Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 382
Filtrar
1.
Plast Reconstr Surg ; 145(2): 459-467, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31985641

RESUMO

BACKGROUND: Injuries to the upper extremity lymphatic system from cancer may require measures to prevent secondary lymphedema. Guidelines were established relating to the use of tourniquet and elective hand and upper extremity surgery. However, reports in the setting of hand surgery have indicated that prior guidelines may not be protective to the patient. METHODS: The study systematically reviewed the current literature evaluating elective hand surgery in breast cancer patients. The authors evaluated the risk of complications, including new or worsening lymphedema and infection. RESULTS: One hundred ninety-eight abstracts were identified, and a bibliographic review was performed. Nine studies pertained to our subject, and four were included for final review. All studies included patients with prior breast cancer treatment involving breast surgery and axillary lymph node dissection. Pneumatic tourniquets were used during nearly all operations. Patients without presurgery ipsilateral lymphedema had a 2.7 percent incidence of developing new lymphedema and a 0.7 percent rate of postoperative infection. Patients with presurgery lymphedema had a 11.1 percent incidence of worsening lymphedema and a 16.7 percent rate of infection. However, all cases of new or exacerbated lymphedema resolved within 3 months. Tourniquet use was not found to increase rates of lymphedema. CONCLUSIONS: Based on the available evidence, there is no increased risk of complications for elective hand surgery in patients with prior breast cancer treatment. Breast cancer patients with preexisting ipsilateral lymphedema carry slightly increased risk of postoperative infection and worsening lymphedema. It is the authors' opinion and recommendation that elective hand surgery with a tourniquet is not a contradiction in patients who have received previous breast cancer treatments.


Assuntos
Neoplasias da Mama/cirurgia , Mãos/cirurgia , Linfedema/cirurgia , Neoplasias da Mama/complicações , Neoplasias da Mama/radioterapia , Síndrome do Túnel Carpal/etiologia , Síndrome do Túnel Carpal/cirurgia , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Feminino , Humanos , Excisão de Linfonodo/efeitos adversos , Excisão de Linfonodo/métodos , Linfedema/complicações , Mastectomia/efeitos adversos , Mastectomia/métodos , Segurança do Paciente , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Cirurgia de Second-Look/estatística & dados numéricos , Biópsia de Linfonodo Sentinela/efeitos adversos , Biópsia de Linfonodo Sentinela/métodos , Infecção da Ferida Cirúrgica/etiologia , Torniquetes , Resultado do Tratamento
2.
Gynecol Oncol ; 156(1): 124-130, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31711658

RESUMO

OBJECTIVE: The sentinel node (SN) procedure is adopted in selected patients with early-stage vulva cancer (VC) in Denmark. Due to the low incidence of VC, large population-based studies on the safety of SN outside multicenter clinical trials are lacking. The current study evaluated the risk of recurrence and survival in SN- negative VC patients. METHODS: Nationwide data was collected and registered prospectively in the Danish Gynecologic Cancer Database from January 2011 to July 2017. Patients with clinically stage IB-II unifocal vulva squamous cell carcinoma, tumor <4 cm and no clinically suspicious groin nodes or distant metastases, who underwent SN-procedure, were included. RESULTS: The SN-procedure was performed in 286 patients, of these 190 (66.4%) patients were SN-negative. Twenty-three of the 190 SN-negative patients (12.1%) had one or more recurrences during a median follow-up of 30 months (range 1-83). Four patients (2.1%) had an isolated groin recurrence identified from 5 to 17 months after primary surgery. Fourteen patients (7.4%) experienced a local recurrence in vulva, 1 patient (0.5%) had a recurrence in the vulva and the groin and 4 patients (2.1%) had distant recurrences. The 3-year overall (OS) and disease-specific survival (DSS) for SN-negative patients was 84% and 93%, respectively. The 3-year OS for patients with recurrent disease was 58%. CONCLUSIONS: This is the largest prospective nationwide study on SN-procedure in vulva cancer. The study confirms the safety of the SN-procedure in selected early-stage VC patients with a low isolated groin recurrence rate and a good DSS.


Assuntos
Recidiva Local de Neoplasia/mortalidade , Recidiva Local de Neoplasia/patologia , Biópsia de Linfonodo Sentinela/estatística & dados numéricos , Neoplasias Vulvares/mortalidade , Neoplasias Vulvares/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células Escamosas/mortalidade , Carcinoma de Células Escamosas/patologia , Dinamarca/epidemiologia , Feminino , Humanos , Metástase Linfática , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Estudos Prospectivos , Sistema de Registros , Linfonodo Sentinela/patologia , Biópsia de Linfonodo Sentinela/efeitos adversos , Biópsia de Linfonodo Sentinela/métodos
3.
Gynecol Oncol ; 156(1): 147-153, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31780238

