Tratamiento quirúrgico de la fibromatosis agresiva en relación con cesárea previa / Surgical treatment of aggressive fibromatosis in relation to previous cesarean section

Introducción. Los tumores desmoides son lesiones de los tejidos blandos, histológicamente benignas, poco frecuentes y con gran agresividad local y carencia de potencial metastásico. Se relacionan estrechamente con antecedentes traumáticos o quirúrgicos, como la cesárea, y su tratamiento generalmente es quirúrgico. Métodos. Presentamos una serie de tres pacientes intervenidas en nuestro centro durante el año 2020. Se revisan sus antecedentes y se describe su tratamiento. Resultados. En todas nuestras pacientes se encontró algún antecedente quirúrgico, dos cesáreas y una resección de un disgerminoma. El tratamiento empleado fue la resección quirúrgica con márgenes libres y reparación del defecto mediante malla. Conclusiones. El tumor desmoide es una patología poco frecuente, su diagnóstico se realiza mediante exámenes imagenológicos y se confirma con el estudio histológico; es importante hacer el diagnóstico diferencial con el sarcoma. La cirugía radical sigue siendo el tratamiento de elección, aunque algunos autores proponen el tratamiento conservador.

Introduction. Desmoid tumors are soft tissue lesions, histologically benign, rare and with great local aggressiveness and lack of metastatic potential. They are closely related to traumatic or surgical history such as caesarean section. Their treatment is generally surgical. Methods. We present a case series of three patients operated on in our center during the year 2020. Their history is reviewed and their type of treatment is presented. Results. In all our patients, surgical history was found (two caesarean sections and one resection of a dysgerminoma). The treatment used was surgical resection with free margins and mesh repair of the defect. Conclusions. Desmoid tumor is a rare pathology; its diagnosis is made by imaging studies, and confirmed by histology. It is important to make a differential diagnosis with sarcoma. Radical surgery remains the treatment of choice, although some authors propose conservative treatment.

Modelo CBCRisk para determinar el riesgo de cáncer de mama contralateral en el cáncer de mama esporádico / CBCRisk model to determine the risk of contralateral breast cancer in sporadic breast cancer

Introducción: La mayoría de los cánceres de mama (CM) se diagnostican en mujeres sin antecedentes familiares y no portadoras de mutaciones de riesgo. En las últimas décadas se ha producido un aumento de mastectomías profilácticas contralaterales (MPC) en estas pacientes. El CBCRisk es un modelo que calcula el riesgo absoluto de cáncer de mama contralateral (CMC) y pretende servir para el asesoramiento de pacientes con CM esporádico sobre la MPC. Método: Análisis observacional retrospectivo de pacientes con un cáncer de mama esporádico sometidas a MPC durante 2017-2019. Análisis descriptivo, comparativo y de regresión logística univariante para identificar factores predictivos de LMAR y/o CMC oculto. Evaluación del modelo CBCRisk publicado en 2017 y distintos valores límite para la recomendación de MPC. Resultados: Se seleccionaron 42 pacientes. Incidencia de LMAR y cáncer oculto (CO) menor que la descrita en la literatura (9,52% LMAR, 2,38% CO). Ninguna de las variables evaluadas alcanzó significación estadística para la predicción de lesiones. El valor de CBCRisk a cinco años medio en pacientes con hallazgos patológicos fue de 2,08 (DE 0,97), superior al CBCRisk medio del conjunto (1,87 ± 0,91) y del subgrupo de MPC sin hallazgos patológicos (1,84 ± 0,91). Solo el CBCRisk ≥ 3 resultó significativo (p = 0,04) para la predicción de hallazgos patológicos. Conclusión: Las pacientes con CM esporádico deben ser adecuadamente informadas de los riesgos y beneficios estimados de la MPC. El CBCRisk puede ser útil para el asesoramiento de estas pacientes, pero precisa validación en cohortes más amplias y prospectivas. (AU)

Introduction: The great majority of breast cancer (BC) cases are diagnosed in women who have no known family history of the disease and are not carriers of any risk mutation. During the past few decades an increase in the number of contralateral prophylactic mastectomy (CPM) has been produced in these patients. The CBCRisk model calculates the absolute risk of suffering from contralateral breast cancer (CBC); thus, it can be used to counselling patients with sporadic breast cancer. Method: An observational, retrospective study including sporadic breast cancer patients treated with contralateral prophylactic mastectomy has been conducted between 2017 and 2019. A descriptive and comparative study with one variation of logistic regression has been carried out in order to identify predictive factors of occult tumors (OT) and medium/high risk damage (MHRD). Evaluation of the CBCRisk model published in 2017 and different limit values for the CPM recommendation. Results: 42 patients were selected. Incidence of MHRD and OT was lower than that described in the literatura (9.52% MHRD, 2.38% OT). None of the evaluated variables reached statistical significance for predicting injuries. The average value of CBCRisk 5 years ahead found in patients with pathological findings was 2.08 (SD 0.97), higher than the average value of the whole group (1.87 ± 0.91) and the subgroup without pathological findings (1.84 ± 0.91). Only values ≥ 3 for CBCRisk were considered statistically significant (p = 0.04) for the prediction of histological lesions. Conclusion: Patients with sporadic breast cancer should be adequately informed about the estimated risks and benefits of undergoing a contralateral prophylactic mastectomy. The CBCRisk may be useful for the counseling of these patients, but it requires validation in larger and prospective cohorts. (AU)

