 99%) in 2016 (p<0,01) but no difference was seen in 2017. A sentinel node surgery was done in 69% of the cases in Iceland compared to 94% in Sweden (p<0,01). For cancers ≤30mm breast conserving surgery was done in 48% cases in Iceland but 80% in Sweden (p<0,01). In Iceland 87% of the cases had radiation therapy after breast conserving surgery but 94% in Sweden (p<0,01). Among mastectomy patients with lymph node metastases, 49% received radiation therapy in Iceland compared to 83% in Sweden (p<0,01). CONCLUSION: Differences were seen in several areas of diagnosis and treatment of invasive breast cancer between Iceland and Sweden. With quality registration it will be possible to monitor and set goals for the diagnosis and treatment, with the aim of providing the best treatment to as many patients as possible.
Sujet(s)
Tumeurs du sein/diagnostic , Tumeurs du sein/chirurgie , Dépistage précoce du cancer/tendances , Disparités d'accès aux soins/tendances , Mastectomie/tendances , Types de pratiques des médecins/tendances , Adulte , Sujet âgé , Tumeurs du sein/épidémiologie , Tumeurs du sein/anatomopathologie , Femelle , Humains , Islande/épidémiologie , Métastase lymphatique , Mastectomie/effets indésirables , Adulte d'âge moyen , Invasion tumorale , Valeur prédictive des tests , Indicateurs qualité santé/tendances , Radiothérapie adjuvante/tendances , Enregistrements , Études rétrospectives , Suède/épidémiologie , Facteurs temps , Résultat thérapeutique , Charge tumoraleRÉSUMÉ
OBJECTIVES: The overall aim of the Swedish Breast Reconstruction Outcome Study was to investigate national long-term outcomes after mastectomy with or without breast reconstruction. The current report evaluates breast reconstruction (BR) patterns in Sweden over time. MATERIALS AND METHODS: This is a cross-sectional, registry-based study where all women operated with mastectomy 2000, 2005, 2010 were identified (N = 5853). Geographical differences in type of BR were investigated using heatmaps. Distribution of continuous variables were compared using the Mann-Whitney U test, categorical variables were compared using the chi-square test. RESULTS: Mean age at survey was 69 years (SD=±11.4) and response rate was 50%, responders were on average six years younger than the non-responders and had a more favourable tumor stage (both p < 0.01). Of the 2904 responders, 31% (895/2904) had received a BR: implant-based in 58% (516/895)autologous in 31% (281/895). BR was immediate in 20% (176/895) and delayed in 80% (719/895) women. Women with BR were on average one year older, more often had a normal BMI, reported to be married or had a partner, had a higher educational level and a higher annual income when compared to those without BR (all p < 0.001). The independent factors of not receiving BR were older age and given radiotherapy. CONCLUSIONS: To our knowledge, this is the first national long-term follow-up study on women undergoing mastectomy with and without BR. Around 30% of the survey responders have had a BR with a significant geographical variation highlighting the importance of information, availability and standardisation of indications for BR.
