Axillary staging and management of cN+breast cancer patients treated with neoadjuvant chemotherapy: results of a survey among breast cancer surgeons in Spain

Introduction Given the high rate of complete nodal response, the role of axillary lymph node dissection on staging the axilla has been questioned. This survey, addressed to breast cancer surgeons in Spain, has the objective of assessing current clinical trends on axillary staging of cN + patients treated with NAC. Methods An online survey was conducted among breast surgeons from the Spanish Society of Surgery (AEC), Spanish Surgical Oncology Society (SEOQ), Spanish Breast Cancer Surgeons Society (AECIMA) and Spanish Gynecology and Obstetrics Society (SEGO). It was structured in 5 sections: general information and clinical practice, knowledge of clinical trials, diagnosis work-up and nodal marking, axillary staging, and axillary treatment. Results 150 breast cancer surgeons completed the full survey (96.7%). 81.8% of respondents performed SLNB or targeted axillary dissection in cN1 patients treated with NAC. Radiological axillary response was the preferred parameter guiding the surgical strategy. The excision of the clipped node (92.0%), use of dual tracer (73.2%), and axillary US (65.9%) after treatment were the most important variables considered by respondents, to increase the accuracy of SLNB in cN + patients. Conclusion This survey confirms a trend toward a less invasive approach for axillary staging in cN + patients treated with NAC among breast cancer surgeons in Spain. While there is widespread agreement in less invasive approaches to axillary staging, there is, however, a lack of consensus around treatment strategy. Further, it shows a wide heterogeneity in their clinical practice. This study highlights the need for clear evidence concerning less invasive staging procedures and their oncological safety, to ensure consistent recommendations in surgical practice (AU)

Axillary staging and management of cN + breast cancer patients treated with neoadjuvant chemotherapy: results of a survey among breast cancer surgeons in Spain.

INTRODUCTION: Given the high rate of complete nodal response, the role of axillary lymph node dissection on staging the axilla has been questioned. This survey, addressed to breast cancer surgeons in Spain, has the objective of assessing current clinical trends on axillary staging of cN + patients treated with NAC. METHODS: An online survey was conducted among breast surgeons from the Spanish Society of Surgery (AEC), Spanish Surgical Oncology Society (SEOQ), Spanish Breast Cancer Surgeons Society (AECIMA) and Spanish Gynecology and Obstetrics Society (SEGO). It was structured in 5 sections: general information and clinical practice, knowledge of clinical trials, diagnosis work-up and nodal marking, axillary staging, and axillary treatment. RESULTS: 150 breast cancer surgeons completed the full survey (96.7%). 81.8% of respondents performed SLNB or targeted axillary dissection in cN1 patients treated with NAC. Radiological axillary response was the preferred parameter guiding the surgical strategy. The excision of the clipped node (92.0%), use of dual tracer (73.2%), and axillary US (65.9%) after treatment were the most important variables considered by respondents, to increase the accuracy of SLNB in cN + patients. CONCLUSION: This survey confirms a trend toward a less invasive approach for axillary staging in cN + patients treated with NAC among breast cancer surgeons in Spain. While there is widespread agreement in less invasive approaches to axillary staging, there is, however, a lack of consensus around treatment strategy. Further, it shows a wide heterogeneity in their clinical practice. This study highlights the need for clear evidence concerning less invasive staging procedures and their oncological safety, to ensure consistent recommendations in surgical practice.

Linfoma anaplásico de células grandes asociado a implantes mamarios. Documento de consenso (I): epidemiología, patogenia, clínica y diagnóstico / Breast-implant associated anaplastic large-cell lymphoma. Consensus document (I). Epidemiology, pathogenesis, symptoms and diagnosis

El linfoma anaplásico de células grandes asociado a implantes mamarios (BIA-ALCL según sus siglas en inglés) es un tipo raro de linfoma no Hodgkin que se ha descrito en el contexto de la cirugía reconstructiva y estética de mama mediante implantes. Estos artículos presentan un consenso de la Sociedad Española de Senología y Patología Mamaria (SESPM) con la idea de unificar, en esta primera parte, los criterios de diagnóstico de esta enfermedad describiendo asimismo la epidemiología y la etiopatogenia

