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1.
Rev. enferm. UERJ ; 29: e56924, jan.-dez. 2021.
Artigo em Inglês, Português | LILACS | ID: biblio-1224444

RESUMO

Objetivo: descrever a incidência de complicações em feridas operatórias de mastectomia e identificar fatores associados. Método: estudo retrospectivo desenvolvido em uma coorte hospitalar de 545 mulheres mastectomizadas por câncer de mama no ano 2018 em um centro de assistência de alta complexidade em oncologia da cidade do Rio de Janeiro, Brasil, após aprovação por Comitê de Ética em Pesquisa. Os dados foram coletados a partir dos prontuários, permitindo cálculos da taxa de incidência e da razão da taxa de incidência para cada complicação. Resultados: a complicação que apresentou maior taxa de incidência foi o sangramento (57,14/100 mastectomias-dia), tendo como fatores associados a raça/cor da pele não branca (Razão da Taxa de Incidência: 3,11) e a diabetes mellitus (Razão da Taxa de Incidência: 0,48). Conclusão: os fatores associados ao sangramento da ferida operatória apontam para a necessidade de novas práticas no cuidado ao pós-operatório de mulheres mastectomizadas.


Objective: to describe the incidence of complications in mastectomy surgical wounds and to identify associated factors. Method: this retrospective study was conducted in a hospital cohort of 545 women mastectomized for breast cancer in 2018 at a high-complexity cancer care center Rio de Janeiro City, Brazil, after approval by the research ethics committee. Data were collected from medical records, allowing incidence rate and incidence rate ratio to be calculated for each complication. Results: the complication with the highest incidence rate was bleeding (57.14/100 mastectomies-day), associated factors being non-white race/skin color (incidence rate ratio 3.11) and diabetes mellitus (incidence rate ratio 0.48). Conclusion: the factors associated with bleeding from the surgical wound point to the need for new practices in post-operative care for women with mastectomies.


Objetivo: describir la incidencia de complicaciones en heridas quirúrgicas de mastectomía e identificar factores asociados. Método: estudio retrospectivo desarrollado en una cohorte hospitalaria de 545 mujeres mastectomizadas por cáncer de mama en 2018 en un centro de atención de alta complejidad en oncología de la ciudad de Río de Janeiro, Brasil, previa aprobación del Comité de Ética en Investigación. Los datos se obtuvieron de las historias clínicas, lo que permitió calcular la tasa de incidencia y el cociente de la tasa de incidencia para cada complicación. Resultados: la complicación que presentó mayor tasa de incidencia fue el sangrado (57,14 / 100 mastectomías-día), con factores asociados a la raza / color de piel no blanca (índice de tasa de incidencia: 3,11) y diabetes mellitus (índice de tasa de incidencia: 0,48). Conclusión: los factores asociados al sangrado de la herida quirúrgica apuntan a la necesidad de nuevas prácticas en el cuidado al postoperatorio de las mujeres con mastectomía.


Assuntos
Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Adulto Jovem , Complicações Pós-Operatórias/epidemiologia , Ferida Cirúrgica/complicações , Mastectomia/efeitos adversos , Brasil/epidemiologia , Neoplasias da Mama/cirurgia , Incidência , Estudos Retrospectivos , Fatores de Risco , Hemorragia Pós-Operatória/epidemiologia
2.
J BUON ; 26(4): 1379-1385, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34564995

RESUMO

PURPOSE: The purpose of this study was to examine the effect of COVID-19 infection on the morbidity and mortality rates of breast cancer patients performed in the East Mediterranean region of Turkey during the COVID-19 pandemic and to share the results of those investigations. METHODS: This retrospective study included all breast cancer patients that underwent surgery during the COVID-19 pandemic in the General Surgery Clinic of Adana City Training and Research Hospital, a regional pandemic hospital, between March 11, 2020 and December 25, 2020. The patients were evaluated preoperatively and postoperatively (the first 30 days) in terms of COVID-19 infection. Moreover, these patients were also evaluated in terms of admission to the hospital, length of hospital stay, and mortality due to COVID-19 infection during the follow-up period of the study. RESULTS: Included in the study were 139 patients that underwent surgery for breast cancer during the pandemic period, with no observed mortality or morbidity associated with COVID-19 in any patient postoperatively within the first 30 days. In addition, within 121.22±70.05 days, the mean and standard deviation of the study's follow-up period, 19 patients (15.7%) were admitted to the hospital with a suspected COVID-19 infection (after the first 30 days postoperatively) and 6 of them (4.3%) returned a positive PCR test. All of the COVID-19 positive patients (6 patients, 4.3%) were hospitalised and 3 of them (2.2%) died due to the COVID-19 infection. CONCLUSION: Breast cancer surgery can be performed safely during the COVID-19 pandemic period after taking the necessary precautions.


