Evaluación de la percepción preoperatoria de la calidad de vida y satisfacción de la mujer con cáncer de mama mediante el cuestionario BREAST-Q™ / Evaluation of the preoperative perception of quality of life and satisfaction of women with breast cancer using the BREAST-Q™ questionnaire

INTRODUCCIÓN: Cerca del 40% de las mujeres intervenidas por un carcinoma mamario refieren estar insatisfechas con la toma de decisiones y con el resultado cosmético de la cirugía. El objetivo del estudio es demostrar la utilidad del cuestionario prequirúrgico BREAST-Q™ para evaluar la satisfacción y calidad de vida de las mujeres con cáncer de mama en un estado basal previo a la cirugía e identificar perfiles de satisfacción. MÉTODOS: Estudio observacional de una corte prospectiva en mujeres con carcinoma de mama donde se evaluó la calidad de vida antes y después de la intervención propuesta mediante el cuestionario prequirúrgico BREAST-Q™. Se presentan los resultados preliminares del estudio, con el análisis de la fase prequirúrgica. Se calcularon los percentiles para cada dominio del cuestionario y se evaluaron las características físicas basales para su posterior análisis. RESULTADOS: La satisfacción media de las pacientes con sus mamas fue de 58,9 ± 16,9. La media de bienestar psicosocial prequirúrgico fue de 70,5 ± 16,1. A las pacientes que se les propuso una cirugía conservadora presentaron una media de bienestar físico de 80,7 ± 18,5 y a las pacientes que se les propuso una mastectomía con reconstrucción fue de 79,9 ± 17,7. La media de score para el bienestar sexual fue de 63,2 ± 20,7. No se encontraron diferencias estadísticamente significativas entre el grupo de mujeres con score bajo y el grupo con score medio o alto en cuanto a las características clinicoepidemiológicas de las pacientes. CONCLUSIONES: La evaluación preoperatoria de las pacientes con cáncer de mama permite una correcta valoración del impacto de la cirugía sobre la satisfacción y calidad de vida, siendo de utilidad para orientar el proceso informativo acerca de las expectativas de los resultados postoperatorios

INTRODUCTION: Almost 40% of women who undergo breast surgery are dissatisfied with the decision-making process as well as cosmetic results. Our objective was to demonstrate the usefulness of the BREAST-Q™ preoperative questionnaire to evaluate the satisfaction and health-related quality of life in women with diagnosis of breast cancer prior to surgery, as well as identifying satisfaction profiles. METHODS: Prospective cohort observational study in women with breast cancer, evaluating preoperative quality of life using the BREAST-Q™ questionnaire. Percentile measures for each domain and baseline physical characteristics were assessed for posterior analysis. RESULTS: The average score in the breast satisfaction domain was 58.9±16.9. The average score in the preoperative psychosocial well-being domain was 70.5±16.1. Patients who were offered conservative surgery had a mean physical well-being score of 80.7±18.5, and those who were offered mastectomy had an average score of 79.9±17.7. The sexual well-being average score was 63.2±20.7. No statistically significant differences were found between low-score and high-score groups regarding epidemiological and clinical characteristics. CONCLUSIONS: Preoperative evaluation in breast cancer patients provides correct assessment of the effect of surgical treatment on patient satisfaction and quality of life. This information is useful for communicating with patients about their expectations and postoperative results

Evaluation of the preoperative perception of quality of life and satisfaction of women with breast cancer using the BREAST-Q™ questionnaire. / Evaluación de la percepción preoperatoria de la calidad de vida y satisfacción de la mujer con cáncer de mama mediante el cuestionario BREAST-Q™.

INTRODUCTION: Almost 40% of women who undergo breast surgery are dissatisfied with the decision-making process as well as cosmetic results. Our objective was to demonstrate the usefulness of the BREAST-Q™ preoperative questionnaire to evaluate the satisfaction and health-related quality of life in women with diagnosis of breast cancer prior to surgery, as well as identifying satisfaction profiles. METHODS: Prospective cohort observational study in women with breast cancer, evaluating preoperative quality of life using the BREAST-Q™ questionnaire. Percentile measures for each domain and baseline physical characteristics were assessed for posterior analysis. RESULTS: The average score in the breast satisfaction domain was 58.9±16.9. The average score in the preoperative psychosocial well-being domain was 70.5±16.1. Patients who were offered conservative surgery had a mean physical well-being score of 80.7±18.5, and those who were offered mastectomy had an average score of 79.9±17.7. The sexual well-being average score was 63.2±20.7. No statistically significant differences were found between low-score and high-score groups regarding epidemiological and clinical characteristics CONCLUSIONS: Preoperative evaluation in breast cancer patients provides correct assessment of the effect of surgical treatment on patient satisfaction and quality of life. This information is useful for communicating with patients about their expectations and postoperative results.