CBCRisk model to determine the risk of contralateral breast cancer in sporadic breast cancer.

INTRODUCTION: The great majority of breast cancer (BC) cases are diagnosed in women who have no known family history of the disease and are not carriers of any risk mutation. During the past few decades an increase in the number of contralateral prophylactic mastectomy (CPM) has been produced in these patients. The CBCRisk model calculates the absolute risk of suffering from contralateral breast cancer (CBC); thus, it can be used to counselling patients with sporadic breast cancer. METHOD: An observational, retrospective study including sporadic breast cancer patients treated with contralateral prophylactic mastectomy has been conducted between 2017 and 2019. A descriptive and comparative study with one variation of logistic regression has been carried out in order to identify predictive factors of occult tumors (OT) and medium/high risk damage (MHRD). Evaluation of the CBCRisk model published in 2017 and different limit values for the CPM recommendation. RESULTS: 42 patients were selected. Incidence of MHRD and OT was lower than that described in the literatura (9.52%MHRD, 2.38%OT). None of the evaluated variables reached statistical significance for predicting injuries. The average value of CBCRisk 5 years ahead found in patients with pathological findings was 2.08 (DE 0.97), higher than the average value of the whole group (1.87 ± 0.91) and the subgroup without pathological findings (1.84 ± 0.91). Only values >3 for CBCRisk were considered statistically significant (P = .04) for the prediction of histological lesions. CONCLUSION: Patients with sporadic breast cancer should be adequately informed about the estimated risks and benefits of undergoing a contralateral prophylactic mastectomy. The CBCRisk may be useful for the counseling of these patients, but it requires validation in larger and prospective cohorts.

Mastectomía preservadora de piel con colgajo dermograso desepitelizado (técnica de Spira modificada) y reconstrucción mediante implante directo / Nipple sparing mastectomy with a de-epithelialized derma-fat flap (modified Spira technique) and direct-to implant reconstruction

Introducción: La técnica de Spira es un tipo de mastectomía preservadora de piel que permite la reconstrucción inmediata (RMI), ideal en mamas ptósicas. Si bien, persiste controversia sobre resultados oncológicos en el cáncer de mama. El objetivo es analizar complicaciones, secuelas cosméticas, causas de reintervención y resultados oncológicos. Métodos: Estudio observacional retrospectivo de pacientes intervenidas durante 2003-2018 en nuestro centro. La población de estudio la constituyen pacientes con carcinoma de mama o sometidas a mastectomía profiláctica por alto riesgo, en las que se realizó una mastectomía preservadora de piel con colgajo dermograso desepitelizado (técnica de Spira modificada) y reconstrucción mediante implante directo. Se analiza la presencia de complicaciones precoces y tardías, secuelas, recidiva tumoral y supervivencia. Resultados: Se realizaron 247 mastectomías con reconstrucción en 139 pacientes, 216 bilaterales (87,4%) y 31 unilaterales (12,5%); 121 terapéuticas (49%) y 126 profilácticas (51%). La mediana de seguimiento fue de 81 meses. Se observaron complicaciones en un 16,2%; necrosis cutánea en 5,3% y cinco casos de necrosis del CAP (2%). La tasa de reintervención por secuelas cosméticas fue del 17,4% (la más frecuente fue contractura capsular 11,3%) y, de ellas, el 39,3% recibieron RT. La tasa de recidiva fue del 14% (0,8% cutánea, 3,3% locorregional y 9,9% a distancia). Ocho pacientes fallecieron (6,6%). La SLE y SG fue del 92,6% y 93,3% a cinco años. Conclusión: La técnica de Spira constituye una opción segura y ofrece buenos resultados cosméticos y oncológicos como tratamiento y profilaxis de cáncer de mama en mamas ptósicas de moderado a gran tamaño. (AU)