Assuntos
Neoplasias da Mama/cirurgia , COVID-19/prevenção & controle , Mastectomia , Adulto , Idoso , Neoplasias da Mama/mortalidade , COVID-19/mortalidade , COVID-19/transmissão , Feminino , Mortalidade Hospitalar , Humanos , Mastectomia/efeitos adversos , Mastectomia/mortalidade , Pessoa de Meia-Idade , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Turquia
3.
Surg Clin North Am ; 101(5): 845-863, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34537147

RESUMO

Breast cancer surgery is associated with low rates of surgical morbidity. Postoperative complications related to breast surgery include seroma, infection, hematoma, mastectomy flap necrosis, wound dehiscence, persistent postsurgical pain, Mondor disease, fat necrosis, reduced tactile sensation after mastectomy, and venous thromboembolism. Postoperative complications related to axillary surgery include seroma, infection, lymphedema, nerve injury, and reduced shoulder/arm mobility. The overall rate of complication related to axilla surgery may be confounded by the type of breast surgery performed. The management of postoperative complications related to oncologic breast and axillary surgery independent of reconstruction is reviewed here.


Assuntos
Neoplasias da Mama/cirurgia , Mastectomia/efeitos adversos , Feminino , Humanos , Mastectomia/métodos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/terapia
4.
In Vivo ; 35(5): 2739-2746, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34410963

RESUMO

AIM: This research compares postoperative complication rates with Strattice™, SERAGYN® BR, and TiLOOP® Bra interposition devices for subpectoral implant placement after skin or nipple sparing mastectomy. PATIENTS AND METHODS: 188 breast reconstructions in 157 patients after primary (n=96), secondary (n=71), or prophylactic (n=21) surgery were analyzed regarding major and minor complications. RESULTS: With acellular dermal matrix (ADM) Strattice™, 27.5% major and 27.5% minor complications occurred. Implant loss rates were 27.3% in primary and 30.8% in secondary reconstructions. With SERAGYN® BR, 11.1% major and 13,0% minor complications occurred. Implant losses (6.1%) occurred exclusively in primary reconstructions. With TiLOOP® Bra, 14.9% major and 9.6% minor complications occurred. Implant loss rates were 7.7% in primary and 7.1% in secondary reconstructions. CONCLUSION: ADM was associated with high complication rates in primary and secondary reconstructions. Low complication rates were seen with mesh interposition devices in primary, secondary, and prophylactic reconstructions.


Assuntos
Derme Acelular , Implante Mamário , Implantes de Mama , Neoplasias da Mama , Mamoplastia , Animais , Implante Mamário/efeitos adversos , Implantes de Mama/efeitos adversos , Neoplasias da Mama/cirurgia , Feminino , Humanos , Mamoplastia/efeitos adversos , Mastectomia/efeitos adversos , Polipropilenos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Suínos
5.
Anesth Analg ; 133(3): 772-780, 2021 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-34232953

RESUMO

BACKGROUND: Breast cancer is the most common malignancy in women. Surgery is a mainstay therapy unfortunately burdened by complications as severe postoperative pain. Regional anesthesia may play a role in a multimodal strategy for prevention and treatment of postoperative pain. The main purpose of this survey was to investigate the rate of use of regional anesthesia techniques in patients undergoing breast surgery in the Italian public hospital system. METHODS: We designed an online survey that consisted of 22 questions investigating the anesthesia management of breast surgery, particularly focused on regional anesthesia. The survey lasted from November 18, 2019 to February 28, 2020. Directors of anesthesia departments of 168 Italian public health system hospitals were contacted and invited to forward the survey to every anesthesiologist in their unit. RESULTS: A total of 935 anesthesiologists received the survey; among them 460 entered the final analysis. Regional anesthesia was not used by 44.6% of the anesthesiologists and lack of experience/training was the main cause (75.6%). Logistic regression models revealed that anesthesiologists with more than 15 years of experience (odds ratio [OR] = 0.55; 95% confidence interval [CI], 0.33-0.93) or working most of their days in intensive care unit (ICU) compared to operating theater (OR = 0.25; 95% CI, 0.14-0.43) were less likely to perform regional anesthesia techniques. CONCLUSIONS: Low implementation of regional anesthesia techniques in breast surgery emerges from our survey and the major reason cited is a lack of proper training. An improved training program in regional anesthesia, especially in residents' curricula, could be useful to increase its rate of use and to standardize its practice.


Assuntos
Anestesia por Condução/tendências , Anestesiologistas/tendências , Neoplasias da Mama/cirurgia , Mastectomia , Programas Nacionais de Saúde , Dor Pós-Operatória/prevenção & controle , Padrões de Prática Médica/tendências , Anestesia por Condução/efeitos adversos , Anestesiologistas/educação , Competência Clínica , Currículo , Educação de Pós-Graduação em Medicina , Feminino , Pesquisas sobre Serviços de Saúde , Humanos , Internato e Residência , Itália , Mastectomia/efeitos adversos , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/etiologia , Fatores de Tempo , Resultado do Tratamento
6.
J Surg Oncol ; 124(5): 722-730, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34235740