Breast implant-associated anaplastic large-cell lymphoma (BIA-ALCL) is a rare type of non-Hodgkin lymphoma that has been described in the context of reconstructive and aesthetic breast implant surgery. These articles present a consensus of the Spanish Society of Senology and Breast Disease (SESPM). In this first part, the aim is to unify the diagnostic criteria of this disease and describe its epidemiology and etiopathogenesis

Linfoma anaplásico de células grandes asociado a implantes mamarios. Documento de consenso parte II: estadificación, tratamiento, pronóstico y seguimiento / Breast implant-associated anaplastic large-cell lymphoma. Consensus document part II: Staging, prognosis and follow-up

El linfoma anaplásico de células grandes asociado a implantes mamarios (BIA-ALCL según sus siglas en inglés) es un tipo raro de linfoma no Hodgkin que se ha descrito en el contexto de la cirugía reconstructiva y estética de mama mediante implantes. Este segundo artículo presenta la parte del consenso de la Sociedad Española de Senología y Patología Mamaria (SESPM) sobre el tratamiento quirúrgico, médico, radioterápico, pronóstico y seguimiento

Breast implant-associated anaplastic large-cell lymphoma (BIA-ALCL) is a rare type of non-Hodgkin lymphoma that has been described in the context of breast implant reconstructive and cosmetic surgery. This second article presents the consensus of the Spanish Society of Senology and Breast Disease (SESPM) on the medical and surgical treatment of this disease, radiotherapy, prognosis and follow-up

Splenic metastases from mucinous neoplasms of the appendix and colon.

AIMS AND BACKGROUND: Splenic metastases associated with mucinous intraabdominal tumors have been an enigma in the radiologic and oncology literature. These focal parenchymal defects from a non-metastasizing malignancy within an organ that rarely develops metastatic foci, even with high-grade cancer, were studied. METHODS: Information on 9 patients who underwent splenectomy with intraparenchymal splenic masses associated with appendiceal or colorectal mucinous tumors with peritoneal dissemination was collected. The CT scan, the histopathology and the clinical parameters of these patients were studied. A literature review searching for prior reports of this subject was performed. RESULTS: Eight of these patients had mucinous appendiceal tumors and 1 a mucinous sigmoid colon cancer. All patients had mucinous carcinomatosis at some time in their clinical course. These splenic tumor masses had a CT image compatible with metastases and not compatible with mucinous tumor layered out of the splenic capsule. None of the patients had evidence of metastases to other sites such as liver or lymph nodes. All patients had a mucinous histopathology. Splenectomy may be associated with prolonged survival. CONCLUSIONS: From our review of the clinical information available on these 9 patients, these splenic lesions were thought to be an entrapment of mucinous tumor within splenic surface trabeculae, which expand into the splenic parenchyma resembling metastatic disease. These CT findings may be more accurately referred to as splenic pseudometastases.

Limited survival in the treatment of carcinomatosis from rectal cancer.

PURPOSE: Carcinomatosis from colon and rectal cancer has always been regarded as a lethal condition. Recently, numerous reports suggest that long-term survival is possible in selected patients if a definitive management strategy is used. An important task involves the clear description of the clinical features that influence prognosis in these patients. METHODS: From June 1981 to November 2004, 156 patients with peritoneal carcinomatosis secondary to colorectal cancer underwent cytoreductive surgery with perioperative intraperitoneal chemotherapy. Among these patients, 11 had rectal cancer with carcinomatosis and are the focus of the present study. The survival of patients with peritoneal carcinomatosis of rectal cancer origin was compared with patients with colon cancer. In the data analysis, patients were classified by completeness of cytoreduction score. RESULTS: The mean follow-up for 11 patients with rectal cancer was 15.7 (range, 3-51) months. At the end of the cytoreductive surgery, the cytoreduction was complete in six patients, nearly complete in two patients, and there was gross disease in three patients. The median survival of the six rectal cancer patients with complete cytoreduction was 17 (range, 12-29) months and 35 (range, 3-241) months for 64 colon cancer patients with complete cytoreduction (P = 0.126). The five-year survival for patients with rectal cancer with complete cytoreduction was 0 percent and for patients with colon cancer was 33 percent. CONCLUSIONS: Patients with peritoneal carcinomatosis secondary to rectal cancer treated by cytoreductive surgery combined with intraperitoneal chemotherapy have a poor prognosis. Some improvement in these poor results may occur if resection of a rectal cancer with carcinomatosis is delayed until definitive treatment of the primary cancer plus the carcinomatosis is possible.