Introduction: Spira technique is a type of nipple-sparing mastectomy that allows immediate reconstruction (IBR), ideal for ptosic breasts. Although, controversy persists regarding oncological results in breast cancer. The aim is to analyze complications, cosmetic outcomes, causes of reoperation and oncological results. Methods: Retrospective observational analysis of patients undergone surgery during 2003-2018 in our center. Study population is based on patients with breast carcinoma or undergoing prophylactic mastectomy due to high-risk, in which a skin-sparing mastectomy with a de-epithelialized derma-fat flap (modified Spira technique) and direct to implant reconstruction was performed. Short and long-term complications, sequelae, tumor recurrence and survival rates are analyzed. Results: A total of 247 mastectomies with immediate reconstruction in 139 patients, 216 bilateral (87.4%) and 31 unilateral (12.5%) were performed. 121 therapeutic (49%) and 126 prophylactic (51%). Median follow-up 81 months. Complications were observed in 16.2%; skin necrosis 5.3% and 5 cases of NAC necrosis (2%). Reoperation rate due to cosmetic sequelae was 17.4% (capsular contracture was the most frequent,11.3%) and a 39.3% of these patients have received RT. Recurrence of 14% (0.8% skin, 3.3% locoregional and 9.9% metastatic), 8 patients died (6.6%). Rates of FSD and OS were 92.6% and 93.3% respectively. Conclusion: Spira mastectomy is a safe option and provides good cosmetic and oncologic results as breast cancer treatment and prophylaxis in moderate-large ptosic breasts. (AU)

Prolapso rectal incarcerado: rectosigmoidectomía perineal urgente / Strangle rectal prolapse: Emergency perineal rectosigmoidectomy

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Nipple sparing mastectomy with a de-epithelialized derma-fat flap (modified Spira technique) and direct-to implant reconstruction. / Mastectomía preservadora de piel con colgajo dermograso desepitelizado (técnica de Spira modificada) y reconstrucción mediante implante directo.

INTRODUCTION: Spira technique is a type of nipple-sparing mastectomy that allows immediate reconstruction (IBR), ideal for ptosic breasts. Although, controversy persists regarding oncological results in breast cancer. The aim is to analyze complications, cosmetic outcomes, causes of reoperation and oncological results. METHODS: Retrospective observational analysis of patients undergone surgery during 2003-2018 in our center. Study population is based on patients with breast carcinoma or undergoing prophylactic mastectomy due to high-risk, in which a skin-sparing mastectomy with a de-epithelialized derma-fat flap (modified Spira technique) and direct to implant reconstruction was performed. Short and long-term complications, sequelae, tumor recurrence and survival rates are analyzed. RESULTS: A total of 247 mastectomies with immediate reconstruction in 139 patients, 216 bilateral (87.4%) and 31 unilateral (12.5%) were performed. 121 therapeutic (49%) and 126 prophylactic (51%). Median follow-up 81 months. Complications were observed in 16.2%; skin necrosis 5.3% and 5 cases of NAC necrosis (2%). Reoperation rate due to cosmetic sequelae was 17.4% (capsular contracture was the most frequent,11.3%) and a 39.3% of these patients have received RT. Recurrence of 14% (0.8% skin, 3.3% locoregional and 9.9% metastatic), 8 patients died (6.6%). Rates of FSD and OS were 92.6% and 93.3% respectively. CONCLUSION: Spira mastectomy is a safe option and provides good cosmetic and oncologic results as breast cancer treatment and prophylaxis in moderate-large ptosic breasts.

CBCRisk model to determine the risk of contralateral breast cancer in sporadic breast cancer. / Modelo CBCRisk para determinar el riesgo de cáncer de mama contralateral en el cáncer de mama esporádico.

INTRODUCTION: The great majority of breast cancer (BC) cases are diagnosed in women who have no known family history of the disease and are not carriers of any risk mutation. During the past few decades an increase in the number of contralateral prophylactic mastectomy (CPM) has been produced in these patients. The CBCRisk model calculates the absolute risk of suffering from contralateral breast cancer (CBC); thus, it can be used to counselling patients with sporadic breast cancer. METHOD: An observational, retrospective study including sporadic breast cancer patients treated with contralateral prophylactic mastectomy has been conducted between 2017 and 2019. A descriptive and comparative study with one variation of logistic regression has been carried out in order to identify predictive factors of occult tumors (OT) and medium/high risk damage (MHRD). Evaluation of the CBCRisk model published in 2017 and different limit values for the CPM recommendation. RESULTS: 42 patients were selected. Incidence of MHRD and OT was lower than that described in the literatura (9.52% MHRD, 2.38% OT). None of the evaluated variables reached statistical significance for predicting injuries. The average value of CBCRisk 5 years ahead found in patients with pathological findings was 2.08 (SD 0.97), higher than the average value of the whole group (1.87 ± 0.91) and the subgroup without pathological findings (1.84 ± 0.91). Only values ≥ 3 for CBCRisk were considered statistically significant (p = 0.04) for the prediction of histological lesions. CONCLUSION: Patients with sporadic breast cancer should be adequately informed about the estimated risks and benefits of undergoing a contralateral prophylactic mastectomy. The CBCRisk may be useful for the counseling of these patients, but it requires validation in larger and prospective cohorts.