RESUMO

BACKGROUND: Staged implant-based breast reconstruction is the most common reconstructive modality following mastectomy. Postoperative implant infections can have a significant impact on adjuvant oncologic care and reconstructive outcome. Here, we investigate the impact of ß-lactam antibiotics (i.e., bactericidal) compared to alternative antibiotic agents on postoperative outcomes for implant-based breast reconstruction. METHODS: A retrospective analysis of patients who underwent immediate sub-pectoral tissue expander placement with an inferior acellular dermal matrix (ADM) sling at a single institution between May 2008 and July 2018 was performed. Patient demographics, comorbidities, and complication rates were retrieved. The impact of antibiotic regimen on postoperative outcomes, including infection rate and reconstructive failure, was investigated. RESULTS: A total of 320 patients with a mean age and BMI of 48.2 years and 25.0 kg/m2 , respectively, who underwent 542 immediate breast reconstructions were included in the study. The use of a ß-lactam antibiotic was protective against postoperative infection (odds ratio [OR] = 0.467, p = .046), infection requiring operative management (OR = 0.313, p = .022), and reconstructive failure (OR = 0.365, p = .028). Extended, that is, post-discharge, prophylaxis was not associated with any clinical benefit. CONCLUSION: The use of ß-lactam antibiotics for pre-/peri-operative prophylaxis is superior to alternative antibiotics with a bacteriostatic mechanism of action regarding rates of postoperative infection and reconstructive failure following immediate tissue expander-based breast reconstruction. Extended, that is, post-discharge, prophylaxis does not appear to be indicated, regardless of the antibiotic chosen.


Assuntos
Neoplasias da Mama/cirurgia , Mamoplastia/efeitos adversos , Mastectomia/efeitos adversos , Complicações Pós-Operatórias/tratamento farmacológico , Infecção da Ferida Cirúrgica/tratamento farmacológico , Dispositivos para Expansão de Tecidos/efeitos adversos , beta-Lactamas/farmacologia , Assistência ao Convalescente , Antibioticoprofilaxia/métodos , Neoplasias da Mama/patologia , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/patologia , Prognóstico , Estudos Retrospectivos , Infecção da Ferida Cirúrgica/etiologia , Infecção da Ferida Cirúrgica/patologia
8.
J Int Med Res ; 49(6): 3000605211021375, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34130539

RESUMO

The post-operative complication of chylous leakage after breast cancer is relatively rare, and few clinical studies have been published. We report a 64-year-old woman with chylous leakage following modified radical mastectomy. We describe the patient's diagnostic and treatment process in detail. The patient was diagnosed with grade II (left) breast invasive ductal carcinoma. Post-operatively, the patient's chest wall and axilla were pressurized, and negative pressure drainage was initiated. On the fifth post-operative day, the drainage from the chest wall and axilla increased significantly, and the patient developed chylous leakage on the eighth postoperative day. We injected meglumine diatrizoate (100 mL) and elemene (10 mL) into the patient's axilla, and the chylous leakage gradually resolved 18 days post-operatively. In this report, we focus on managing a case of chylous leakage after modified radical mastectomy for breast cancer. Meglumine diatrizoate combined with elemene is a possible treatment for the management of this rare complication.


Assuntos
Neoplasias da Mama , Axila , Neoplasias da Mama/cirurgia , Feminino , Humanos , Excisão de Linfonodo , Mastectomia/efeitos adversos , Mastectomia Radical Modificada , Pessoa de Meia-Idade
9.
Medicine (Baltimore) ; 100(26): e26438, 2021 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-34190167

RESUMO

BACKGROUND: Postoperative nausea and vomiting (PONV) is a common complaint in patients following general anesthesia. Various antiemetics, including 5-hydroxytryptamine type 3 (5-HT3) receptor antagonists, are effective but still have limited efficacy. Therefore, combination therapy is preferable to using a single drug alone in high-risk patients. We performed a comparative study on the antiemetic effect of palonosetron, a 5-HT3 receptor antagonist, monotherapy vs palonosetron-midazolam combination therapy for the prevention of PONV. METHODS: A total of 104 female patients scheduled for breast cancer surgery were enrolled. They were randomly divided into 2 groups, a palonosetron monotherapy group (group P) and palonosetron-midazolam combination therapy group (group PM). Both groups received 0.075 mg palonosetron intravenously after induction of anesthesia. Patient-controlled analgesia (PCA) was applied according to the allocated group. Intravenous (IV)-PCA in group P consisted of fentanyl 20 µg/kg plus normal saline (total volume: 100 ml); IV-PCA in group PM consisted of fentanyl 20 µg/kg plus midazolam 4 mg plus normal saline (total volume: 100 ml). Efficacy parameters were collected during 0 to 1, 1 to 6, 6 to 24, and 24 to 48 hours postoperative time intervals. These measures included complete response (defined as no PONV and no rescue anti-emetic use) rate, incidence of PONV, sedation score, rescue antiemetic use, rescue analgesic use, and numerical rating scale (NRS) for pain. The complete response rate during the 0 to 24 hours interval was analyzed as the primary outcome. RESULTS: Although the complete response rate between 0 and 24 hours was higher in group PM (42.3% and 48.1% in group P and PM, respectively), there was no statistically significant difference (P = .55). The complete response rates in other time intervals were not different between the 2 groups as well. The sedation score and NRS score also showed no differences between the 2 groups. CONCLUSIONS: The combination therapy of palonosetron with midazolam did not lead to a greater reduction in the incidence of PONV than monotherapy in patients undergoing breast surgery and receiving IV-PCA containing fentanyl.