RESUMO

OBJECTIVE: To compare the prevalence of patient-reported lower-extremity lymphedema (LEL) with sentinel lymph node (SLN) mapping versus comprehensive lymph node dissection (LND) for the surgical management of newly diagnosed endometrial carcinoma. METHODS: Patients who underwent primary surgery for endometrial cancer from 01/2006-12/2012 were mailed a survey that included a validated 13-item LEL screening questionnaire in 08/2016. Patients diagnosed with LEL prior to surgery and those who answered ≤6 survey items were excluded. RESULTS: Of 1275 potential participants, 623 (49%) responded to the survey and 599 were evaluable (180 SLN, 352 LND, 67 hysterectomy alone). Median BMI was similar among cohorts (P = 0.99). External-beam radiation therapy (EBRT) was used in 10/180 (5.5%) SLN and 35/352 (10%) LND patients (P = 0.1). Self-reported LEL prevalence was 27% (49/180) and 41% (144/352), respectively (OR, 1.85; 95% CI, 1.25-2.74; P = 0.002). LEL prevalence was 51% (23/45) in patients who received EBRT and 35% (170/487) in those who did not (OR, 1.95; 95% CI, 1.06-3.6; P = 0.03). High BMI was associated with increased prevalence of LEL (OR, 1.04; 95% CI, 1.02-1.06; P = 0.001). After controlling for EBRT and BMI, LND retained independent association with an increased prevalence of LEL over SLN (OR, 1.8; 95% CI, 1.22-2.69; P = 0.003). Patients with self-reported LEL had significantly worse QOL compared to those without self-reported LEL. CONCLUSIONS: This is the first study to assess patient-reported LEL after SLN mapping for endometrial cancer. SLN mapping was independently associated with a significantly lower prevalence of patient-reported LEL. High BMI and adjuvant EBRT were associated with an increased prevalence of patient-reported LEL.


Assuntos
Neoplasias do Endométrio/cirurgia , Excisão de Linfonodo/estatística & dados numéricos , Linfedema/epidemiologia , Biópsia de Linfonodo Sentinela/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias do Endométrio/epidemiologia , Feminino , Humanos , Perna (Membro)/patologia , Excisão de Linfonodo/efeitos adversos , Linfonodos/patologia , Linfonodos/cirurgia , Metástase Linfática , Linfedema/etiologia , Linfedema/patologia , Pessoa de Meia-Idade , Medidas de Resultados Relatados pelo Paciente , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Prevalência , Linfonodo Sentinela/patologia , Linfonodo Sentinela/cirurgia , Biópsia de Linfonodo Sentinela/efeitos adversos , Inquéritos e Questionários
4.
Zhonghua Wai Ke Za Zhi ; 57(9): 713-716, 2019 Sep 01.
Artigo em Chinês | MEDLINE | ID: mdl-31474063

RESUMO

In the surgical treatment of breast cancer, "de-escalating" is becoming more popular, especially in the treatment of axilla. Axillary sentinel lymph node biopsy has become a routine treatment for axillary-negative breast cancer patients because it can effectively reduce the occurrence of upper limb lymphedema, so that some patients with sentinel lymph node negative can be exempted from axillary lymph node dissection. However, in recent years, several international clinical studies, such as AMAROS trial, explored the use of radiotherapy instead of dissection when 1 to 2 sentinel lymph nodes were positive. The results showed that radiotherapy can reduce the incidence of upper limb edema by nearly 50% compared with dissection. How to interpret the results of such non-inferiority studies, and how to treat the impact of axillary dissection and axillary radiotherapy on the occurrence of lymphedema? Based on the review of literature in recent 10 years, the incidence and hazard ratio of edema related to the two axillary treatments were compared. The conclusion is the hazard ratios are close to each other, around 3 for both arms. The results of clinical studies such as radiotherapy instead of axillary dissection need to be carefully interpreted. At the same time, axillary dissection is still suitable for some patients at current stage, and the corresponding prevention of upper limb lymphedema still needs attention.


Assuntos
Axila , Neoplasias da Mama/patologia , Excisão de Linfonodo/efeitos adversos , Linfedema/prevenção & controle , Radioterapia/efeitos adversos , Axila/patologia , Axila/efeitos da radiação , Axila/cirurgia , Humanos , Linfonodos/patologia , Linfonodos/efeitos da radiação , Linfonodos/cirurgia , Metástase Linfática/patologia , Linfedema/etiologia , Biópsia de Linfonodo Sentinela/efeitos adversos , Extremidade Superior/patologia , Extremidade Superior/efeitos da radiação , Extremidade Superior/cirurgia
5.
Actas dermo-sifiliogr. (Ed. impr.) ; 110(6): 482-489, jul.-ago. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-185276

RESUMO

Antecedentes y objetivo: La biopsia selectiva de ganglio centinela (BSGC) no tiene utilidad terapéutica y solo se utiliza por su valor pronóstico. Su beneficio ha sido menor del esperado, por lo que los riesgos cobran más valor y no están claramente definidos. Nos hemos propuesto describir las complicaciones y secuelas sufridas por pacientes con melanoma expuestos a la técnica de BSGC en la práctica clínica habitual. Pacientes y métodos: En este estudio de cohortes retrospectivo unicéntrico hemos recogido los datos de todos los pacientes diagnosticados de melanoma y sometidos a la BSGC en nuestro centro (Vigo) entre enero de 2011 y julio de 2017, revisando sus historias clínicas. Resultados: Se realizaron 124 BSGC. El tiempo de seguimiento medio fue de 52,7 meses (rango 10,8-88,7 meses). El 37,9% de los pacientes presentaron complicaciones. Excluyendo a aquellos en los que se realizó linfadenectomía, el porcentaje de complicaciones fue del 30,9%. De las complicaciones totales, 14 (11,3%) fueron alteraciones en la cicatrización, 13 (10,5%) infecciones de la herida quirúrgica, 12 (9,7%) linfedemas, 11 (8,9%) seromas, 4 (3,2%) hematomas, 4 (3,2%) heridas dehiscentes, 2 (1,6%) linforragias, 2 (1,6%) alteraciones sensitivas y una (0,8%) infección del tracto urinario. El 15,3% de los pacientes presentaron secuelas, siendo el linfedema la más frecuente. Entre los pacientes sin linfadenectomía completa presentaron secuelas el 7,5%. El tabaquismo se asoció con un aumento en el porcentaje de complicaciones de un 33 a un 73%. La principal limitación de este estudio es que pueda haber un sesgo de información que infravalore los resultados por un seguimiento incompleto de los pacientes. Conclusiones: La BSGC es una técnica de estadificación del melanoma no exenta de complicaciones y secuelas. La recomendación de su uso rutinario en las guías de práctica clínica debería revisarse, sopesando los riesgos y los beneficios en cada caso. En especial tienen un alto riesgo de presentar complicaciones los pacientes fumadores. El desarrollo de otras herramientas de estadificación menos invasivas puede ser de gran utilidad para los pacientes con melanoma