Sujet(s)
Tumeurs du sein/chirurgie , Mammoplastie/tendances , Mastectomie/tendances , Facteurs âges , Sujet âgé , Sujet âgé de 80 ans ou plus , Antinéoplasiques hormonaux/usage thérapeutique , Implantation de prothèse mammaire/statistiques et données numériques , Implantation de prothèse mammaire/tendances , Tumeurs du sein/anatomopathologie , Traitement médicamenteux adjuvant , Études transversales , Niveau d'instruction , Femelle , Humains , Revenu/statistiques et données numériques , Mammoplastie/statistiques et données numériques , Situation de famille/statistiques et données numériques , Mastectomie/statistiques et données numériques , Adulte d'âge moyen , Stadification tumorale , Radiothérapie adjuvante/statistiques et données numériques , Enquêtes et questionnaires , Suède , Facteurs tempsRÉSUMÉ
Nipple Sparing Mastectomy (NSM) requires the entire breast tissue to be removed, maintaining the nipple-areola complex, and represents nowadays the gold standard of the demolitive breast surgery. Although it represents the evolution of conservative breast surgery, NSM presents some limitations in the selection of women candidates for treatment, and still there are no real guidelines regarding its indications, but simply objective data to address the choice. How the breast surgery approach to demolitive and conservative surgery has changed over time? We evaluated throughout the years (from 2009 up to 2018) the time trend of NSM at our institution and analysed the main differences between patients undergone NSM and other mastectomies and/or breast conserving surgery in terms of cancer size, multicentricity and biological profile. We found 781 NSMs, 1261 other mastectomies and 5621 breast conservative surgeries. Among NSMs, 39.6% were reconstructed with tissue expander and 58.1% with definitive prosthesis. From 2009 to 2018 we found a general increase of NSM rate (from 21.3% of all mastectomies in 2009 to 67.3% in 2018) and a decrease of total mastectomies (from 78.7% of all mastectomies in 2009 to 32.7% in 2018). In line with the literature data, our data confirm that in the recent years NSM represents the gold standard for radical breast surgery. Undisputed in prophylaxis, NSM is continuously acquiring more support in being used as first line treatment for locally advanced disease.
Sujet(s)
Tumeurs du sein/chirurgie , Région mammaire/chirurgie , Mastectomie/méthodes , Mastectomie/tendances , Mamelons/chirurgie , Traitements préservant les organes/méthodes , Traitements préservant les organes/tendances , /méthodes , /tendances , Implants mammaires , Tumeurs du sein/anatomopathologie , Femelle , Humains , Stadification tumorale , Expanseurs tissulairesRÉSUMÉ
Background and Objectives: The surgical choice treatment of the breast cancer mostly depends on the stage of the disease. In the last years, breast cancer surgery has moved from being destructive to being more respectful of the anatomical and physiological integrity of the gland. The aim of the breast surgery should be finalized to obtain the best aesthetic and functional results, respecting the principles of oncologic radicality. The present study is a retrospective analysis aimed to evaluate the long-term outcomes of a conservative technique like the nipple-sparing mastectomy. Materials and Methods: We observed 894 patients with a median age of 47.5 years old, underwent nipple-sparing mastectomy between 2002-2017. The data acquired include population and tumor characteristics, patient reconstructive outcomes, including locoregional, regional, and distant metastases; other variables, among nipple-areola complex necrosis and infection were collected. Results: The complications detected were considered as "early" within 1 month later the nipple-sparing mastectomy or "late" after this time. The overall complications rate (early and late) and the overall survival and the relapses detected by this study were comparable with those reported in the literature. In order to identify factors that correlate with complications, either early or later, it has been processed an evaluation of the univariate analysis showing adjuvant chemotherapy as the only predictive factor for late complications, while we encountered no predictors for early complications. Conclusions: The present study adds to the data already present in literature, demonstrating that the nipple-sparing mastectomy is a safe procedure, providing good oncological and aesthetic results in patients carefully selected.