Assuntos
Analgesia Controlada pelo Paciente/efeitos adversos , Neoplasias da Mama/cirurgia , Fentanila , Midazolam/administração & dosagem , Palonossetrom/administração & dosagem , Náusea e Vômito Pós-Operatórios , Anestésicos Intravenosos/administração & dosagem , Antieméticos/administração & dosagem , Antieméticos/efeitos adversos , Método Duplo-Cego , Quimioterapia Combinada/métodos , Feminino , Fentanila/administração & dosagem , Fentanila/efeitos adversos , Humanos , Mastectomia/efeitos adversos , Mastectomia/métodos , Midazolam/efeitos adversos , Pessoa de Meia-Idade , Palonossetrom/efeitos adversos , Náusea e Vômito Pós-Operatórios/etiologia , Náusea e Vômito Pós-Operatórios/prevenção & controle , Resultado do Tratamento
10.
Medicine (Baltimore) ; 100(24): e26337, 2021 Jun 18.
Artigo em Inglês | MEDLINE | ID: mdl-34128878

RESUMO

ABSTRACT: Continuous wound infusion usually provides postoperative analgesia as a multimodal analgesia with systemic opioid use. When continuous wound infusion of local anesthetics (LA) supports successful postoperative analgesia without systemic opioid use, the side effects of opioid can be reduced. Nevertheless, continuous wound infusion after mastectomy with immediate autologous breast reconstruction leads to concerns about wound healing. This study evaluated analgesic effects and wound healing conditions of continuous wound infusion of LA compared with opioid-based, intravenous patient-controlled analgesia (IV PCA) in mastectomy with immediate autologous breast reconstruction.This retrospective observational study included females, aged between 33 and 67 years, who underwent mastectomy with immediate autologous breast reconstruction. Sixty-five patients were enrolled. The eligible patients were placed into 2 groups for managing postoperative pain, one used continuous wound infusion with 0.5% ropivacaine (ON-Q, n = 32) and the other used a fentanyl-based IV PCA (IV PCA, n = 33). Using the electronic medical record system, the postoperative recovery profiles were examined over 5 days using a visual analogue scale (VAS), incidence of postoperative nausea and vomiting (PONV), incidence of sleep disturbance, frequency of rescue analgesic use, analgesia-related adverse events, length of hospital stay, and degree of patient satisfaction. The condition of the surgical wound was observed for 1 year after surgery.The primary endpoint was the intensity of pain at 6 hours after surgery. The VAS was comparable between the groups (P > .05). Although recovery profiles and the degree of patient satisfaction were similar between the groups, the incidence of PONV was significantly lower in the ON-Q group than in the IV PCA group on the day of surgery and postoperative day 1. No patients had severe wound complications. The satisfaction score of analgesia in the ON-Q group was comparable with that of the patients in the IV PCA group.This study demonstrates that single use of continuous wound infusion showed comparable analgesia with fentanyl-based IV PCA in patients who underwent mastectomy with immediate autologous breast reconstruction. Furthermore, the continuous infusion of LA directly on the surgical site did not significantly affect wound healing.


Assuntos
Analgesia Controlada pelo Paciente/métodos , Anestésicos Locais/administração & dosagem , Manejo da Dor/métodos , Dor Pós-Operatória/tratamento farmacológico , Ropivacaina/administração & dosagem , Adulto , Idoso , Analgésicos Opioides/uso terapêutico , Neoplasias da Mama/cirurgia , Feminino , Humanos , Infusões Intralesionais , Tempo de Internação , Mamoplastia/efeitos adversos , Mastectomia/efeitos adversos , Pessoa de Meia-Idade , Medição da Dor , Dor Pós-Operatória/etiologia , Satisfação do Paciente , Estudos Retrospectivos , Ferida Cirúrgica/complicações , Ferida Cirúrgica/tratamento farmacológico , Resultado do Tratamento , Cicatrização/efeitos dos fármacos
11.
Plast Reconstr Surg ; 148(1): 1e-11e, 2021 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-34181599

RESUMO

BACKGROUND: The impact of breast reconstruction on financial toxicity remains poorly understood despite growing awareness. The authors sought to illustrate the relationship between breast reconstruction subtypes and the risk of financial toxicity. METHODS: The authors conducted a single-institution cross-sectional survey of all female breast cancer patients undergoing any form of breast reconstruction between January of 2018 and June of 2019. Financial toxicity was measured by means of the validated Comprehensive Score for Financial Toxicity instrument. Demographics, clinical course, and coping strategies were abstracted from a purpose-built survey and electronic medical records. Multivariable linear regression was performed to identify associations with financial toxicity. RESULTS: The authors' analytical sample was 350 patients. One hundred eighty-four (52.6 percent) underwent oncoplastic reconstruction, 126 (36 percent) underwent implant-based reconstruction, and 40 (11.4 percent) underwent autologous reconstruction. Oncoplastic reconstruction recipients were older, had a higher body mass index, and were more likely to have supplemental insurance and receive adjuvant hormonal therapy. No significant differences in the risk of financial toxicity were uncovered across breast reconstruction subtypes (p = 0.53). Protective factors against financial toxicity were use of supplemental insurance (p = 0.0003) and escalating annual household income greater than $40,000 (p < 0.0001). Receipt of radiation therapy was positively associated with worsening financial toxicity (-2.69; 95 CI percent, -5.22 to -0.15). Financial coping strategies were prevalent across breast reconstruction subtypes. CONCLUSIONS: Breast reconstruction subtype does not differentially impact the risk of financial toxicity. Increasing income and supplemental insurance were found to be protective, whereas receipt of radiation therapy was positively associated with financial toxicity. Prospective, multicenter studies are needed to identify the main drivers of out-of-pocket costs and financial toxicity in breast cancer care.