Lobectomía caudada con asistencia robótica: video de demostración técnica / Robotic-assisted caudate lobectomy: A video technique

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The Application of Indocyanine Green (ICG) Staining Technique During Robotic-Assisted Right Hepatectomy: with Video.

INTRODUCTION: The application of indocyanine green (icg) properties in the field of HPB surgery is gaining momentum. The adoption of the staining technique for the visualization of hepatic liver parenchyma is still preliminary. METHODS: We performed a 1:1 case- matched comparison among 20 patients who underwent robotic liver resection with or without the application of icg fluorescence. RESULTS: The icg enabled the reduction of postoperative liver abscess and bile leakage rate. The staining technique was not time-consuming and provided excellent enhancement of liver transection line. CONCLUSION: The routine use of icg-fluorescence could potentially reduce the postoperative complications during robotic liver surgery.

Single-Incision Approach for Breast-Conserving Surgery: Effectiveness, Complications and Quality of Life.

OBJECTIVE: The aim of this study was to assess the success of tumor resection and its postoperative complications, satisfaction, and quality of life using a single-incision approach for breast-conserving surgery. MATERIALS AND METHODS: This was an observational, prospective study conducted between 2015 and 2018. The study group consisted of patients in whom tumor extirpation and lymph node (LN) staging was performed using a single incision, while the control group consisted of patients who underwent a breast-conserving procedure with independent incisions. All patients were given the preoperative and postoperative module of the Breast-Q™ questionnaire. RESULTS: Overall, 226 patients met the study's inclusion criteria, 152 of whom successfully underwent breast and LN removal using a single-incision approach (98.7% overall success). There were no significant differences in postoperative complications, although there was a greater tendency towards breast seroma in the study group and axillary neuralgia in the control group. Both groups presented a similar rate of breast and axillary salvage surgery. The postoperative Breast-Q™ questionnaire showed that the study group had greater satisfaction with both the breast and the information provided by the surgeon. CONCLUSION: The single-incision approach is as effective as standard surgery, with custom incisions in terms of breast resection, LN staging, and complications. There was greater satisfaction with both the breast and the information provided.

El declive de la linfadenectomía axilar en el cáncer de mama. Evolución de su indicación durante los últimos 20 años / The decline of axillary lymph node dissection in breast cancer. Evolution of its indication over the last 20 years

Introducción: En los últimos 20 años los procedimientos de estadificación ganglionar en el cáncer de mama se han modificado. El objetivo de este estudio es describir la evolución de estos procedimientos en nuestro centro. Métodos: Estudio prospectivo observacional que incluye a las mujeres con cáncer de mama intervenidas entre el 2001 y el 2017. Se identificaron 4 grupos según el esquema terapéutico utilizado y 3 periodos a estudio definidos por las indicaciones de la linfadenectomía. Resultados: Mil trescientos diecinueve pacientes cumplieron los criterios de inclusión. La cirugía conservadora primaria fue el esquema terapéutico más frecuente (54,13%) y se realizaron 615 linfadenectomías axilares (46,62%) durante los 20 años estudiados. El porcentaje de linfadenectomías axilares disminuyó progresivamente en el tiempo, pasando del 91% en el primer periodo al 34% en el último periodo. Las linfadenectomías axilares fútiles descendieron al 6,6% en el último año. En la cirugía conservadora primaria no se realizó ninguna linfadenectomía axilar fútil los 2 últimos años. Conclusión: La introducción de la biopsia de ganglio centinela en 2001 y de los criterios ACOSOG Z0011 han modificado la indicación de la linfadenectomía axilar. Así, se han disminuido las linfadenectomías axilares sin afectación, evitando la morbilidad que asocia este procedimiento, especialmente linfedema. El estudio refleja el descenso progresivo de la indicación de la linfadenectomía en los diferentes grupos a estudio, similar a lo expuesto por otros autores. En diversos ensayos clínicos se ha descrito que estos cambios no han impactado negativamente en supervivencia