Cáncer de mama contralateral y recurrencia en portadoras BRCA1/2 y no portadoras con alto riesgo de cáncer de mama hereditario tras mastectomía bilateral / Contralateral breast cancer and tumor recurrence in BRCA1/2 carriers and non-carriers at a high risk of hereditary breast cancer after bilateral mastectomy

INTRODUCCIÓN: La mastectomía contralateral profiláctica (MCP) reduce el riesgo de cáncer contralateral en al menos un 90%. Además, las portadoras de mutación BRCA tienen mayor riesgo de recurrencia ipsilateral y de un segundo tumor primario. El objetivo es evaluar el riesgo de cáncer contralateral y la recurrencia, y analizar factores predictivos en pacientes con cáncer de mama y mutaciones BRCA1/2 y no portadoras con alto riesgo de cáncer hereditario. MÉTODOS: Análisis observacional retrospectivo de 46 pacientes sometidas a mastectomía bilateral durante 2004-2018. Nueve pacientes BRCA1, 12 BRCA2 y 25 con alto riesgo sin mutación. RESULTADOS: Dieciséis pacientes con diagnóstico de novo y 30 tratadas previamente por cáncer de mama a las que realizamos MCP de manera diferida (en 10 de ellas por detección de mutación en BRCA a posteriori); mediana de seguimiento 79 meses. La técnica quirúrgica más usada fue la incisión lateral externa. En todas las pacientes se realizó reconstrucción inmediata. En las piezas de MCP se encontraron 4 tumores in situ, 3 invasivos y una hiperplasia atípica. La incidencia de cáncer contralateral oculto fue del 15,2%. Cinco pacientes presentaron recidiva 21,2 meses de media tras la intervención; SLE 83,74 meses y SG 84,33 meses. Los modelos de regresión identificaron mutación BRCA1/2 y alto riesgo sin mutación como factores predictivos significativos para tumor oculto, mientras que el tamaño tumoral ≥ 2 cm fue predictivo de recidiva. CONCLUSIONES: En nuestra serie 7 pacientes (15,2%) habrían desarrollado un tumor contralateral en los años posteriores, y un 10,8% presentaron recurrencia a pesar de MCP

INTRODUCTION: Contralateral prophylactic mastectomy (CPM) has been reported to reduce risk of contralateral breast cancer (CBC) by at least 90%.In addition, BRCA carriers presents higher risk of ipsilateral recurrence and a second primary tumor. The aim is to evaluate risk of CBC and recurrence and to analyze predictive factors in BRCA1/2 mutation carriers and non-carriers at high-risk of hereditary breast cancer patients. METHODS: Retrospective observational study. 46 patients underwent bilateral mastectomy during 2004-2018. RESULTS: Cohort comprised 9 patients BRCA1,12 BRCA2 and 25 at high-risk without mutation. Median follow-up 79 months. 16 patients recently diagnosed and 30 previously treated by breast cancer whom underwent CPM at second time (because of later detection of BRCA mutation in 10 cases). The external lateral incision was most frequent surgical technique. In all patients immediate reconstruction was performed. In CPM pieces, 4 in situ carcinoma, 3 invasive and 1 atypical hyperplasia were found. The incidence of occult contralateral cancer was 15.2%. Recurrence was observed in 5 patients a media of 21.2 months after surgery. FSD was 83.74 months and OS 84.33 months. Regression models identified BRCA1/2 mutation and high risk without mutation as significant occult tumor predictive factors while tumor size ≥ 2 cm was predictive of recurrence. CONCLUSIONS: In our series we found a10.8% recurrence despite CPM and 7 patients (15.2%) would have developed a CBC in subsequent years

Resección segmentaria de cuarta porción duodenal mediante Robot Da Vinci / Segmental resection of the fourth duodenal portion using the Da Vinci Robot

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Reflexiones y evidencias sobre la mastectomía reductora de riesgo. Respuesta de los autores / Risk reducing mastectomy: reflections and evidences. Author's reply

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Contralateral breast cancer and tumor recurrence in BRCA1/2 carriers and non-carriers at a high risk of hereditary breast cancer after bilateral mastectomy. / Cáncer de mama contralateral y recurrencia en portadoras BRCA1/2 y no portadoras con alto riesgo de cáncer de mama hereditario tras mastectomía bilateral.