Assuntos
Neoplasias da Mama/cirurgia , Efeitos Psicossociais da Doença , Estresse Financeiro/epidemiologia , Gastos em Saúde/estatística & dados numéricos , Mamoplastia/economia , Adulto , Idoso , Neoplasias da Mama/economia , Estudos Transversais , Feminino , Estresse Financeiro/diagnóstico , Estresse Financeiro/economia , Humanos , Renda/estatística & dados numéricos , Cobertura do Seguro/economia , Cobertura do Seguro/estatística & dados numéricos , Seguro Saúde/economia , Seguro Saúde/estatística & dados numéricos , Mamoplastia/métodos , Mastectomia/efeitos adversos , Pessoa de Meia-Idade , Projetos Piloto , Estudos Prospectivos , Medição de Risco/estatística & dados numéricos , Fatores de Risco , Inquéritos e Questionários/estatística & dados numéricos
12.
Sci Rep ; 11(1): 9620, 2021 05 05.
Artigo em Inglês | MEDLINE | ID: mdl-33953312

RESUMO

Patients and breast cancer surgeons are frequently confronted with wound complications after mastectomy. Negative pressure wound therapy (NPWT) is a promising technique for preventing wound complications after skin closure in elective surgery. However, a clinical study evaluating postoperative complications following the use of NPWT, focusing solely on closed incisions in patients undergoing mastectomy, has yet to be performed. Between June 2019 and February 2020, 50 consecutive patients underwent mastectomy with NPWT during the first seven postoperative days. This group was compared to a cohort of patients taking part in a randomized controlled trial between June 2014 and July 2018. Primary outcome was the rate of postoperative wound complications, i.e. surgical site infections, wound necrosis or wound dehiscence during the first three postoperative months. Secondary outcomes were the number of patients requiring unplanned visits to the hospital and developing clinically significant seroma (CSS). In total, 161 patients were analyzed, of whom 111 patients in the control group (CON) and 50 patients in the NPWT group (NPWT). Twenty-eight percent of the patients in the NPWT group developed postoperative wound complications, compared to 18.9% in the control group (OR = 1.67 (95% CI 0.77-3.63), p = 0.199). The number of patients requiring unplanned visits or developing CSS was not statistically significant between the groups. This study suggests that Avelle negative pressure wound therapy in mastectomy wounds does not lead to fewer postoperative wound complications. Additionally, it does not lead to fewer patients requiring unplanned visits or fewer patients developing clinically significant seromas.Trial registration: ClinicalTrials.gov number, NCT03942575. Date of registration: 08/05/2019.


Assuntos
Neoplasias da Mama/cirurgia , Mastectomia/efeitos adversos , Seroma/prevenção & controle , Retalhos Cirúrgicos/efeitos adversos , Deiscência da Ferida Operatória/prevenção & controle , Infecção da Ferida Cirúrgica/prevenção & controle , Idoso , Bandagens , Feminino , Humanos , Pessoa de Meia-Idade , Tratamento de Ferimentos com Pressão Negativa , Seroma/etiologia , Transplante de Pele/efeitos adversos , Retalhos Cirúrgicos/cirurgia , Deiscência da Ferida Operatória/etiologia , Infecção da Ferida Cirúrgica/etiologia , Cicatrização
13.
Anesth Analg ; 133(3): 707-712, 2021 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-34043309

RESUMO

BACKGROUND: There is a continued perception that intravenous line (IV) placement is contraindicated in the arm ipsilateral to prior breast cancer surgery to avoid breast cancer-related lymphedema (BCRL). The aim of this retrospective study was to determine the risk for development of BCRL in ipsilateral arm IV placement compared to contralateral arm IV placement to prior breast cancer surgery. METHODS: We performed a retrospective review, via our Integrated Clinical Systems and Epic Electronic Heath Record of IV placement for anesthesia and surgery in patients with a prior history of breast cancer surgery with or without axillary lymph node dissection. Complication rates were compared for IVs placed in the ipsilateral and contralateral arms. We identified 3724 patients undergoing 7896 IV placements between January 1, 2015, and May 5, 2018, with a prior history of breast cancer surgery via their index anesthesia and surgical procedures. RESULTS: The median time from breast cancer surgery to IV placement was 1.5 years (range, 1 day to 17.8 years). Of 2743 IVs placed in the arm contralateral to prior breast cancer surgery, 2 had a complication, corresponding to an incidence of 7.3 per 10,000 (95% confidence interval [CI], 0.9-26.3 per 10,000). Of 5153 IVs placed in the arm ipsilateral to prior breast cancer surgery, 2 IVs had a complication, for an incidence of 3.9 per 10,000 (95% CI, 0.5-14.0 per 10,000). The frequency of complications was not found to differ significantly between the groups (P = .91), and the 95% CI for the risk difference (ipsilateral minus contralateral) was -23 to +8 complications per 10,000. The complication rate is similar when only the first IV placed following breast cancer surgery is considered (overall 5.4 per 10,000 [95% CI, 0.7-19.4] per 10,000; contralateral 7.0 [95% CI, 0.2-39.0] per 10,000, ipsilateral 4.4 [95% CI, 0.1-24.2] per 10,000; P = 1.00; 95% CI for risk difference [ipsilateral minus contralateral], -41 to +22 per 10,000). CONCLUSIONS: We found very few complications in patients who had an IV placed for surgery following a previous breast cancer surgery and no complications in those patients with IV placement ipsilateral with axillary node dissection. Avoidance of IV placement in the arm ipsilateral to breast cancer surgery is not necessary.