Introduction: In last 20 years, lymph node staging procedures in breast cancer have been modified. The objective of this study is to describe the evolution of these procedures at our hospital. Methods: A prospective observational study that included women with breast cancer who were treated surgically between 2001 and 2017. Four groups were identified according to the therapeutic regimen and 3 study periods defined by the lymph node dissection. Results: 1319 patients met the inclusion criteria. Primary conservative surgery was the most frequent therapy (54.13%), and 615 (46.62%) axillary lymph node dissections (ALND) were performed in the 20-year study period. The percentage of ALND decreased progressively over time, going from 91% in the first period to 34% in the last period. The futile ALND fell to 6.6% in the last year. In the primary conservative surgery, no futile ALND was performed in the last two years. Conclusion: The introduction of sentinel lymph node biopsy and the ACOSOG Z0011 criteria have modified the indication for ALND. Thus, ALND without involvement have been reduced, thereby avoiding the associated morbidity. The study demonstrates the progressive decrease in the indication of lymphadenectomy in the different study groups, similar to reports by other authors. Several clinical trials have described that these changes have not negatively impacted survival

The decline of axillary lymph node dissection in breast cancer. Evolution of its indication over the last 20 years. / El declive de la linfadenectomía axilar en el cáncer de mama. Evolución de su indicación durante los últimos 20 años.

INTRODUCTION: In last 20 years, lymph node staging procedures in breast cancer have been modified. The objective of this study is to describe the evolution of these procedures at our hospital. METHODS: A prospective observational study that included women with breast cancer who were treated surgically between 2001 and 2017. Four groups were identified according to the therapeutic regimen and 3 study periods defined by the lymph node dissection. RESULTS: 1319 patients met the inclusion criteria. Primary conservative surgery was the most frequent therapy (54.13%), and 615 (46.62%) axillary lymph node dissections (ALND) were performed in the 20-year study period. The percentage of ALND decreased progressively over time, going from 91% in the first period to 34% in the last period. The futile ALND fell to 6.6% in the last year. In the primary conservative surgery, no futile ALND was performed in the last two years. CONCLUSION: The introduction of sentinel lymph node biopsy and the ACOSOG Z0011 criteria have modified the indication for ALND. Thus, ALND without involvement have been reduced, thereby avoiding the associated morbidity. The study demonstrates the progressive decrease in the indication of lymphadenectomy in the different study groups, similar to reports by other authors. Several clinical trials have described that these changes have not negatively impacted survival.

Predictive factors of satisfaction and quality of life after immediate breast reconstruction using the BREAST-Q©.

AIMS AND OBJECTIVES: To analyse quality of life and satisfaction after immediate breast reconstruction due to cancer and its determining factors. BACKGROUND: Studying breast reconstruction is important because of its frequency and variability. In addition to the surgical results, it is necessary to analyse the quality of life and patient satisfaction using a specific tool. DESIGN METHODS: An ambispective design was used (n = 101; α = 0.05; precision = 10%), studying anthropometric, sociocultural data, Fagerström test and the BREAST-Q© questionnaire. A logistic regression analysis was performed to identify variables associated with quality of life and satisfaction. RESULTS: Mean age of the patients on diagnosis was 44.87 ± 8.5 years. Forty-one of the patients were carried out a skin-sparing mastectomy (42.7%). Immediate reconstruction was performed with implant in 73 (74.5%). The domains on the BREAST-Q© for quality of life with the lowest scores were physical well-being chest (74) and sexual well-being (61.5). The satisfaction domain with the lowest score was with the breast (59). The variables associated with the worst quality of life in the physical well-being chest domain were the skin-sparing mastectomy (OR, 4.2; 95% confidence interval (CI), 1.2-14.1) and lymphedema (OR, 12.9; 95% CI, 1.0-159.9). Antibody treatment was associated with a worse score on the psychosocial well-being domain (OR, 4.25; 95% CI, 1.0-18.0) and sexual well-being domain (OR, 7.34; 95% CI, 0.9-54.6). Satisfaction was associated with nicotine dependence on the breast and outcome scale. The higher the dependence on nicotine, the greater the dissatisfaction with the breasts (OR, 2.41; 95% CI, 1.1-5.3) and with the result (OR, 2.45; 95% CI, 1.0-5.9). CONCLUSIONS: The type of treatment and lymphedema modify the patients' quality of life. Nicotine dependence is associated with lower satisfaction with the breast and with the outcome. RELEVANCE TO CLINICAL PRACTICE: This study suggests the need for multidisciplinary attention during the first year of adjuvant treatment despite the benefits of immediate reconstruction. It shows the need for preoperative assessment of the level of nicotine dependence, anxiety and depression of smoking patients before preoperative counselling.

The role of oncoplastic breast reduction in the conservative management of breast cancer: Complications, survival, and quality of life.