INTRODUCTION: Contralateral prophylactic mastectomy (CPM) has been reported to reduce risk of contralateral breast cancer (CBC) by at least 90%.In addition, BRCA carriers presents higher risk of ipsilateral recurrence and a second primary tumor. The aim is to evaluate risk of CBC and recurrence and to analyze predictive factors in BRCA1/2 mutation carriers and non-carriers at high-risk of hereditary breast cancer patients. METHODS: Retrospective observational study. 46 patients underwent bilateral mastectomy during 2004-2018. RESULTS: Cohort comprised 9 patients BRCA1,12 BRCA2 and 25 at high-risk without mutation. Median follow-up 79 months. 16 patients recently diagnosed and 30 previously treated by breast cancer whom underwent CPM at second time (because of later detection of BRCA mutation in 10 cases). The external lateral incision was most frequent surgical technique. In all patients immediate reconstruction was performed. In CPM pieces, 4 in situ carcinoma, 3 invasive and 1 atypical hyperplasia were found. The incidence of occult contralateral cancer was 15.2%. Recurrence was observed in 5 patients a media of 21.2 months after surgery. FSD was 83.74 months and OS 84.33 months. Regression models identified BRCA1/2 mutation and high risk without mutation as significant occult tumor predictive factors while tumor size≥2cm was predictive of recurrence. CONCLUSIONS: In our series we found a10.8% recurrence despite CPM and 7 patients (15.2%) would have developed a CBC in subsequent years.

Mastectomía ahorradora de piel y pezón en carcinoma ductal in situ. Seguridad oncológica a 10 años / Nipple-sparing mastectomy in ductal carcinoma in situ. Oncological results over a 10-year period

OBJETIVO: El objetivo es evaluar la seguridad oncológica a 10 años de la mastectomía ahorradora de piel y pezón (MAP) en pacientes con carcinoma ductal in situ (CDIS). MÉTODO: Análisis observacional retrospectivo. Se realizaron 35 MAP en pacientes con CDIS durante 2005-2018. Evaluamos resultados histológicos, oncológicos y de morbilidad. RESULTADOS: Las indicaciones más frecuentes fueron márgenes afectos tras tumorectomía (31,5%), multifocalidad/multicéntricidad (22,8%), tumor >3 cm (8,6%) correlación desfavorable tamaño tumoral/mama (8,6%) y decisión de la paciente (8,6%). La técnica más usada fue incisión lateral externa en 11 pacientes, seguida de técnica de Spira en nueve casos. La presencia de CDIS se confirmó en 22 pacientes y en 11 no se encontró tumor en la pieza de mastectomía. La tasa de complicaciones fue 22,8%. Tras una mediana de seguimiento de 104 meses (DE 69,9) no se observó necrosis del pezón. Un 20% de pacientes precisó reintervención a largo plazo. Once pacientes (31,4%) recibieron tratamiento adyuvante (QT y/o RT). Solamente una paciente presentó recurrencia local (2,8%) 28 meses tras la intervención. Una paciente presentó metástasis tras 78 meses de SLE. Las tasas de SLE y SG fueron 94,3% y 97,22%. El análisis univariante mostró dos factores de riesgo de recurrencia: edad <40 [OR (IC95) 2,529 (1,230 - 5,199)] y márgenes afectos [OR (IC95) 5,242 (2,041 - 13,464)]. CONCLUSIÓN: La MAP es factible y segura en pacientes con CDIS no candidatas a cirugía conservadora

OBJECTIVE: The aim of this study was to assess the oncological safety of nipple-sparing mastectomy (NSM) in patients with ductal in situ carcinoma (DCIS) over a 10-year period. METHOD: Retrospective observational analysis. A total of 35 NSM were performed in patients with DCIS from 2005 - 2018. We assessed the histological, oncological and morbidity results. RESULTS: The most frequent indications were margin involvement after lumpectomy (31.5%), multifocality / multicentricity (22.8%), tumour size >3 cm (8.6%) unfavourable tumour / breast size correlation (8.6%) and patient choice (8.6%). The most commonly used technique was external lateral incision in 11 patients, followed by the Spira technique in 9 patients. DCIS was confirmed in 22 patients and no tumour was found in mastectomy specimen in 11 patients. The complication rate was 22.8%. After a median follow-up of 104 months (SD 69.9) there was no nipple necrosis. In all, 20% of the patients required long-term reintervention. Eleven patients (31.4%) underwent adjuvant treatment (chemotherapy and / or radiotherapy). Only one patient showed local recurrence (2.8%) 28 months after the intervention. One patient developed metastases after 78 months of disease-free survival (DFS). DFS and overall survival rates were 94.3% and 97.22%. Univariate analysis showed two risk factors for recurrence: age <40 years [OR (95% CI) 2.529 (1.230-5.199)] and margin involvement [OR (95% CI) 5.242 (2.041 - 13.464)]. CONCLUSION: NSM is safe and feasible in patients with DCIS who are not candidates for conservative surgery