Background and objective: Sentinel lymph node (SLN) biopsy is a staging, not a therapeutic, procedure. The benefits of SLN biopsy have been more modest than expected and could be outweighed by the risks, which remain unclear. The aim of this study was to describe complications and sequelae observed in patients with melanoma who underwent routine SLN biopsy at our hospital. Patients and methods: In this retrospective cohort study, we performed a chart review of all patients with melanoma who underwent SLN biopsy at our hospital in Vigo, Spain, between January 2011 and July 2017. Results: In the period analyzed, 124 SLN biopsies were performed. Over a mean follow-up of 52.7 months (range 10.8-88.7 months). A percentage of 37.9 of the patients experienced complications. The complication rate after excluding patients who underwent lymph node dissection was 30.9%. In the full chort group, there were 14 scar-related complications (11.3%), 13 surgical wound infections (10.5%), 12 lymphedemas (9.7%), 11 seromas (8.9%), 4 hematomas (3.2%), 4 wound dehiscences (3.2%), 2 cases of lymphorrhagia (1.6%), 2 cases of sensitivity alteration (1.6%), and one urinary tract infection (0.8%). The most common sequela was lymphedema. Sequelae were on record for 15.3% of patients in the full cohort (7.5% of the patients who did not undergo lymphadenectomy). Smoking was associated with a 33 to 73% increased risk of complications. The main limitation of this study is the risk of information bias due to incomplete follow-up. Conclusions: SLN biopsy is a melanoma staging procedure that causes complications and sequelae. Recommendations for its use in clinical practice guidelines should be revised and the risks and benefits carefully evaluated in each case. Smokers in particular seem to have a high risk of complications. Patients with melanoma could benefit greatly from the development of less invasive staging tools


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Metástase Linfática/patologia , Melanoma/secundário , Biópsia de Linfonodo Sentinela/efeitos adversos , Cicatriz/epidemiologia , Linfedema/etiologia , Hemorragia/epidemiologia , Cicatriz/etiologia , Seguimentos , Hemorragia/etiologia , Excisão de Linfonodo , Linfedema/epidemiologia , Melanoma/patologia , Estadiamento de Neoplasias , Estudos Retrospectivos , Biópsia de Linfonodo Sentinela/métodos , Deiscência da Ferida Operatória
6.
Jpn J Clin Oncol ; 49(6): 495-500, 2019 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-31070770

RESUMO

Pelvic lymphadenectomy is generally performed to treat early-stage cervical cancer, and pelvic ± para-aortic lymphadenectomy is performed in patients with endometrial cancer confined to the uterus. However, systematic lymphadenectomy is frequently associated with sequelae including lymphocele, lymphedema and cellulitis. The sentinel lymph node concept has been recently applied in the management of patients with gynecological cancer, with the goal of avoiding systematic lymphadenectomy and its associated postoperative complications. In this review, we examine and summarize the recently expanding body of literature and discuss sentinel lymph node navigation during surgery in patients with cervical and endometrial cancer. Current data suggest that sentinel node navigation surgery (SNNS) appears to be feasible for detecting lymph node metastasis compared with systematic lymphadenectomy in patients with early-stage cervical or endometrial cancer. The non-inferiority of long-term prognosis through omission of systematic lymphadenectomy has not been proven by randomized trial, but SNNS decreases lymphatic complications related to systematic lymphadenectomy. Further studies are needed to clarify the necessity of additional systematic lymphadenectomy and/or adjuvant therapy in cases with isolated tumor cells or micrometastasis in SLNs.


Assuntos
Neoplasias do Endométrio/patologia , Biópsia de Linfonodo Sentinela/métodos , Neoplasias do Colo do Útero/patologia , Neoplasias do Endométrio/cirurgia , Feminino , Humanos , Linfonodos/patologia , Linfonodos/cirurgia , Metástase Linfática/patologia , Pessoa de Meia-Idade , Estadiamento de Neoplasias/métodos , Complicações Pós-Operatórias/epidemiologia , Prognóstico , Linfonodo Sentinela/patologia , Linfonodo Sentinela/cirurgia , Biópsia de Linfonodo Sentinela/efeitos adversos , Neoplasias do Colo do Útero/cirurgia
7.
Urology ; 130: 186-190, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31051164

RESUMO

OBJECTIVE: To understand uncertainties and knowledge gaps regarding lymphatic drainage in renal tumors, we performed 2 prospective studies to demonstrate regional lymph node (LN) drainage with sentinel lymph node (SN) imaging and biopsy. Here, we report the technique and perioperative safety of retroperitoneal SN dissection with different surgical approaches. METHODS: Seventy three patients from the 2 trials were included in the analysis. Patients had cT1-2N0M0 renal tumors (