Sujet(s)
Tumeurs du sein/chirurgie , Mastectomie/méthodes , Adulte , Sujet âgé , Tumeurs du sein/physiopathologie , Femelle , Humains , Mastectomie/effets indésirables , Mastectomie/tendances , Adulte d'âge moyen , Mamelons/physiologie , Mamelons/chirurgie , Études rétrospectivesRÉSUMÉ
BACKGROUND: Pain and nausea are the most common challenges in postoperative recovery after mastectomy. Preventive measures include multimodal analgesia with preoperative glucocorticoid. The aim of this study was to investigate whether 24 mg of preoperative dexamethasone was superior to 8 mg on early recovery after mastectomy in addition to a simple analgesic protocol. METHODS: In a randomized, double-blind trial, patients 18 yr of age or older having mastectomy were randomized 1:1 to 24 mg or 8 mg dexamethasone, and all received a standardized anesthetic and surgical protocol with preoperative acetaminophen, total intravenous anesthesia, and local anesthetic wound infiltration. The primary endpoint was number of patients transferred to the postanesthesia care unit according to standardized discharge criteria (modified Aldrete score). Secondary endpoints included pain and nausea at extubation, transfer from the operating room and upon arrival at the ward, length of stay, seroma occurrence, and wound infections. RESULTS: One hundred thirty patients (65 in each group) were included and analyzed for the primary outcome. Twenty-three (35%) in each group met the primary outcome, without significant differences in standardized discharge scores (odds ratio, 1.00 [95% CI, 0.49 to 2.05], P > 0.999). More patients had seroma requiring drainage in the 24 mg versus 8 mg group, 94% versus 81%, respectively (odds ratio, 3.53 [95% CI, 1.07 to 11.6], P = 0.030). Median pain scores were low at all measured time points, numeric rating scale less than or equal to 2 versus less than or equal to 1 in the 24 mg versus 8 mg group, respectively. Six patients in each group (9%) experienced nausea at any time during hospital stay (P > 0.999). Length of stay was median 11 and 9.2 h in the 24 and 8 mg group, respectively (P = 0.217). CONCLUSIONS: The authors found no evidence of 24 mg versus 8 mg of dexamethasone affecting the primary outcome regarding immediate recovery after mastectomy. The authors observed a short length of stay and low pain scores despite a simple analgesic protocol.
Sujet(s)
Dexaméthasone/administration et posologie , Glucocorticoïdes/administration et posologie , Mastectomie/tendances , Douleur postopératoire/diagnostic , Douleur postopératoire/prévention et contrôle , Récupération fonctionnelle/effets des médicaments et des substances chimiques , Adulte , Sujet âgé , Sujet âgé de 80 ans ou plus , Relation dose-effet des médicaments , Méthode en double aveugle , Femelle , Humains , Mâle , Mastectomie/effets indésirables , Adulte d'âge moyen , Soins postopératoires/méthodes , Études prospectives , Récupération fonctionnelle/physiologie , Facteurs temps , Jeune adulteRÉSUMÉ
The surgical management of breast cancer began to change in the middle of the last decade. The use of unilateral mastectomy decreased while the rate of contralateral prophylactic mastectomy for unilateral cancer increased sixfold from 1998 to 2011. The use of immediate breast reconstruction increased from 30% in 2005 to 45% in 2012. Four changes came together in the middle of the last decade to cause this paradigm shift in the surgical management of early breast cancer. (a) Breast MRI would be available in nearly 75% of breast imaging centers. (b) Genetic counseling would become a standard of care for patients with potential hereditary breast cancer. (c) In 2006, the FDA would approve the use of silicone-gel implants. (d) Nipple-sparing mastectomy would become a standard of care in the treatment of early breast cancer.
Sujet(s)
Mastectomie/histoire , Tumeurs du sein/chirurgie , Femelle , Histoire du 20ème siècle , Histoire du 21ème siècle , Humains , Mastectomie/tendances , Mastectomie sous-cutanée/histoire , Mastectomie sous-cutanée/tendances , Types de pratiques des médecins/histoire , Types de pratiques des médecins/tendances , États-UnisRÉSUMÉ
BACKGROUND: Acute post-mastectomy pain is frequently challenging to adequately treat with local anesthetic-based regional anesthesia techniques due to its relatively long duration measured in multiple weeks. CASE: We report three cases in which preoperative ultrasound-guided percutaneous intercostal nerve cryoneurolysis was performed to treat pain following mastectomy. Across all postoperative days and all three patients, the mean pain score on the numeric rating scale was 0 for each day. Similarly, no patient required any supplemental opioid analgesics during the entire postoperative period; and, no patient reported insomnia or awakenings due to pain at any time point. This was a significant improvement over historic cohorts. CONCLUSIONS: Ultrasound-guided percutaneous cryoanalgesia is a potential novel analgesic modality for acute pain management which has a duration that better-matches mastectomy than other currently-described techniques. Appropriately powered randomized, controlled clinical trials are required to demonstrate and quantify both potential benefits and risks.