Factores relacionados con la obtención de respuesta patológica completa tras quimioterapia neoadyuvante en cáncer de mama y su efecto sobre la reconstrucción tras mastectomía ahorradora de piel / Effect of complete pathological response related factors after neoadjuvant chemotherapy on skin-sparing mastectomy and breast reconstruction

INTRODUCCIÓN: La reconstrucción mamaria inmediata tras mastectomías ahorradoras de piel en pacientes sometidas a quimioterapia neoadyuvante todavía resulta controvertida. El objetivo es determinar factores relacionados con downstaging axilar y respuesta patológica completa (RPC), y como esta, condiciona la decisión de someterse a mastectomía bilateral con reconstrucción inmediata. MÉTODOS: Se realizó un análisis retrospectivo de pacientes con cáncer de mama sometidas a quimioterapia neoadyuvante y mastectomía bilateral con reconstrucción inmediata entre 2000-2018. Se compararon dos grupos: 1) RPC y 2) no RPC. Se analizaron datos demográficos, anatomopatológicos y el estadio clínico inicial y final. Análisis estadístico descriptivo y comparativo. RESULTADOS: Sesenta y nueve pacientes; Grupo1: 26 (37,68%) alcanzaron RPC y 43(62,32%) no RPC. Mediana de seguimiento 45,3meses (RIQ: 23,0-94,0). En análisis bivariante, edad menor a 35 (p < 0,001), menor T al diagnóstico (p = 0,006) y subtipo HER2 (p < 0,001) se asociaron significativamente con mayores tasas de RPC. La indicación más frecuente fue la elección de la paciente (31,8%). La tasa de negativización axilar fue del 80% en el grupo 1 y 59,3% en grupo 2 y las tasas de linfadenectomía axilar fueron similares (73,1% y 83,72%). CONCLUSIONES: La RPC tras la quimioterapia neoadyuvante no parece ser un factor de peso en la decisión de realizar la mastectomía bilateral con reconstrucción inmediata

INTRODUCTION: Immediate breast reconstruction after skin-sparing mastectomy in patients undergoing neoadjuvant chemotherapy is still controversial. The objective of this study is to determine factors related with axillary downstaging and complete pathological response (CPR), and how CPR influences the decision to perform bilateral mastectomy with immediate reduction. METHODS: A retrospective analysis of breast cancer patients who had undergone neoadjuvant chemotherapy and bilateral mastectomy with immediate reduction between 2000-2018 was performed. Two groups were compared:1) CPR and 2) non-CPR. Descriptive and comparative statistical analyses are provided. RESULTS: 69 patients; 26 (37.68%) reached CPR and 43 (62.32%) non-CPR. Median follow-up of 45.3 months (IQR: 23.0-94.0). Age under 35 (p < .001), small size tumor at diagnosis (p = .006) and subtype HER2 (p < .001) were associated with higher rates of CPR in bivariate analysis. Axillary negativization rate was 80% in group 1 and 59.3% in group 2, and lymphadenectomy rates were similar (73.1% and 83.72%). CONCLUSIONS: CPR after neoadjuvant chemotherapy did not influence the decision to perform bilateral mastectomy with immediate reduction

Effect of complete pathological response related factors after neoadjuvant chemotherapy on skin-sparing mastectomy and breast reconstruction. / Factores relacionados con la obtención de respuesta patológica completa tras quimioterapia neoadyuvante en cáncer de mama y su efecto sobre la reconstrucción tras mastectomía ahorradora de piel.

INTRODUCTION: Immediate breast reconstruction after skin-sparing mastectomy in patients undergoing neoadjuvant chemotherapy is still controversial. The objective of this study is to determine factors related with axillary downstaging and complete pathological response (CPR), and how CPR influences the decision to perform bilateral mastectomy with immediate reduction. METHODS: A retrospective analysis of breast cancer patients who had undergone neoadjuvant chemotherapy and bilateral mastectomy with immediate reduction between 2000-2018 was performed. Two groups were compared:1) CPR and 2) non-CPR. Descriptive and comparative statistical analyses are provided. RESULTS: 69 patients; 26 (37.68%) reached CPR and 43 (62.32%) non-CPR. Median follow-up of 45.3 months (IQR: 23.0-94.0). Age under 35 (p <.001), small size tumor at diagnosis (p=.006) and subtype HER2 (p <.001) were associated with higher rates of CPR in bivariate analysis. Axillary negativization rate was 80% in group 1 and 59.3% in group 2, and lymphadenectomy rates were similar (73.1% and 83.72%). CONCLUSIONS: CPR after neoadjuvant chemotherapy did not influence the decision to perform bilateral mastectomy with immediate reduction.