Assuntos
Neoplasias Renais/patologia , Neoplasias Renais/cirurgia , Excisão de Linfonodo/métodos , Nefrectomia , Biópsia de Linfonodo Sentinela/métodos , Adulto , Idoso , Feminino , Humanos , Excisão de Linfonodo/efeitos adversos , Masculino , Pessoa de Meia-Idade , Nefrectomia/métodos , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Biópsia de Linfonodo Sentinela/efeitos adversos
8.
Actas Dermosifiliogr ; 110(6): 482-489, 2019.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-30982568

RESUMO

BACKGROUND AND OBJECTIVE: Sentinel lymph node (SLN) biopsy is a staging, not a therapeutic, procedure. The benefits of SLN biopsy have been more modest than expected and could be outweighed by the risks, which remain unclear. The aim of this study was to describe complications and sequelae observed in patients with melanoma who underwent routine SLN biopsy at our hospital. PATIENTS AND METHODS: In this retrospective cohort study, we performed a chart review of all patients with melanoma who underwent SLN biopsy at our hospital in Vigo, Spain, between January 2011 and July 2017. RESULTS: In the period analyzed, 124 SLN biopsies were performed. Over a mean follow-up of 52.7 months (range 10.8-88.7 months). A percentage of 37.9 of the patients experienced complications. The complication rate after excluding patients who underwent lymph node dissection was 30.9%. In the full chort group, there were 14 scar-related complications (11.3%), 13 surgical wound infections (10.5%), 12 lymphedemas (9.7%), 11 seromas (8.9%), 4 hematomas (3.2%), 4 wound dehiscences (3.2%), 2 cases of lymphorrhagia (1.6%), 2 cases of sensitivity alteration (1.6%), and one urinary tract infection (0.8%). The most common sequela was lymphedema. Sequelae were on record for 15.3% of patients in the full cohort (7.5% of the patients who did not undergo lymphadenectomy). Smoking was associated with a 33 to 73% increased risk of complications. The main limitation of this study is the risk of information bias due to incomplete follow-up. CONCLUSIONS: SLN biopsy is a melanoma staging procedure that causes complications and sequelae. Recommendations for its use in clinical practice guidelines should be revised and the risks and benefits carefully evaluated in each case. Smokers in particular seem to have a high risk of complications. Patients with melanoma could benefit greatly from the development of less invasive staging tools.


Assuntos
Metástase Linfática/patologia , Melanoma/secundário , Biópsia de Linfonodo Sentinela/efeitos adversos , Cicatriz/epidemiologia , Cicatriz/etiologia , Feminino , Seguimentos , Hemorragia/epidemiologia , Hemorragia/etiologia , Humanos , Excisão de Linfonodo , Linfedema/epidemiologia , Linfedema/etiologia , Masculino , Melanoma/patologia , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Estudos Retrospectivos , Biópsia de Linfonodo Sentinela/métodos , Deiscência da Ferida Operatória/epidemiologia , Deiscência da Ferida Operatória/etiologia , Infecções Urinárias/epidemiologia , Infecções Urinárias/etiologia , Infecção dos Ferimentos/epidemiologia , Infecção dos Ferimentos/etiologia
9.
Med Sci Monit ; 25: 3154-3160, 2019 Apr 29.
Artigo em Inglês | MEDLINE | ID: mdl-31032820

RESUMO

BACKGROUND The objective of this paper was to assess the complications following sentinel lymph node biopsy (SLNB) in breast cancer patients using the SentiMag® method. MATERIAL AND METHODS The study material consisted of 368 patients who had received the SLNB procedure in combination with wide local excision (WLE), simple mastectomy or who had an autonomous SLNB procedure in the period from January 2014 to September 2017. The final study group consisted of 303 patients who attended follow-up consultations. RESULTS Sensory disturbances in the arm occurred in 12 patients (9.9%), including 3 patients (1.5%) after WLE and 9 patients (8.4%) after simple mastectomy. Restricted mobility in the upper limb was experienced by 9 patients (7.1%), including 3 patients (1.5%) after WLE and 6 patients (5.6%) after simple mastectomy. Minimal-degree lymphedema developed in 9 patients (7.5%), including 2 patients (1%) after WLE and 7 patients (6.5%) after simple mastectomy. A significant correlation was demonstrated between the incidence of these complications and the number of lymph nodes dissected. A significantly higher incidence of paresthesia and lymphedema was revealed for simple mastectomy with SLNB when compared to WLE with SLNB. Discolorations upon tracer administration were observed in 47 patients (15.5%). CONCLUSIONS SentiMag® is a safe sentinel lymph node identification method used in breast cancer and has a low risk of complications. The rate of complications increases together with the number of dissected lymph nodes and the extent of the surgery. The possibility of temporary discolorations on the skin should be communicated to the patients explicitly prior to surgery.


Assuntos
Neoplasias da Mama/patologia , Biópsia de Linfonodo Sentinela/efeitos adversos , Linfonodo Sentinela/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Axila , Neoplasias da Mama/cirurgia , Feminino , Humanos , Excisão de Linfonodo/métodos , Linfonodos/patologia , Metástase Linfática/patologia , Mastectomia , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Linfonodo Sentinela/citologia , Biópsia de Linfonodo Sentinela/métodos
10.
Ann Surg Oncol ; 26(7): 2263-2267, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31011899

RESUMO

BACKGROUND: The majority of patients undergoing sentinel lymph node biopsy (SLNB) for melanoma will have a negative SLN. The long-term sequelae of a negative result are important when discussing this staging investigation with patients. The objective of this study was to assess rates of lymphoedema and quality of life for these patients. METHODS: A prospective, cross-sectional study was performed on patients under routine follow-up with a history of melanoma, who had undergone sentinel lymph node biopsy where no metastasis was found (N0) at a high-volume melanoma centre. Relevant limbs were measured to assess for lymphoedema and patients completed the FACT-M quality of life instrument and a study specific questionnaire. RESULTS: A total of 102 patients were recruited. Wound complications were observed in 25% and lymphoedema in 2% of patients. Physical and functional well-being scores were lowest in patients seen within 3 months of their SLNB. Functional well-being and quality of life improved over the 2 years following the procedure. CONCLUSIONS: SLNB has low complication rates. The procedure is associated with a short-term impact on patient quality of life and well-being. The vast majority of patients are pleased with the outcomes of this procedure and the information that it provides.