Assuntos
Linfedema Relacionado a Câncer de Mama/etiologia , Neoplasias da Mama/cirurgia , Cateterismo Periférico/efeitos adversos , Excisão de Linfonodo/efeitos adversos , Mastectomia/efeitos adversos , Extremidade Superior/irrigação sanguínea , Administração Intravenosa , Adulto , Idoso , Linfedema Relacionado a Câncer de Mama/diagnóstico , Contraindicações de Procedimentos , Registros Eletrônicos de Saúde , Feminino , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
14.
Plast Reconstr Surg ; 148(1): 1-9, 2021 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-34003807

RESUMO

BACKGROUND: The rising popularity of prepectoral tissue expander placement with acellular dermal matrices in immediate breast reconstruction has prompted many studies on the safety of this technique. However, a comprehensive propensity-matched, historically controlled trial comparing perioperative outcomes following prepectoral versus partial subpectoral (dual-plane) placement of tissue expanders is lacking. METHODS: Retrospective propensity-matched cohort analysis was performed on all patients of two senior reconstructive surgeons who underwent bilateral tissue expander placement following a mastectomy with one of three breast surgeons at a single academic institution from 2012 onward (n = 260). Two matched groups (prepectoral and partial subpectoral) each consisted of 102 patients. Univariate and multivariable analyses were also performed to contextualize the risks associated with prepectoral reconstruction relative to demographic characteristics and other clinical factors. RESULTS: Compared to dual-plane subpectoral placement, prepectoral placement resulted in similar rates of overall perioperative complications (32 percent versus 31 percent; p = 1.00) and perioperative complications that required operative treatment (21 percent versus 21 percent; p = 1.00). There were no significant differences between the groups in complication rates for hematomas, seromas, impaired wound healing, and infection. Although prepectoral placement was associated with prolonged time to drain removal, those patients completed the expansion process twice as fast, were expanded further in the operating room, and were more than twice as likely to forgo clinic-based expansion. Prepectoral reconstruction was not associated with increased risk for any complications in univariate or multivariable analysis. CONCLUSIONS: Prepectoral tissue expander placement permitted greater intraoperative filling of expanders and a reduced likelihood of clinic-based expansion, with no increase in adverse outcomes compared to partial subpectoral placement. Adoption of this technique may reduce unnecessary clinic visits; shorten the delay before adjuvant therapy; and minimize patient apprehension, pain, and discomfort related to clinic-based expansion. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.


Assuntos
Implante Mamário/efeitos adversos , Neoplasias da Mama/cirurgia , Complicações Pós-Operatórias/epidemiologia , Expansão de Tecido/efeitos adversos , Derme Acelular/efeitos adversos , Adulto , Implante Mamário/instrumentação , Implante Mamário/métodos , Implantes de Mama/efeitos adversos , Feminino , Humanos , Mastectomia/efeitos adversos , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Pontuação de Propensão , Estudos Retrospectivos , Expansão de Tecido/instrumentação , Expansão de Tecido/métodos , Dispositivos para Expansão de Tecidos/efeitos adversos , Resultado do Tratamento
15.
Plast Reconstr Surg ; 148(1): 11-20, 2021 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-34003814

RESUMO

BACKGROUND: Autologous fat grafting has been an increasingly popular procedure for remodeling the breast of patients undergoing breast cancer surgery. This study's objective was to investigate whether autologous fat grafting is associated with a higher risk of disease recurrence in the context of late breast reconstruction for patients diagnosed with breast cancer who have undergone either breast-conserving surgery or mastectomy. METHODS: A retrospective matched cohort study was performed in a single tertiary health care center. Data were collected from 42 patients formerly treated for breast cancer who underwent the first session of autologous fat grafting between August of 2007 and June of 2016. A total of 126 patients with similar features, who did not undergo autologous fat grafting, were individually matched at a 1:3 ratio with the autologous fat grafting group. The primary endpoint was locoregional recurrence. Secondary outcomes were rates of local and distant recurrences, disease-free survival, and overall survival. RESULTS: At a mean follow-up of 65 months after fat grafting, no significant differences were found between the lipofilling and control groups for locoregional recurrence (7.1 percent versus 6.3 percent; p = 0.856), local recurrence (7.1 percent versus 5.6 percent; p = 0.705), distant recurrence (14.3 percent versus 7.9 percent; p = 0.238), disease-free survival (21.4 percent versus 19.0 percent; p = 0.837), and overall survival (14.3 percent versus 7.1 percent; p = 0.181). CONCLUSIONS: No evidence of increased risk in any of the survival outcomes was identified. Lipofilling seems to be a safe procedure for breast reconstruction after surgical treatment of breast cancer. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.


