Antibiotic prophylaxis in breast cancer surgery. A randomized controlled trial.

PURPOSE: To assess the effect of antibiotic prophylaxis on surgical site infection (SSI) rates in women undergoing breast cancer surgery in two tertiary hospitals in Brazil. METHODS: This was a randomized, double-blind, placebo-controlled, parallel-group clinical trial. A total of 124 women without independent risk factors for SSI were randomly assigned to receive either cefazolin (antibiotic group, n = 62) or placebo (control group, n = 62) as preoperative prophylaxis. After surgery, all surgical wounds were examined once a week, for four weeks, according to the Centers for Disease Control and Prevention definitions and classifications for SSI. RESULTS: Baseline characteristics were homogeneous between the two groups. Only one patient in the antibiotic group developed SSI, which was classified as superficial incisional. The overall SSI rate was low, with no significant difference between groups. CONCLUSION: Antibiotic prophylaxis had no significant effect on reducing SSI rates in women without independent risk factors for SSI undergoing breast cancer surgery.

Antibiotic prophylaxis in breast cancer surgery. A randomized controlled trial

Abstract Purpose To assess the effect of antibiotic prophylaxis on surgical site infection (SSI) rates in women undergoing breast cancer surgery in two tertiary hospitals in Brazil. Methods This was a randomized, double-blind, placebo-controlled, parallel-group clinical trial. A total of 124 women without independent risk factors for SSI were randomly assigned to receive either cefazolin (antibiotic group, n = 62) or placebo (control group, n = 62) as preoperative prophylaxis. After surgery, all surgical wounds were examined once a week, for four weeks, according to the Centers for Disease Control and Prevention definitions and classifications for SSI. Results Baseline characteristics were homogeneous between the two groups. Only one patient in the antibiotic group developed SSI, which was classified as superficial incisional. The overall SSI rate was low, with no significant difference between groups. Conclusion Antibiotic prophylaxis had no significant effect on reducing SSI rates in women without independent risk factors for SSI undergoing breast cancer surgery.

Evaluations of aesthetic outcomes of oncoplastic surgery by surgeons of different gender and specialty: a prospective controlled study.

This prospective trial was designed to assess aesthetic outcomes of oncoplastic surgery. Standardized photographs were taken of 45 breast cancer patients undergoing oncoplastic surgery, preoperatively and 6 and 12 months postoperatively (oncoplastic group), and of 45 patients treated by conservative surgery without breast reconstruction (control group). Photographs were assessed by senior male and female physicians, 2 breast surgeons and 2 plastic surgeons. Aesthetic outcomes were evaluated using patients' own assessments (rated 0 to 10) and scoring by panelists (using 0 to 10 global rating scales and a subscales system). Patients in both groups scored the aesthetic outcomes better than physicians did. Panelists and patients considered aesthetic outcomes of oncoplastic group better than control group outcomes. Patients and plastic surgeons attributed progressively higher grades to outcomes of oncoplastic group at 6 and 12 months postoperatively; breast surgeons did not. Overall, female physicians and breast surgeons scored better the aesthetic outcomes of both groups.

Mastectomy versus conservative surgical treatment: the impact on the quality of life of women with breast cancer / Mastectomia versus tratamento cirúrgico conservador: impacto na qualidade de vida de mulheres com câncer mamário

OBJECTIVES: to compare the impact of mastectomy and conservative surgery on the quality of life of patients with breast cancer. METHODS: an assessment was made of the quality of life of patients undergoing mastectomy or segmentary mastectomy, at the Pouso Alegre Clinical Hospital, in the Brazilian State of Minas Gerais, using SF-36. The patients were grouped by age (<50 years and >50 years) and years of schooling (<8 years and >8 years). The Mann-Whitney test was used to compare the groups with regard to the age and schooling domains of SF-36. RESULTS: a significant difference between the two groups was found in the domains of physical functioning (p=0.04) and pain (p=0.01): with the patients undergoing a mastectomy registering the worst scores. Young patients who had undergone a mastectomy displayed the worst quality of life in terms of physical functioning (p=0.03), pain (p=0.01) and social functioning (p=0.01); those undergoing conservative surgery aged over 50 years scored worst on role emotional (p=0.05). Patients undergoing a mastectomy with lower levels of schooling scored lower in physical functioning (p=0.01), role physical (p=0.05) and pain (p=0.05). Among those who had attended school for more than eight years, those having undergone a mastectomy scored less in the pain domain (p=0.04). CONCLUSIONS: patients who had undergone a mastectomy had worse results in the physical component of the evaluation of quality of life and this negative impact was more strongly felt among younger patients and those with lower levels of schooling.