Recurrence of pseudomyxoma peritonei within the inguinal canal.

AIM AND BACKGROUND: Tumor appearing in an inguinal hernia sac indicates widespread carcinomatosis with ascites. A new onset hernia is a common clinical presentation of pseudomyxoma peritonei syndrome arising in an appendiceal mucinous tumor. Recurrence of pseudomyxoma peritonei within the inguinal region was previously reported in only a single patient. We present five patients with a recurrence of pseudomyxoma peritonei tumor nodules in the inguinal region following cytoreductive surgery and attempt to understand the etiology of this treatment failure. METHODS AND STUDY DESIGN: From a database of 910 patients with mucinous appendiceal tumors with peritoneal dissemination who had definitive treatment, five patients who had disease recurrence within the inguinal region were identified. The clinical histories were studied and presented in order to make future recommendations regarding the management of these patients. RESULTS: Five patients with ages ranging 39 to 67 years had a mucinous tumor in the inguinal region as a recurrence after a previous cytoreductive surgery combined with perioperative intraperitoneal chemotherapy. One of them had separate recurrence in both right and left inguinal regions. All these patients were made disease-free by the reoperative surgery with a sacrifice of the testicle in four. None have evidence of a recurrence of an inguinal hernia despite the lack of formal repair. CONCLUSION: At the time of initial cytoreductive surgery the surgeon should be aware of the inguinal region as a possible site of relapse. This may be more problematic in patients who have had prior surgery with mucoid fluid in a hernia as the presenting sign of pseudomyxoma peritonei. Inguinal recurrences should be removed with clear margins even if orchiectomy is required.

Cirugía radiodirigida del adenoma de paratiroides / Radioguided surgery for parathyroid adenoma

Introducción. En la última década, coincidiendo con la introducción de la gammagrafía marcada con sestamibi se han descrito distintos protocolos de cirugía con abordaje unilateral. Entre ellos surge la posibilidad de utilizar sondas manuales de detección de radiación gamma para identificar las glándulas marcadas con sestamibi. En el trabajo se evalúa la posibilidad de un abordaje unilateral en el hiperparatiroidismo primario facilitado por la sonda manual. Pacientes y método. Se incluye a 20 pacientes diagnosticados de hiperparatiroidismo primario en los que la gammagrafía preoperatoria con sestamibi muestra la sospecha de un adenoma, y se comparan con un grupo control de cirugía convencional recogido del archivo histórico del hospital. Resultados. Hubo un cado de conversión a cervicotomía bilateral (5 por ciento). En el resto se completó la intervención con abordaje unilateral sin que se produjeran recidivas del hiperparatiroidismo ni complicaciones importantes. La duración mediana de la cirugía fue de 40 min en el grupo radiodirigido (30 por ciento menor que con el abordaje convencional), con una estancia postoperatoria de un día (incluyendo a 4 pacientes que fueron intervenidos en régimen ambulatorio). El tamaño de las incisiones realizadas en los pacientes tratados con cirugía unilateral fue de 2,8 cm. Conclusion. Un abordaje unilateral mínimamente invasivo es posible y seguro cuando la gammagrafía preoperatoria muestra la sospecha de un adenoma de paratiroides. Con ello se consigue evitar una disección cervical innecesaria y una reducción de la duración de la cirugía, la estancia postoperatoria y el tamaño de la cicatriz, con la consiguiente satisfacción por parte de los pacientes y los cirujanos (AU)