Assuntos
Tecido Adiposo/transplante , Neoplasias da Mama/cirurgia , Mamoplastia/efeitos adversos , Recidiva Local de Neoplasia/epidemiologia , Adulto , Autoenxertos/patologia , Mama/patologia , Mama/cirurgia , Neoplasias da Mama/mortalidade , Neoplasias da Mama/patologia , Estudos de Coortes , Intervalo Livre de Doença , Feminino , Seguimentos , Humanos , Mamoplastia/métodos , Mastectomia/efeitos adversos , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/etiologia , Estudos Prospectivos , Estudos Retrospectivos , Transplante Autólogo/efeitos adversos , Transplante Autólogo/métodos
16.
Medicine (Baltimore) ; 100(20): e25872, 2021 May 21.
Artigo em Inglês | MEDLINE | ID: mdl-34011053

RESUMO

RATIONALE: Despite significant advances in microsurgical techniques, simultaneous release of transverse carpal ligament (TCL) and lymphovenous anastomosis (LVA) surgeries may be effective for treatment of carpal tunnel syndrome (CTS) and advanced-stage lymphedema. This case report describes the successful treatment of lymphedema with LVA in a patient with CTS and advanced-stage lymphedema. PATIENT CONCERNS: A 60-year-old female patient was referred to our lymphedema clinic with a 12-year history of chronic, acquired, right upper extremity lymphedema and CTS following right mastectomy and axillary lymph node dissection and adjuvant chemoradiotherapy for treating breast cancer. DIAGNOSIS: According to the indocyanine green lymphography, magnetic resonance lymphangiography, and electromyography, the patient was diagnosed with CTS and advanced-stage lymphedema (International Society of Lymphology late stage 2). INTERVENTION: Release of the TCL was performed first, followed by LVA at the wrist, forearm, and antecubital area. The right arm was compressed and elevated immediately postoperatively and postoperative compression bandage therapy with 35 to 40 mm Hg pressure was instituted following surgery. OUTCOMES: After 2 simultaneous surgeries, the patient had significant circumference and volume reduction of the right hand. The CTS and lymphedema symptoms have decreased following synchronous TCL release and LVA surgeries. LESSONS: Simultaneous LVA and release of the TCL may be effective and safe in patients with advanced lymphedema and CTS.


Assuntos
Síndrome do Túnel Carpal/cirurgia , Descompressão Cirúrgica/métodos , Linfedema/cirurgia , Complicações Pós-Operatórias/cirurgia , Anastomose Cirúrgica/métodos , Neoplasias da Mama/terapia , Síndrome do Túnel Carpal/etiologia , Doença Crônica/terapia , Feminino , Humanos , Verde de Indocianina/administração & dosagem , Excisão de Linfonodo/efeitos adversos , Vasos Linfáticos/diagnóstico por imagem , Vasos Linfáticos/cirurgia , Linfedema/diagnóstico , Linfedema/etiologia , Linfografia , Mastectomia/efeitos adversos , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Resultado do Tratamento , Extremidade Superior/irrigação sanguínea , Extremidade Superior/cirurgia , Veias/cirurgia
17.
J Surg Oncol ; 124(4): 483-491, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34028818

RESUMO

BACKGROUND: The American College of Surgeon (ACS) Surgical Risk Calculator is an online tool that helps surgeons estimate the risk of postoperative complications for numerous surgical procedures across several surgical specialties. METHODS: We evaluated the predictive performance of the calculator in 385 cancer patients undergoing breast surgery. Calculator-predicted complication rates were compared with observed complication rates; calculator performance was evaluated using calibration and discrimination analyses. RESULTS: The mean calculator-predicted rates for any complication (4.1%) and serious complication (3.2%) were significantly lower than the observed rates (11.2% and 5.2%, respectively). The area under the curve was 0.617 for any complication and 0.682 for serious complications. p Values for the Hosmer-Lemeshow test were significant (<.05) for both outcomes. Brier scores were 0.102 for any complication and 0.048 for serious complication. CONCLUSIONS: The ACS risk calculator is not an ideal tool for predicting individual risk of complications following breast surgery in a Mexican cohort. The most valuable use of the calculator may reside in its role as an aid for patient-led surgery planning. The possibility of introducing breast surgery-specific data could improve the performance of the calculator. Furthermore, a disease-specific calculator could provide more accurate predictions and include complications more frequently found in breast cancer surgery.


