Clinical and cost outcomes of a polyethylene glycol (PEG)-coated patch versus drainage after axillary lymph node dissection in breast cancer: results from a multicentre randomized clinical trial.

BACKGROUND: The aim of this study was to compare the clinical outcomes between breast cancer patients who underwent axillary lymph node dissection with postoperative management using a polyethylene glycol-coated patch versus axillary drainage. The direct costs associated with both postoperative management strategies were also evaluated. METHODS: This was a multicentre RCT in women with breast cancer who underwent axillary lymph node dissection (ClinicalTrials.gov identifier: NCT04487561). Patients were randomly assigned (1 : 1) to receive either drainage or a polyethylene glycol-coated patch as postoperative management. The primary endpoints were the need for an emergency department visit for any event related to the surgery and the rate of seroma development. RESULTS: A total of 227 patients were included , 115 in the patch group (50.7 per cent) and 112 (29.4 per cent ) in the drainage group. The incidence of emergency department visits was significantly greater for patients with drainage versus a polyethylene glycol-coated patch (incidence rate difference 26.1 per cent, 95 per cent c.i. 14.5 to 37.7 per cent; P < 0.001). Conversely, the seroma rate was significantly higher in the polyethylene glycol-coated patch group (incidence rate difference 22.8 per cent, 95 per cent c.i. 6.7 to 38.9 per cent; P < 0.0055). Compared with drainage, using a polyethylene glycol-coated patch resulted in cost savings of €100.41 per patient. An incremental cost-effectiveness ratio analysis found that drainage was associated with an incremental cost-effectiveness ratio of €7594.4 for no need for hospital admission and €491.7 for no need for an emergency department visit. CONCLUSION: Compared with patients who received drainage after axillary lymph node dissection, the use of a polyethylene glycol-coated patch resulted in a higher rate of seroma, but a lower number of postoperative outpatient or emergency department visits and thus a reduction in overall costs.

Mastectomía ahorradora de piel y complejo areola-pezón con reconstrucción inmediata: una técnica en auge en el tratamiento del cáncer de mama / Nipple-sparing mastectomy with immediate reconstruction: An increasing technique for breast cancer treatment

Introducción: La mastectomía ahorradora de piel y pezón (MAP-CAP) es una técnica quirúrgica cada vez más empleada en el tratamiento del cáncer de mama. Nuestro objetivo es describir la técnica quirúrgica y exponer nuestros resultados. Métodos: Se analizaron retrospectivamente 46 MAP-CAP con reconstrucción inmediata con implante definitivo, realizadas en 35 pacientes con cáncer de mama. Resultados: Se realizaron 46 MAP-CAP entre 2010 y 2015. En 9 casos se realizó una mastectomía contralateral reductora de riesgo por mutaciones en los genes BRCA o acúmulo de riesgo familiar. La edad media fue de 48 años. El tipo histológico más frecuente fue el carcinoma ductal infiltrante (58%). El 26% de las neoplasias fueron carcinoma ductal in situ. Se evidenció multicentricidad en el 44,7% de los casos. Se administró neoadyuvancia en el 41% de los casos y radioterapia adyuvante (RT) en 24 casos (63%). En 4 casos aparecieron complicaciones postoperatorias (8,7%). En 13 casos se produjo una contractura capsular, habiéndose administrado RT en todos ellos. En 7 casos (15%) se requirió una segunda intervención quirúrgica para recambio de la prótesis inicial por contractura o alteraciones estéticas significativas. Existió un único caso de recidiva regional en axila (2,2%), con una mediana de seguimiento de 44 meses. Conclusiones: La MAP-CAP con prótesis definitiva es una técnica oncológicamente segura, con una tasa de recidivas similar a la mastectomía clásica. La administración de RT eleva la tasa de contractura capsular, implicando una segunda intervención en el 15% de los casos, por lo que debemos restringir su administración a los casos estrictamente necesarios