Reconstrucción inmediata mediante implante directo tras quimioterapia neoadyuvante. ¿Es una práctica segura? / Direct-to-implant breast reconstruction after neoadjuvant chemotherapy: A safe option?

Introducción: La reconstrucción inmediata (RMI) tras mastectomía en pacientes que han recibido quimioterapia neoadyuvante (QTNA) sigue siendo controvertida. El objetivo de este estudio es analizar y comparar resultados oncológicos y las tasas de complicaciones y reintervención en pacientes sometidas a QTNA y un grupo control. Métodos: Análisis observacional retrospectivo de casos-controles. Pacientes con cáncer de mama intervenidas de mastectomía bilateral con RMI (MBRMI) mediante prótesis directa durante el periodo 2000-2016. Grupo que recibió QTNA emparejadas máximo 1:5 respecto a las pacientes sin QTNA (grupo control). Evaluamos diferencias entre grupos mediante test χ2 o Fisher (variables cualitativas), U de Mann-Whitney o t de Student (variables cuantitativas). Análisis de supervivencia mediante curvas de Kaplan-Meier y test de log-rank (SPSS 22.0). Resultados: Un total de 171 pacientes con MBRMI, 62 pacientes (36,3%) tras QTNA y 109 pacientes (63,7%) en grupo control sin QTNA. Mediana de seguimiento de 52,0 (RIQ: 23,0-94,0) meses. La indicación para practicar una MBRMI más frecuente en ambos grupos es la elección de la paciente (32,7%). No hay diferencias estadísticamente significativas entre los grupos en cuanto a tasa de complicaciones (24,2% en el grupo QTNA y 19,3% en el grupo control [p = 0,44]). Sí existen diferencias en resultados oncológicos. Las pacientes del grupo QTNA tienen 3 veces más riesgo que las pacientes del grupo control de presentar recidiva en un momento determinado del tiempo (3,009 [1,349-6,713]) según el análisis univariante. Conclusiones: La RMI mediante prótesis directa tras mastectomías ahorradoras de piel es una opción viable de tratamiento para pacientes con cáncer de mama que reciben QTNA

Introduction: Immediate reconstruction (IBR) after mastectomy in patients who have received neoadjuvant chemotherapy (NACT) remains controversial. The aim of this study is to analyze and compare oncological results as well as complication and reoperation rates in patients undergoing NACT and a control group. Methods: Retrospective observational case-control study of patients with breast cancer who underwent bilateral mastectomy and direct-to-implant IBR (BMIBR) from 2000-2016. The group that received NACT was matched 1:5 to patients without NACT (Control group). We evaluated differences between groups using the χ2 or Fisher test (qualitative variables), Mann-Whitney U or Student's t-test (quantitative variables). The survival analysis was performed using Kaplan-Meier curves and log-rank test (SPSS 22.0). Results: The study included a total of 171 patients with BMIBR: 62 patients (36.3%) after NACT and 109 patients (63.7%) in the control group without NACT. Median follow-up was 52.0 (IQR: 23.0-94.0) months. In both groups, the indication for BMIBR was patient choice (32.7%). There were no statistically significant differences between groups in terms of complication rate (24.2% in the NACT group and 19.3% in the control group [P = .44]), but differences in oncological results were found. Patients in the NACT Group had three times more risk of recurrence at a given time than patients in the control group (3.009 [1.349-6.713]) according to the univariate analysis. Conclusions: Direct-to-implant IBR after skin-sparing mastectomy is a viable option for breast cancer patients undergoing NACT

Direct-to-implant breast reconstruction after neoadjuvant chemotherapy: A safe option? / Reconstrucción inmediata mediante implante directo tras quimioterapia neoadyuvante. ¿Es una práctica segura?