OBJETIVOS: comparar o impacto da mastectomia e da cirurgia conservadora na qualidade de vida de pacientes com câncer mamário. MÉTODOS: avaliou-se qualidade de vida de pacientes submetidas à mastectomia ou à mastectomia segmentar, no Hospital das Clínicas de Pouso Alegre, Minas Gerais, Brasil, utilizando-se o SF-36. As pacientes foram estratificadas quanto à idade (<50 anos e >50 anos) e escolaridade (<8 anos e >8 anos). Aplicou-se o teste de Mann-Whitney para comparar os grupos quanto aos domínios do SF-36, idade e escolaridade. RESULTADOS: observou-se diferença significante entre os grupos nos domínios capacidade funcional (p=0,04) e dor (p=0,01): as pacientes mastectomizadas com piores resultados. Pacientes mastectomizadas mais jovens apresentaram pior qualidade de vida em capacidade funcional (p=0,03), dor (p=0,01) e aspectos sociais (p=0,01); as submetidas à cirurgia conservadora, com mais de 50 anos, resultado pior em aspectos emocionais (p=0,05). Pacientes mastectomizadas com menor escolaridade apresentaram escores menores em capacidade funcional (p=0,01), aspectos físicos (p=0,05) e dor (p=0,05). Entre as que frequentaram a escola por mais de oito anos, as mastectomizadas pontuaram menos no domínio dor (p=0,04). CONCLUSÕES: pacientes mastectomizadas apresentaram piores resultados no componente físico da qualidade de vida, e este impacto negativo foi mais acentuado entre pacientes mais jovens e com menor escolaridade.

Impacto de fatores clínico-epidemiológicos sobre a opção de reconstrução mamária após mastectomia

Embora a reconstrução mamária não retarde o diagnóstico nem aumente o risco de recidivas do câncer mamário, ela ainda não é uma opção de todas as pacientes submetidas à mastectomia. O objetivo do trabalho foi avaliar a influência de fatores clínico-epidemiológicos no desejo das pacientes de se submeter ou não à reconstrução mamária. Foram selecionadas 78 pacientes mastectomizadas há pelo menos um ano, avaliadas por meio de um questionário de dados clínico-epidemiológicos, incluindo idade, etnia, estado marital, paridade, doenças associadas, tratamento adjuvante, tempo decorrido da mastectomia e desejo ou não de reconstrução. Observou-se diferença com significância estatística (p < 0,005) entre as 49 (62,8%) pacientes que desejavam ser submetidas à reconstrução mamária e as 29 (37,1 %) que não manifestaram desejo de se submeter ao procedimento. Não houve diferença estatística entre os grupos quanto a estado marital, escolaridade e etnia. Houve diferença estatística nos fatores idade, realização de radioterapia e tabagismo (p < 0,001). Os motivos mais freqüentemente relatados para se submeter ou não ao procedimento foram medo de novo procedimento cirúrgico, no caso de resposta negativa, e restabelecimento da imagem corporal, no caso de resposta afirmativa. Conclui-se que a idade das pacientes foi o fator clínico-epidemiológico de maior impacto sobre a opção de submeter-se ou não à reconstrução mamária.

Although the breast reconstruction don't slow down the diagnostic neither increase the recurrence, not yet the option among all postmastectomy patients. The aim of the present study was to assess the influence of clinical and epidemiological aspects on the option for undergoing or not breast reconstruction among postmastectomy patients. Seventy-eight breast cancer patients aged 32 to 75 years-old were enrolled. All the patients had undergone mastectomy at least one year before the enrollment. Clinical and epidemiological aspect, as well as the option for undergoing or not breast reconstruction were assessed. The mean age of participants was 53, 8 years-old. Forty-nine (62%) of the women opted for reconstruction and 29 (48%) did not. The variables with statistical difference were age, radiotherapy and smokers (p < 0,001). The data of this study suggest that age is aspect with more impact on option for undergoing or not breast reconstruction among postmastectomy patients. Informations concerning breast reconstruction must be adapted to the clinical and epidemiological profile of patients, but must be considered as an essential stage of breast cancer treatment.