Assuntos
Excisão de Linfonodo/efeitos adversos , Linfedema/diagnóstico , Melanoma/patologia , Qualidade de Vida , Biópsia de Linfonodo Sentinela/efeitos adversos , Neoplasias Cutâneas/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Seguimentos , Humanos , Linfedema/etiologia , Masculino , Melanoma/cirurgia , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Neoplasias Cutâneas/cirurgia , Inquéritos e Questionários
11.
Zhonghua Zhong Liu Za Zhi ; 41(4): 251-256, 2019 Apr 23.
Artigo em Chinês | MEDLINE | ID: mdl-31014049

RESUMO

Objective: To determine the clinical benefits of internal mammary sentinel lymph node biopsy (IM-SLNB) acquired by breast cancer patients with clinically positive axillary lymph node (ALN), and further optimize the IM-SLNB indications. Methods: All primary breast cancer patients with clinically positive ALN from February 2014 to September 2017 were prospectively recruited in this study. IM-SLNB was performed under the guidance of the modified injection technique. The success rate and visualization rate of IM-SLNB, metastatic rate of internal mammary sentinel lymph node (IMSLN) and its related factors were analyzed, and the clinical benefits were accessed according to the current guidelines. Results: Among 126 patients, all of 94 patients (74.6%) who showed internal mammary drainage successfully underwent IM-SLNB. The incidence of internal mammary artery bleeding and pleural lesion were 4.3%(4/94) and 9.6%(9/94), respectively. The metastatic rate of IMSLN was 38.3% (36/94), which was significantly associated with the number of positive ALN (P<0.001) and tumor size (P=0.024). The lymph node staging of 94 patients who underwent IM-SLNB was more accurate. Among them, 36 cases with positive IMSLN underwent internal mammary radiotherapy (IMRT), while the other 58 cases with negative IMSLN avoided radiotherapy. Conclusions: IM-SLNB should be routinely performed in patients with positive ALN. IM-SLNB can provide more accurate staging and guide tailored IMRT to benefit more breast cancer patients.


Assuntos
Neoplasias da Mama/patologia , Biópsia de Linfonodo Sentinela , Axila , Neoplasias da Mama/tratamento farmacológico , Feminino , Humanos , Metástase Linfática , Estadiamento de Neoplasias , Medicina de Precisão , Estudos Prospectivos , Linfonodo Sentinela/patologia , Biópsia de Linfonodo Sentinela/efeitos adversos , Biópsia de Linfonodo Sentinela/estatística & dados numéricos
12.
J Gynecol Oncol ; 30(3): e34, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30887756

RESUMO

OBJECTIVE: The aim of this study was to determine the predictive factors of postoperative morbidity of patients who have undergone a radical trachelectomy (RT) for early-stage cervical cancer and to assess the oncologic outcomes. METHODS: We retrospectively analysed the data of 2 prospective trials on sentinel node biopsy for cervical cancer (SENTICOL I and II). Patients having a RT for early-stage cervical cancer with negative sentinel lymph node and safe margins, were included. RESULTS: Forty-nine patients met the inclusion criteria. Forty-five patients had a laparoscopic-assisted vaginal technique and 4 patients a total laparoscopic technique. The median age was 32 years (range, 22-46 years). 83.7% of patients had a stage IB1 disease. There were 63.3% squamous cell carcinomas and 34.7% adenocarcinomas. The median follow-up was 46 months (range, 1-85 months). Two patients (3.3%) had a severe postoperative complication (Clavien-Dindo ≥III and/or CTCAE ≥3). The main postoperative complications were urinary (28.6%), lymphovascular (26.5%) and neurologic (14.3%). On a multivariate analysis, postoperative complications were significantly associated with history of pelvic surgery and IB1 International Federation of Gynecology and Obstetrics stage. Inclusion in high surgical skills centers decrease the risk of postoperative complications. During the follow-up, 3 patients (6.1%) had a local recurrence and one patient died from a breast cancer. Between group with complications and group without any complications, overall survival and recurrence-free survival did not significantly differ at 5-year of follow-up. CONCLUSION: RT has few severe postoperative complications and appears as a safe alternative to spare fertility of young patients. To guarantee best surgical outcomes, patients should be referred to expert center.