Introduction: Nipple-sparing mastectomy (NSM) is a surgical procedure that is increasingly used for the treatment of breast cancer. Our aim was to describe the technique performed at our institution and to present our results. Methods: We retrospectively analysed data from 46 NSM with immediate breast reconstruction with definitive implants performed in 35 patients with breast cancer. Results: We performed 46 NSMs between 2010 and 2015. Nine of these patients received a contralateral prophylactic NSM because of BRCA mutations or high familial cancer risk. The median age was 48 years. The most frequent histologic type was ductal invasive carcinoma (58%). A total of 26% of the neoplasms were ductal carcinoma in situ. Neoadjuvant treatment was administered to 41% of the patients and adjuvant radiotherapy was administered in 24 (63%). Early complications appeared in 4 patients (8.7%). Capsular contracture occurred in 13 patients. All of them had received radiotherapy. In 7 of the 46 patients (15%), a second surgery to change the initial prosthesis was required because of high-grade capsular contracture or to improve cosmetic results. There was only one case of regional recurrence (2.2%) in the axilla, with a median of follow-up of 44 months. Conclusions: NSM is an oncologically safe technique for breast cancer, with a similar recurrence rate to classic mastectomy. Radiotherapy increases the rate of capsular contracture, requiring a second intervention in 15% of patients. Consequently, its use should be restricted to cases in which it is strictly necessary

Manejo diagnóstico y terapéutico de la filariasis mamaria / Diagnostic and therapeutic management to breast filariasis

La filariasis es una enfermedad parasitaria benigna poco frecuente en los países occidentales, sobre todo la afectación mamaria es inusual. Sin embargo, aumenta la frecuencia de casos de filariasis mamaria en nuestro medio debido a las corrientes migratorias y el turismo a zonas endémicas. Nuestro objetivo es incidir en el manejo diagnóstico y terapéutico de la filariasis mamaria a propósito de un caso clínico

Filariasis is a benign parasitic disease that is unusual in western countries, especially filariasis of the breast. However, cases of breast filariasis are increasing in our environment due to greater immigration and tourism to endemic areas. We report a case of breast filariasis to describe the diagnostic and therapeutic management of this disease

Factors associated with health-related quality of life in a cohort of Spanish breast cancer patients.

BACKGROUND: Several factors can modify health-related quality of life (HRQOL) of breast cancer survivors. The objective of the current study was to analyse the associations between HRQOL scores 1 year after breast cancer surgery and sociodemographic and clinical factors. METHODS: This was an observational, multicentre and prospective study of a cohort of patients who underwent oncological breast cancer surgery and which was followed up for 1 year. The HRQOL was assessed at 1 year after surgery using three questionnaires: EuroQol-5D, EORTC QLQ-C30 and its breast-specific module BR-23. RESULTS: A total of 364 patients participated in the study. Some factors were associated with better HRQOL 1 year after surgery: age between 60 and 69 years and under 50 years, being single or a housewife, stage I-II, invasive papillary carcinoma, breast-conserving surgery (BCS) or lack of axillary dissection. However, only the following were independent predictive factors: being single or a housewife, BCS, invasive papillary carcinoma, coming from an outpatient clinic or not receiving radiotherapy. Further, some factors were independent predictors of a worse HRQOL: age over 70 years, being married, separated or widowed, stage III or not receiving adjuvant chemotherapy. CONCLUSIONS: Demographic and clinical factors can influence HRQOL, some of them independently.

Evolution of Health-Related Quality of Life in Breast Cancer Patients during the First Year of Follow-Up.

PURPOSE: The objective of this study was to describe the evolution of health-related quality of life (HRQOL) in a cohort of breast cancer patients over 1 year after surgery and to analyse the predictive ability of HRQOL measurement instruments. METHODS: Observational, multicenter and prospective study of a cohort of breast cancer patients, assessing HRQOL at 1, 6, and 12 months after surgery using three questionnaires: EuroQol-5D-3L, EORTC QLQ-C30, and EORTC QLQ-BR23. RESULTS: A total of 364 women participated in the study. Visual Analogue Scale (VAS) scores from the EuroQol improved (1 month vs. 1 year: 70 vs. 80; p<0.0001); however, the EuroQol score showed no significant change (0.81 vs. 0.83; p=0.1323). In contrast, Global Health Status on the EORTC QLQ-C30 improved (66.67 vs. 100.00; p<0.0001), as did all of this instrument's scales and most of its independent items. The EORTC QLQ-BR23 dimensions showed improvement, except for sexual functioning (100.00 vs. 86.67; p=0.0030) and future perspective (33.33 vs. 66.67; p<0.0001). Patients with good HRQOL outcomes at 1 month showed improved levels of HRQOL at 1 year; HRQOL measured at 1 month was predictive of HRQOL at 1 year. CONCLUSION: HRQOL improved during the follow-up period. Likewise, HRQOL measurement instruments can predict early HRQOL.