BACKGROUND AND OBJECTIVES: Reduction Mammaplasty (RM) in breast cancer allows mammary remodeling after wide excisions. We aimed to analyze the complications, survival, and quality of life after RM. METHODS: Retrospective study of women who underwent a surgical intervention for breast cancer between 2000 and 2016. Patients were divided into two groups: RM and tumorectomy. Postoperative complications, survival and quality of life were assessed using the Breast-Q questionnaire. RESULTS: A total of 801 patients were evaluated, with a mean follow up of 84 months. RM patients experienced a longer operating time and hospital stay, and a higher proportion of tissue necrosis compared to tumorectomy patients (P < 0.001). No significant differences were observed regarding rate of re-excision or rate of mastectomy, but the recurrence rate at 10 years was higher for RM patients (P < 0.03). Patients who underwent RM reported optimal satisfaction with the breast and a good quality of life. CONCLUSIONS: RM is a useful approach in breast cancer surgery, with a low rate of re-excision and mastectomy. Overall survival at 10 years is similar to that associated with tumorectomy, though with a higher rate of local recurrence. Patient satisfaction and quality of life appears to be good one year after radiotherapy.

Colgajos por rotación en la cirugía oncológica de la mama. Fundamentos anatómicos y técnicos para su planificación quirúrgica / Rotational flaps in oncologic breast surgery. Anatomical and technical considerations

Los colgajos por rotación constituyen un grupo de procedimientos quirúrgicos que permiten solventar el cierre de grandes defectos torácicos después de la cirugía oncológica de la mama con una menor morbilidad y dificultad técnica respecto a los colgajos a distancia. Su utilización en las complicaciones por necrosis cutánea después de una cirugía conservadora o mastectomías preservadoras de piel permite el inicio de los tratamientos adyuvantes y disminuye las demoras en este grupo de pacientes. Este artículo describe los fundamentos anatómicos para la planificación de colgajos por rotación torácicos y abdominales. Asimismo, se muestra la aplicación de estos colgajos para el cierre de grandes defectos en el tórax y de colgajos selectivos para la cobertura cutánea después de una necrosis durante la cirugía conservadora de mama

Local flaps are a group of surgical procedures that can solve the thoracic closure of large defects after breast cancer surgery with low morbidity. Its use in skin necrosis complications after conservative surgery or skin sparing mastectomies facilitates the initiation of adjuvant treatments and reduces delays in this patient group. This article describes the anatomical basis for the planning of thoracic and abdominal local flaps. Also, the application of these local flaps for closing large defects in the chest and selective flaps for skin coverage by necrosis in breast conserving surgery

Alternativas quirúrgicas para el tratamiento de la trombosis venosa portal en el trasplante hepático / Surgical alternatives in the treatment of portal vein thrombosis in liver transplantation

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Radioterapia axilar en la cirugía conservadora del cáncer de mama en estadio temprano (estadio I y II) / Axillary radiotherapy in conservative surgery for early-stage breast cancer (stage I and II)

INTRODUCCIÓN: Diversos estudios clínicos analizan el tratamiento axilar en el cáncer de mama temprano debido a los cambios actuales en la indicación de la linfadenectomía axilar. El objetivo de este estudio fue analizar el impacto de la radioterapia axilar en la supervivencia global y libre de enfermedad en mujeres con un carcinoma de mama en estadio inicial tratadas mediante cirugía conservadora. MÉTODOS: Estudio retrospectivo en mujeres con un carcinoma infiltrante de mama en estadios iniciales tratadas mediante cirugía conservadora. Análisis comparativo de las mujeres con afectación ganglionar y factores de riesgo asociados que recibieron radioterapia axilar frente a un grupo con afectación ganglionar de bajo riesgo sin tratamiento radioterápico. Se utilizó una regresión logística para determinar los factores que influían en la supervivencia y en la aparición de linfedema. RESULTADOS: Se incluyó a 541 mujeres, 384 (71%) sin afectación de ganglios linfáticos axilares y 157 (29%) con afectación de 1-3 ganglios axilares. Las pacientes con radioterapia axilar tenían un mayor número de ganglios metastásicos respecto a las no irradiadas (1,6 ± 0,7 vs. 1,4 ± 0,6; p = 0,02). El grupo de mujeres con afectación ganglionar y radioterapia axilar tuvo una supervivencia global y libre de enfermedad a los 10 años similar a las pacientes sin irradiación de la axila (89,7 y 77,2%, respectivamente). La afectación de 3 ganglios incrementó 7 veces el riesgo de fallecer (HR = 7,20; IC 95%: 1,36-38,12). En el estudio multivariante, la linfadenectomía axilar fue el único factor de riesgo independiente de aparición de linfedema (HR = 22,22; IC 95%: 4,71-105,59; p < 0,001). CONCLUSIÓN: La recidiva axilar en el cáncer de mama en estadios I y II es un evento poco frecuente. En las enfermas con afectación axilar y factores de riesgo asociados, la radioterapia regional contribuye al control locorregional de la enfermedad con igual supervivencia global