Assuntos
Carcinoma de Células Escamosas/cirurgia , Excisão de Linfonodo/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Traquelectomia/efeitos adversos , Neoplasias do Colo do Útero/cirurgia , Adenocarcinoma/epidemiologia , Adenocarcinoma/patologia , Adenocarcinoma/cirurgia , Adulto , Carcinoma de Células Escamosas/epidemiologia , Carcinoma de Células Escamosas/patologia , Bases de Dados como Assunto , Feminino , França/epidemiologia , Humanos , Excisão de Linfonodo/estatística & dados numéricos , Pessoa de Meia-Idade , Morbidade , Estadiamento de Neoplasias , Pelve/cirurgia , Período Perioperatório/estatística & dados numéricos , Ensaios Clínicos Controlados Aleatórios como Assunto/estatística & dados numéricos , Estudos Retrospectivos , Biópsia de Linfonodo Sentinela/efeitos adversos , Biópsia de Linfonodo Sentinela/métodos , Biópsia de Linfonodo Sentinela/estatística & dados numéricos , Traquelectomia/estatística & dados numéricos , Neoplasias do Colo do Útero/epidemiologia , Neoplasias do Colo do Útero/patologia , Adulto Jovem
13.
Am J Surg ; 217(5): 878-881, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30799018

RESUMO

BACKGROUND: Lymphocele is a complication of sentinel node biopsy (SNB) for melanoma. Plant-based hemostatic powder (PBHP) may have a lymphostatic benefit. We studied whether PBHP placed intraoperatively could reduce lymphocele rates. METHODS: We performed an open label, prospective, IRB -approved, before- and-after, matched control trial of PBHP placed into the wound in patients undergoing SNB of groin or axillary nodes for melanoma staging. Patient/tumor features and lymphocele rates were compared by standard statistical tests. RESULTS: 66 control and 66 treatment (49 axillary and 17 groin in each arm) SNBs were performed in 61 and 55 patients, respectively, for a total 132 SNBs in 116 patients. Patient and tumor features were similar between groups. Nineteen lymphoceles occurred (14.4%); lymphocele rates were 22.2% (14/66) in the control group and 7.6% (5/66) in the treatment group (p = 0.026). The reduction in lymphocele rates between arms was greater for axillary than for groin sites (87.5% vs. 33%); the axillary reduction was statistically significant (p = 0.030). CONCLUSIONS: Intra-operative placement of PBHP reduced the rate of lymphoceles in patients undergoing SNB for melanoma.


Assuntos
Hemostáticos/uso terapêutico , Linfocele/prevenção & controle , Biópsia de Linfonodo Sentinela/efeitos adversos , Amido/uso terapêutico , Feminino , Humanos , Cuidados Intraoperatórios , Linfocele/etiologia , Masculino , Melanoma/patologia , Pessoa de Meia-Idade , Estudos Prospectivos , Neoplasias Cutâneas/patologia
14.
Ann Surg Oncol ; 26(4): 1046-1054, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30706226

RESUMO

PURPOSE: To assess postbiopsy pigmentation (PBP) as a prognostic feature in patients with cutaneous head and neck (H&N) melanoma. METHODS: Retrospective review of patients undergoing sentinel lymph node biopsy (SLNB) for H&N melanoma (1998-2018). PBP was defined as visible remaining pigment at the scar or biopsy site that was documented on physical exam by both a medical oncologist and a surgeon at initial consultation. Variables associated with disease-free survival (DFS) and overall survival (OS) were analyzed using multivariable Cox proportional hazards models. RESULTS: Among 300 patients, 34.3% (n = 103) had PBP and 44.7% (n = 134) had microscopic residual disease on final pathology after wide local excision. Prognostic factors associated with DFS included advanced age, tumor depth, ulceration, PBP, and positive SLNB (p < 0.05). Patients with PBP fared worse than their counterparts without PBP in 5-year DFS [44.1% (31.1-56.3%) vs. 73.0% (64.1-80.0%); p < 0.001] and 5-year OS [65.0% (50.0-76.6%) vs. 83.6% (75.7-89.2%); p = 0.005]. After multivariable adjustment, PBP remained associated with shorter DFS [hazard ratio (HR) 1.72, 95% confidence interval (CI) 1.01-2.93; p = 0.047], but was not prognostic of OS. CONCLUSIONS: In patients with H&N melanoma, PBP is associated with significantly shorter DFS. Patients with PBP may warrant greater consideration for SLNB and closer postoperative surveillance.


Assuntos
Neoplasias de Cabeça e Pescoço/cirurgia , Melanoma/cirurgia , Complicações Pós-Operatórias/etiologia , Biópsia de Linfonodo Sentinela/efeitos adversos , Neoplasias Cutâneas/cirurgia , Pigmentação da Pele , Feminino , Seguimentos , Neoplasias de Cabeça e Pescoço/patologia , Humanos , Masculino , Melanoma/patologia , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Neoplasias Cutâneas/patologia , Taxa de Sobrevida
15.
Clin Nucl Med ; 44(5): 359-364, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30688735

RESUMO

PURPOSE: BRAF V600E mutation papillary thyroid cancer (PTC) is more aggressive with a higher risk of lymph node involvement and a poorer prognosis. Prior studies failed to demonstrate the superiority of prophylactic lymphadenectomy. We investigated the utility of additional radio-guided sentinel node biopsy (SNB). METHODS: We analyzed 15 patients with N0 PTC by ultrasound and BRAF mutation on preoperative biopsy treated with total thyroidectomy (TT) or TT + prophylactic central neck dissection (PCND) alone or with SNB. Conventional surgery was performed before SNB. We recorded primary tumor diameter, multifocality, extrathyroid infiltration, neoplastic emboli, and tall cell variant. At follow-up, we evaluated basal and stimulated thyroglobulin and ultrasound or radioiodine scintigraphy. RESULTS: Of 15 consecutive patients, 5 received conventional surgery alone, and 10 had SNB. For the first group, 4 underwent TT, and 1 had TT + PCND. Among the SNB group, 1 had no sentinel node detected and underwent a simple TT, 2 had TT + PCND+ SNB in the lateral compartment, and 7 had TT + SNB in 1 to 3 neck compartments. Micrometastases were found in 1 of 3 PCND specimens. Sentinel node biopsy revealed metastasis in 3 of 6 central compartment biopsies, in 2 of 6 biopsies in the ipsilateral lateral compartment, and in none of 2 biopsies in the contralateral compartment. Sentinel node biopsy allowed the removal of micrometastases in 4 of 10 patients. At 53 months' (mean) follow-up, no relapse was documented. CONCLUSIONS: Radio-guided SNB correctly and efficiently stages cN0 BRAF-mutated PTC patients. Sentinel node biopsy could limit time-consuming, risk-exposing compartmental prophylactic dissections.