INTRODUCTION: Immediate reconstruction (IBR) after mastectomy in patients who have received neoadjuvant chemotherapy (NACT) remains controversial. The aim of this study is to analyze and compare oncological results as well as complication and reoperation rates in patients undergoing NACT and a control group. METHODS: Retrospective observational case-control study of patients with breast cancer who underwent bilateral mastectomy and direct-to-implant IBR (BMIBR) from 2000-2016. The group that received NACT was matched 1:5 to patients without NACT (Control group). We evaluated differences between groups using the χ2 or Fisher test (qualitative variables), Mann-Whitney U or Student's t-test (quantitative variables). The survival analysis was performed using Kaplan-Meier curves and log-rank test (SPSS 22.0). RESULTS: The study included a total of 171 patients with BMIBR: 62 patients (36.3%) after NACT and 109 patients (63.7%) in the control group without NACT. Median follow-up was 52.0 (IQR: 23.0-94.0) months. In both groups, the indication for BMIBR was patient choice (32.7%). There were no statistically significant differences between groups in terms of complication rate (24.2% in the NACT group and 19.3% in the control group [P=.44]), but differences in oncological results were found. Patients in the NACT Group had three times more risk of recurrence at a given time than patients in the control group (3.009 [1.349-6.713]) according to the univariate analysis. CONCLUSIONS: Direct-to-implant IBR after skin-sparing mastectomy is a viable option for breast cancer patients undergoing NACT.

Mastectomía bilateral con reconstrucción inmediata como tratamiento y profilaxis del cáncer de mama: indicaciones, técnicas y complicaciones durante 15 años / Bilateral mastectomy with immediate reconstruction in the treatment and prophylaxis of breast cancer: changes in indications, techniques and complications over a 15-year period

Objetivos: El propósito de este trabajo fue evaluar la evolución de la mastectomía bilateral con reconstrucción inmediata (MBRI) como tratamiento del cáncer unilateral o como profilaxis en pacientes de alto riesgo. También, analizar la variación en las técnicas quirúrgicas de reconstrucción y las complicaciones en diferentes periodos de tiempo. Métodos: Análisis retrospectivo de pacientes con MBRI como tratamiento y profilaxis de cáncer de mama. Periodos de estudio: 2001-2006, 2007-2011 y 2012-2016. Resultados: En total, se realizaron 332 MBRI: 110 (33,1%) en el primer periodo, 82 (24,7%) en el segundo y 140 (42,2%) en el tercero. En el primer periodo la indicación más frecuente en pacientes con cáncer unilateral fue la elección de la paciente (12 casos [10,9%]), y en el segundo y tercero, la multifocalidad o la multicentricidad, con 20 (24,4%) y 34 casos (24,3%), respectivamente. La mastectomía bilateral profiláctica se practicó por riesgo histológico en 10 (9,1%), 6 (7,3%) y 0 casos; por riesgo familiar sin mutación en 4 (3,6%), 3 (3,7%) y 5 casos (3,6%); y por mutación en los genes BRCA1/2 en 3 (2,7%), 2 (2,4%) y 14 casos (10%). Las técnicas más empleadas fueron Spira (39,1,39,6 y 41,4%) e incisión lateral externa (32,7, 25,6 y 38,9%). Las tasas de complicaciones son similares (25%) y la causa más frecuente de reintervención por secuelas es la contractura capsular en los 3 grupos: 17/110 (15,5%), 10/82 (12,2%) y 14/140 (10%). Conclusiones: Las pacientes con cáncer unilateral siguen demandando la mastectomía contralateral profiláctica, mientras las indicaciones de mastectomía bilateral profiláctica o reductora de riesgo han variado notablemente

Objectives: The aim of this study was to analyse changes in bilateral mastectomy with immediate reconstruction (BMIR) in the treatment of unilateral cancer or as prophylaxis in high-risk patients. We also analysed variation in surgical reconstruction techniques and complications in different time periods. Methods: Retrospective analysis of patients with BMIR in the treatment and prophylaxis of breast cancer. The study periods were 2001-2006, 2007-2011 and 2012-2016. Results: In total, 332 BMIR interventions were performed: 110 (33.1%) in the first period, 82 (24.7%) in the second and 140 (42.2%) in the third. The most frequent indication in unilateral cancer was patient choice in the first period (12 cases [10.9%]), and multifocality and/or multicentricity in the second and third periods; 20 cases (24.4%) and 34 cases (24.3%). BMIR was performed due to histological risk in 10 (9.1%), 6 (7.3%) and 0 patients; family risk without mutation in 4 (3.6%), 3 (3.7%) and 5 patients (3.6%); and mutation in BRCA1/2 genes in 3 (2.7%), 2 (2.4%) and 14 cases (10%) in the different periods, respectively. The most commonly used techniques were Spira (39.1, 39.6, 41.4%) and external lateral incision (32.7, 25.6, 38.9%). Complication rates were similar (25%) and the main cause of reoperation due to sequels was capsular contracture in the 3 groups (17/110 [15.5%], 10/82 [12.2%] and 14/140 [10%]). Conclusions: Patients with unilateral cancer continue to request prophylactic contralateral mastectomy, while the indications for prophylactic bilateral mastectomy have varied markedly