INTRODUCTION: Several clinical studies analyze axillary treatment in women with early-stage breast cancer because of changes in the indication for axillary lymph node dissection. The aim of the study is to analyze the impact of axillary radiotherapy in disease-free and overall survival in women with early breast cancer treated with lumpectomy. METHODS: Retrospective study in women with initial stages of breast carcinoma treated by lumpectomy. A comparative analysis of high-risk women with axillary lymph node involvement who received axillary radiotherapy with the group of women with low risk without radiotherapy was performed. Logistic regression was used to determine factors influencing survival and lymphedema onset. RESULTS: A total of 541 women were included in the study: 384 patients (71%) without axillary lymph node involvement and 157 women (29%) with 1-3 axillary lymph node involvement. Patients with axillary radiotherapy had a higher number of metastatic lymph node compared to non-irradiated (1.6 ± 0.7 vs. 1.4 ± 0.6, P=.02). The group of women with axillary lymph node involvement and radiotherapy showed an overall and disease-free survival at 10 years similar to that obtained in patients without irradiation (89.7% and 77.2%, respectively). 3 lymph nodes involved multiplied by more than 7 times the risk of death (HR = 7.20; 95% CI: 1.36 to 38.12). The multivariate analysis showed axillary lymph node dissection as the only variable associated with the development of lymphedema. CONCLUSION: The incidence of axillary relapse on stage I and II breast cancer is rare. In these patients axillary radiotherapy does not improve overall survival, but contributes to regional control in those patients with risk factors

Axillary radiotherapy in conservative surgery for early-stage breast cancer (stage I and II). / Radioterapia axilar en la cirugía conservadora del cáncer de mama en estadio temprano (estadio I y II).

INTRODUCTION: Several clinical studies analyze axillary treatment in women with early-stage breast cancer because of changes in the indication for axillary lymph node dissection. The aim of the study is to analyze the impact of axillary radiotherapy in disease-free and overall survival in women with early breast cancer treated with lumpectomy. METHODS: Retrospective study in women with initial stages of breast carcinoma treated by lumpectomy. A comparative analysis of high-risk women with axillary lymph node involvement who received axillary radiotherapy with the group of women with low risk without radiotherapy was performed. Logistic regression was used to determine factors influencing survival and lymphedema onset. RESULTS: A total of 541 women were included in the study: 384 patients (71%) without axillary lymph node involvement and 157 women (29%) with 1-3 axillary lymph node involvement. Patients with axillary radiotherapy had a higher number of metastatic lymph node compared to non-irradiated (1.6±0.7 vs. 1.4±0.6, P=.02). The group of women with axillary lymph node involvement and radiotherapy showed an overall and disease-free survival at 10 years similar to that obtained in patients without irradiation (89.7% and 77.2%, respectively). 3 lymph nodes involved multiplied by more than 7 times the risk of death (HR=7.20; 95% CI: 1.36 to 38.12). The multivariate analysis showed axillary lymph node dissection as the only variable associated with the development of lymphedema. CONCLUSION: The incidence of axillary relapse on stage I and II breast cancer is rare. In these patients axillary radiotherapy does not improve overall survival, but contributes to regional control in those patients with risk factors.

Rotational flaps in oncologic breast surgery. Anatomical and technical considerations. / Colgajos por rotación en la cirugía oncológica de la mama. Fundamentos anatómicos y técnicos para su planificación quirúrgica.

Local flaps are a group of surgical procedures that can solve the thoracic closure of large defects after breast cancer surgery with low morbidity. Its use in skin necrosis complications after conservative surgery or skin sparing mastectomies facilitates the initiation of adjuvant treatments and reduces delays in this patient group. This article describes the anatomical basis for the planning of thoracic and abdominal local flaps. Also, the application of these local flaps for closing large defects in the chest and selective flaps for skin coverage by necrosis in breast conserving surgery.

Hernia gástrica secundaria a gastroplastia tubular aplicada / Gastric hernia after tubular gastroplasty

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Trauma duodenal. Consecuencias del retraso en su diagnóstico / Duodenal trauma. Consequences of delay in diagnosis

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