Assuntos
Neoplasias da Mama/cirurgia , Mastectomia/efeitos adversos , Complicações Pós-Operatórias/diagnóstico , Melhoria de Qualidade , Medição de Risco/normas , Idoso , Idoso de 80 Anos ou mais , Neoplasias da Mama/patologia , Feminino , Seguimentos , Humanos , Complicações Pós-Operatórias/etiologia , Prognóstico , Estudos Prospectivos , Fatores de Risco
18.
Rev Gaucha Enferm ; 42(spe): e20200331, 2021.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-34037186

RESUMO

OBJECTIVE: Describe the experience lived in an interdisciplinary follow-up care center for mastectomized women at a public university in São Paulo during the beginning of the COVID-19 pandemic. METHOD: Experience report on the health care provided in the health center for mastectomized women. RESULTS: The care was provided three times a week by an interdisciplinary health team. The mentioned areas that cover the women care in the center: Physical, Psychological, Social Support and Health Education. CONCLUSIONS: The attention by an interdisciplinary team becomes prevalent in the care of mastectomized women, since cancer and its treatment produce various changes in women's lives in the short and long term, so follow-up and support must be biopsychosocial, covering all areas that may be affected, especially during the pandemic.


Assuntos
Linfedema Relacionado a Câncer de Mama/reabilitação , COVID-19/epidemiologia , Mastectomia/reabilitação , Pandemias , Equipe de Assistência ao Paciente , Centros de Reabilitação , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil , Linfedema Relacionado a Câncer de Mama/etiologia , Linfedema Relacionado a Câncer de Mama/psicologia , Terapia Focada em Emoções , Terapia por Exercício , Feminino , Educação em Saúde , Humanos , Mastectomia/efeitos adversos , Mastectomia/psicologia , Pessoa de Meia-Idade , Apoio Social
19.
Chirurgia (Bucur) ; 116(2): 201-208, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33950816

RESUMO

Introduction: Seroma is one of the usual postoperative complications after breast and axillary surgery. It is considered as a consequence of prolonged lymphorrhea. Its persistence means a longer healing process, increased risk of infection and in case of implant-based reconstruction, even implant loss which may result in delaying adjuvant oncologic treatment. Nevertheless the patient's comfort is amplified due to frequent follow-up visits to the hospital for percutaneous drainage and sometimes the seroma might affect the aesthetic result. Materials and Methods: Between 1999 and 2017 a total of 137 patients with mastectomy and implant-based breast reconstruction were included in the study. The risk factors for developing seroma were analyzed and an algorithm for postoperative follow-up and ultrasound-guided needle aspiration was implemented. Results: The seroma rate was 9.49% (13/137 patients). It was associated with skin flap ischemia in 37.5% . Risk factors for developing seroma were: the use of synthetic mesh, smoking and overweight. The rate of implant loss attributed to seroma was 2.18% (3/137). In patients having prolonged lymphorheea, beyond ultrasound-guided needle aspiration, Rifampin solution was used to wash the implant pocket. In these cases, the drainage was reduced by 50% after each visit. Conclusion: Overweight patients and smokers have a higher risk of developing seroma after implant- based breast reconstruction. The use of synthetic meshes for breast reconstruction is also a risk factor for seroma. Rifampin solution for washing the implant pocket might be an option for decreasing the lymphorrhea.


Assuntos
Neoplasias da Mama , Mamoplastia , Neoplasias da Mama/cirurgia , Humanos , Mastectomia/efeitos adversos , Complicações Pós-Operatórias , Estudos Retrospectivos , Seroma/epidemiologia , Seroma/etiologia , Resultado do Tratamento
20.
World J Surg Oncol ; 19(1): 148, 2021 May 12.
Artigo em Inglês | MEDLINE | ID: mdl-33980267

RESUMO

BACKGROUND: The aim of this study was to compare conventional suture with prolonged timing of drainage with quilting suture on the formation of seroma at pectoral area after mastectomy (ME) with sentinel lymph node biopsy (SLN) or axillary lymph node dissection (ALND) for breast cancer. METHODS: Three hundred and eighty-eight consecutive breast cancer patients were retrospectively analyzed and categorized into three groups. Patients in group 1 were with quilting suture, group 2 with conventional suture and 13-15 days drainage in situ, and group 3 with conventional suture and 20-22 days drainage. The primary outcome was the incidence of grades 2 and 3 seroma at anterior pectoral area within 1 month postoperatively. Cox regression was used for analysis. RESULTS: The incidence of grades 2 and 3 seroma was comparable among groups (9.5% vs. 7.9% vs. 5.3%, p = 0.437), as well as late grades 2 and 3 seroma among groups (4.3% vs. 2.9% vs. 1.5%, p = 0.412). Old age, high body mass index, and hypertension were independent risk factors for grades 2 and 3 seroma. CONCLUSIONS: Prolonged timing of drainage to 13-15 days in conventional suture was long enough to decrease the incidence of grades 2 and 3 seroma as lower as that in quilting suture group at pectoral area within 1 month after mastectomy.


Assuntos
Neoplasias da Mama , Seroma , Neoplasias da Mama/cirurgia , Drenagem , Humanos , Excisão de Linfonodo/efeitos adversos , Mastectomia/efeitos adversos , Complicações Pós-Operatórias/prevenção & controle , Prognóstico , Estudos Retrospectivos , Seroma/etiologia , Seroma/prevenção & controle , Retalhos Cirúrgicos , Técnicas de Sutura , Suturas
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