Assuntos
Carcinoma Papilar/patologia , Biópsia de Linfonodo Sentinela/métodos , Câncer Papilífero da Tireoide/patologia , Adulto , Idoso , Carcinoma Papilar/genética , Feminino , Humanos , Biópsia Guiada por Imagem , Masculino , Pessoa de Meia-Idade , Mutação , Projetos Piloto , Proteínas Proto-Oncogênicas B-raf/genética , Biópsia de Linfonodo Sentinela/efeitos adversos , Câncer Papilífero da Tireoide/genética
16.
Gynecol Obstet Invest ; 84(4): 383-389, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30661071

RESUMO

BACKGROUND: The sentinel lymph node (SLN) mapping for endometrial cancer staging is gaining wide diffusion, but there is no definitive evidence on the factors associated with the failure of mapping. OBJECTIVES: To analyze the factors associated with the possible failure of bilateral SLN mapping with indocyanine green (ICG). METHODS: A prospective observational study without control on 110 patients with endometrial cancer apparently confined to the uterus, underwent laparoscopic surgical staging with SLN mapping with ICG. RESULTS: Possible risk factors associated with bilateral mapping failure were analyzed, and a multivariate analysis was performed. The bilateral detection rate for SLNs mapping was 72.7%, whereas at least one SLN was detected in 79.1% of patients. No SLNs were identified in 6.3%. None of the patients or features related to tumor were associated with a risk of failure of the method. The only factor analyzed that was significantly associated with the success of bilateral mapping was the surgeon (p = 0.003). CONCLUSIONS: Neither obesity nor the presence of lymph node metastases was associated with mapping failure. However, there remains a need for further studies to understand all the mechanisms linked to the unsuccessful method results and to reduce the use of systematic lymphadenectomy in the case of mapping failure.


Assuntos
Corantes , Neoplasias do Endométrio/cirurgia , Verde de Indocianina , Laparoscopia/efeitos adversos , Estadiamento de Neoplasias/efeitos adversos , Biópsia de Linfonodo Sentinela/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias do Endométrio/patologia , Feminino , Humanos , Laparoscopia/métodos , Excisão de Linfonodo , Metástase Linfática/diagnóstico por imagem , Pessoa de Meia-Idade , Análise Multivariada , Estadiamento de Neoplasias/métodos , Estudos Prospectivos , Fatores de Risco , Linfonodo Sentinela/diagnóstico por imagem , Biópsia de Linfonodo Sentinela/métodos , Falha de Tratamento , Útero/diagnóstico por imagem , Útero/patologia
17.
Int J Dermatol ; 58(2): 185-189, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30229888

RESUMO

BACKGROUND: Sentinel lymph node biopsy (SLNB) is currently a routine procedure in the staging of patients with cutaneous melanoma; however, little information is available about the risk factors for postoperative complications, especially for the risk of seroma formation. METHODS: Medical records of patients undergoing SLNB at the University Hospital of Cologne, Germany, between 2011 and 2016, were reviewed. Binary logistic regression was used to analyze the influence of a wide range of variables on seroma development. RESULTS: A total of 615 patients were included in the study. Overall, 20.4% of patients developed complications with seroma being the most common postoperative complication. Development of seroma was significantly more common among smokers than nonsmokers (OR = 1.956, P = 0.007). Inguinal localization (OR = 3.644, P < 0.0001) was also associated with seroma formation. Male patients developed a seroma significantly more often than female patients following SLNB (OR = 2.104, P = 0.001). The presence or absence of metastasis in the lymph node did not influence seroma development. CONCLUSIONS: Male sex, inguinal localization, and smoking are risk factors for the development of seroma.


Assuntos
Melanoma/secundário , Biópsia de Linfonodo Sentinela/efeitos adversos , Seroma/etiologia , Neoplasias Cutâneas/patologia , Adulto , Idoso , Axila , Feminino , Humanos , Canal Inguinal , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Fatores de Risco , Fatores Sexuais , Fumar
18.
Breast Cancer ; 26(1): 1-10, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29961238

RESUMO

In the past decades, breast surgeons have changed the clinical practice in the surgical treatment of breast cancer, by performing sentinel lymph node biopsy (SLNB) instead of performing axillary lymph node dissection (ALND) in axillary lymph node clinically negative breast cancer patients. ALND can also be avoided in SLN-positive patients who meet the Z-0011 criteria. However, the postoperative complications of SLNB and ALND, such as the secondary upper extremity lymphedema, are common and need effective solutions to prevent as soon as possible. The axillary reverse mapping (ARM) technique has been developed to map and preserve arm lymphatic drainage during ALND and/or SLNB, thereby minimizing arm lymphedema. However, the success of ARM in reducing lymphedema has not been exactly determined. If ARM can be confirmed to be both effective and oncologically safe in preventing lymphedema, this technique should be recommended in the management of breast cancer treatment.


Assuntos
Neoplasias da Mama/cirurgia , Metástase Linfática/diagnóstico por imagem , Linfedema/prevenção & controle , Imagem Óptica/métodos , Complicações Pós-Operatórias/prevenção & controle , Axila , Neoplasias da Mama/patologia , Meios de Contraste/administração & dosagem , Meios de Contraste/efeitos adversos , Feminino , Humanos , Excisão de Linfonodo/efeitos adversos , Excisão de Linfonodo/métodos , Linfonodos/diagnóstico por imagem , Linfonodos/patologia , Metástase Linfática/patologia , Vasos Linfáticos/diagnóstico por imagem , Vasos Linfáticos/patologia , Linfedema/etiologia , Mastectomia/efeitos adversos , Mastectomia/métodos , Oncologia/métodos , Imagem Óptica/efeitos adversos , Tratamentos com Preservação do Órgão/efeitos adversos , Tratamentos com Preservação do Órgão/métodos , Complicações Pós-Operatórias/etiologia , Biópsia de Linfonodo Sentinela/efeitos adversos , Biópsia de Linfonodo Sentinela/métodos
19.
Breast Cancer Res Treat ; 173(2): 343-352, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30343457

RESUMO

PURPOSE: GANEA2 study was designed to assess accuracy and safety of sentinel lymph node (SLN) after neo-adjuvant chemotherapy (NAC) in breast cancer patients. METHODS: Early breast cancer patients treated with NAC were included. Before NAC, patients with cytologically proven node involvement were allocated into the pN1 group, other patient were allocated into the cN0 group. After NAC, pN1 group patients underwent SLN and axillary lymph node dissection (ALND); cN0 group patients underwent SLN and ALND only in case of mapping failure or SLN involvement. The main endpoint was SLN false negative rate (FNR). Secondary endpoints were predictive factors for remaining positive ALND and survival of patients treated with SLN alone. RESULTS: From 2010 to 2014, 957 patients were included. Among the 419 patients from the cN0 group treated with SLN alone, one axillary relapse occurred during the follow-up. Among pN1 group patients, with successful mapping, 103 had a negative SLN. The FNR was 11.9% (95% CI 7.3-17.9%). Multivariate analysis showed that residual breast tumor size after NAC ≥ 5 mm and lympho-vascular invasion remained independent predictors for involved ALND. For patients with initially involved node, with negative SLN after NAC, no lympho-vascular invasion and a remaining breast tumor size 5 mm, the risk of a positive ALND is 3.7% regardless the number of SLN removed. CONCLUSION: In patients with no initial node involvement, negative SLN after NAC allows to safely avoid an ALND. Residual breast tumor and lympho-vascular invasion after NAC allow identifying patients with initially involved node with a low risk of ALND involvement.


Assuntos
Neoplasias da Mama/patologia , Excisão de Linfonodo/estatística & dados numéricos , Metástase Linfática/diagnóstico , Biópsia de Linfonodo Sentinela/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Axila , Mama/patologia , Mama/cirurgia , Neoplasias da Mama/terapia , Reações Falso-Negativas , Feminino , Humanos , Excisão de Linfonodo/efeitos adversos , Metástase Linfática/patologia , Mastectomia , Pessoa de Meia-Idade , Terapia Neoadjuvante/métodos , Neoplasia Residual/patologia , Seleção de Pacientes , Prognóstico , Estudos Prospectivos , Linfonodo Sentinela/patologia , Biópsia de Linfonodo Sentinela/métodos
20.
J Surg Res ; 233: 149-153, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30502241

RESUMO

BACKGROUND: Sentinel lymph node biopsy (SLNB) is an important adjunct in the staging of patients with melanoma. Preoperative lymphoscintigraphy with radiolabeled isotopes is essential to localize sentinel nodes for removal. Our study compared the effectiveness of Lymphoseek to standard sulfur colloids in patients with melanoma undergoing SLNB. METHODS: We queried our IRB-approved melanoma database to identify 370 consecutive patients who underwent SLNB from 2012 to 2016 with at least 1 y of follow-up. There were 185 patients in each group. Data points included characteristics of the primary melanoma lymphoscintigraphy and SLNB. Student's t-test and chi-square were used to analyze the data with a P value of <0.05 being considered significant. RESULTS: Patients were equally matched in regard to age, sex, and primary characteristics of their melanoma. In comparison to sulfur colloid, Lymphoseek required lower radiation dosages (P < 0.001), shorter mapping times (P = 0.008), and decreased number of sentinel nodes removed (P = 0.03). There was no difference in the number of patients with positive nodes (P = 0.5). In addition, there were no statistical differences between the two radioactive tracers in regard to the number of patients with false-negative SLNB. CONCLUSION: Lymphoseek has the potential to decrease radioactivity and mapping time in patients who need SLNB. With a decrease in the number of nodes removed without loss of sensitivity, there is a potential to avoid unnecessary node removal and thus complications such as lymphedema. Longer follow-up will help to determine if there is any increase in false-negative rates despite fewer nodes removed.


Assuntos
Metástase Linfática/diagnóstico por imagem , Melanoma/patologia , Compostos Radiofarmacêuticos/administração & dosagem , Biópsia de Linfonodo Sentinela/métodos , Neoplasias Cutâneas/patologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Dextranos/administração & dosagem , Feminino , Seguimentos , Humanos , Metástase Linfática/patologia , Linfedema/etiologia , Linfedema/prevenção & controle , Linfocintigrafia/métodos , Masculino , Mananas/administração & dosagem , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Estudos Retrospectivos , Biópsia de Linfonodo Sentinela/efeitos adversos , Pentetato de Tecnécio Tc 99m/administração & dosagem , Pentetato de Tecnécio Tc 99m/análogos & derivados , Coloide de Enxofre Marcado com Tecnécio Tc 99m/administração & dosagem , Adulto Jovem
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA