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3.
PLoS One ; 15(9): e0238284, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32966294

RESUMO

PURPOSE: Restricted shoulder mobility is a major upper extremity dysfunction associated with lower quality of life and disability after breast cancer surgery. We hypothesized that a poloxamer and sodium alginate mixture (Guardix-SG®) applied after axillary lymph node dissection (ALND) would significantly improve shoulder range of motion (ROM) in patients with breast cancer. METHODS: We conducted a double-blind, randomized, prospective study to evaluate the clinical efficacy and safety of Guardix-SG® for the prevention of upper extremity dysfunction after ALND. The primary outcome measure was shoulder ROM at baseline (T0) and 3 (T1), 6 (T2), and 12 months (T3) after surgery. Secondary outcome measures were the Disabilities of the Arm, Shoulder, and Hand score(DASH), pain associated with movement, which was assessed using a numeric rating scale, and lymphedema assessed using body composition analyzer. RESULTS: A total of 83 women with breast cancer were randomly assigned to either the Guardix-SG® group or the control group. In the Guardix-SG® group (n = 37), Guardix-SG® was applied to the axillary region after ALND. In the control group (n = 46), ALND was performed without using Guardix-SG®. Comparing ROM for shoulder flexion before surgery (178.2°) and 12 months after surgery (172.3°), that was restored 12 months after surgery in the Guardix-SG® group, and there was no statistically significant difference between that at before surgery and 12 months after surgery (p = 0.182). No adverse effect was observed in either group. CONCLUSIONS: The results of this study have shown that Guardix-SG® help improve shoulder ROM without causing adverse effects in patients who underwent breast cancer surgery. However, there was no statistically significant difference from the control group. A further large-scale study is needed to obtain a more conclusive conclusion. TRIAL REGISTRATION: CRISKCT0003386; https://cris.nih.go.kr (20181207).


Assuntos
Neoplasias da Mama/cirurgia , Carboximetilcelulose Sódica/administração & dosagem , Ácido Hialurônico/administração & dosagem , Excisão de Linfonodo/efeitos adversos , Mastectomia/efeitos adversos , Poloxâmero/administração & dosagem , Amplitude de Movimento Articular/efeitos dos fármacos , Ombro/patologia , Axila , Neoplasias da Mama/patologia , Estudos de Casos e Controles , Método Duplo-Cego , Combinação de Medicamentos , Feminino , Seguimentos , Humanos , Metástase Linfática , Pessoa de Meia-Idade , Projetos Piloto , Prognóstico , Estudos Prospectivos , Tensoativos/administração & dosagem
4.
Anticancer Res ; 40(10): 5739-5742, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32988900

RESUMO

BACKGROUND/AIM: Locoregional recurrence (LRR) of breast cancer is reported to occur at a rate of 5%-15%. Wide excision of LRR is the recommended treatment, which can increase the probability of subsequent local control. Herein, we describe a surgical technique wherein a pedicled skin and subcutaneous flap close the skin defect after resection of a breast cancer LRR without use of a skin graft. PATIENTS AND METHODS: We reviewed four patients who underwent surgical resection using a pedicled rotation flap for chest wall recurrence after mastectomy. RESULTS: The surgical margin was set 2 cm apart from the tumor margin. After resection of tumor from the chest wall, we formed an adjacent pedicled flap and rotated the flap to the skin defect. There were no post-operative complications, including wound necrosis. CONCLUSION: Surgical resection with a pedicled rotation flap for post-mastectomy breast cancer LRR is a highly feasible way to achieve complete resection.


Assuntos
Neoplasias da Mama/cirurgia , Mastectomia/efeitos adversos , Recidiva Local de Neoplasia/patologia , Retalhos Cirúrgicos , Idoso , Neoplasias da Mama/patologia , Feminino , Humanos , Mamoplastia/métodos , Margens de Excisão , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/etiologia
5.
Medicine (Baltimore) ; 99(30): e21417, 2020 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-32791759

RESUMO

BACKGROUND: Postoperative nausea and vomiting (PONV) is a common complication after mastectomy. Although many researches have been studied the prophylactic effect of antiemetics, none of the results are effective. To overcome this problem, dexamethasone was used to relieve the occurrence of PONV. Since concerns about steroid-related morbidity still remain, We carried out a meta-analysis to evaluate the impact of prophylactic dexamethasone on PONV, post-operative pain undergoing mastectomy. METHODS: Literature search was conducted through PubMed, Web of Science, EMBASE, MEDLINE, and Cochrane library database till June 2019 to identify eligible studies. Meanwhile, we also consulted some Chinese periodicals, such as China Academic Journals, Wanfang and Weipu. The research was reported according to the preferred reporting items for systematic reviews and meta-analysis guidelines. Randomized controlled trials were included in our meta-analysis. Meanwhile, the assessment of the risk of bias was conducted according to the Cochrane Handbook for Systematic Reviews of Interventions version. The pooled data are processed by software RevMan 5.3. RESULTS: Four studies with 490 patients were enrolled to this meta-analysis. Our study demonstrated that the dexamethasone group was significantly more effective than the placebo group in term of PONV (risk ratio [RR] = 0.46, 95% confidence intervals [CI]: 0.30-0.70, P = .0003), nausea (RR = 0.26, 95% CI: 0.10-0.68, P = .006) and vomiting (RR = 0.15, 95% CI: 0.04∼0.55, P = .004). The visual analog scale score was significantly diminished at 1 hour (weighted mean difference = -1.40, 95% CI: -1.53 to -1.26, P < .00001) in the dexamethasone group, while, no statistically significant difference was observed between the two groups in terms of visual analog scale at 24 hours (weighted mean difference = -0.56, 95% CI: -1.24 to 0.13, P = 0.11). CONCLUSION: Not only does Dexamethasone reduce the incidence of PONV but also decreases postoperative pain. However, we still need larger samples and higher quality studies to determine the relationship between symptoms and administration time to reach the conclusion. TRIAL REGISTRATION NUMBER: PROSPERO CRD 42018118575.


Assuntos
Antieméticos/uso terapêutico , Dexametasona/uso terapêutico , Mastectomia/efeitos adversos , Dor Pós-Operatória/prevenção & controle , Náusea e Vômito Pós-Operatórios/prevenção & controle , Humanos , Dor Pós-Operatória/etiologia , Náusea e Vômito Pós-Operatórios/etiologia
6.
Plast Reconstr Surg ; 146(2): 402-407, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32740596

RESUMO

BACKGROUND: Obesity is a risk factor for the development of secondary lymphedema after axillary lymphadenectomy and radiation therapy. The purpose of this study was to determine whether obesity influences the morbidity of lymphedema in patients who have the condition. METHODS: Two cohorts of patients were compared: group 1, normal weight (body mass index ≤25 kg/m); and group 2, obese (body mass index ≥30 kg/m). Inclusion criteria were patients aged 21 years or older with lymphedema confirmed by lymphoscintigraphy. Covariates included age, sex, lymphedema type (primary or secondary), location, comorbidities, lymph node dissection, radiation therapy, lymphoscintigram result, and disease duration. Outcome variables were infection, hospitalization, and degree of limb overgrowth. The cohorts were compared using the Mann-Whitney U test, Fisher's exact test, and multivariable logistic regression. RESULTS: Sixty-seven patients were included: group 1, n = 33; and group 2, n = 34. Disease duration did not differ between groups (p = 0.72). Group 2 was more likely to have an infection (59 percent), hospitalization (47 percent), and moderate or severe overgrowth (79 percent), compared to group 1 (18, 6, and 40 percent, respectively; p < 0.001). Multivariable logistic regression showed that obesity was an independent risk factor for infection (OR, 7.9; 95 percent CI, 2.5 to 26.3; p < 0.001), hospitalization (OR, 30.0; 95 percent CI, 3.6 to 150.8; p < 0.001), and moderate to severe limb overgrowth (OR, 6.7; 95 percent CI, 2.1 to 23.0; p = 0.003). CONCLUSIONS: Obesity negatively affects patients with established lymphedema. Obese individuals are more likely to have infections, hospitalizations, and larger extremities compared to subjects with a normal body mass index. Patients with lymphedema should be counseled about the negative effects of obesity on their condition. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.


Assuntos
Excisão de Linfonodo/efeitos adversos , Linfedema/epidemiologia , Mastectomia/efeitos adversos , Obesidade/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Axila , Índice de Massa Corporal , Neoplasias da Mama/terapia , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Linfedema/diagnóstico , Linfedema/etiologia , Linfedema/terapia , Linfocintigrafia , Masculino , Pessoa de Meia-Idade , Obesidade/complicações , Obesidade/diagnóstico , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/terapia , Radioterapia Adjuvante/efeitos adversos , Medição de Risco , Fatores de Risco , Adulto Jovem
7.
Folia Med Cracov ; 60(1): 45-54, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32658211

RESUMO

Takotsubo cardiomyopathy (TCM) represents an acute systolic left ventricular dysfunction typically triggered by severe psychological or physical stress. Oncological patients due to emotional distress of the diagnosis, proinflammatory and prothrombotic nature of cancer and also physical stress often following complex anticancer therapies are at high-risk of TCM. Moreover, there are also few reports of TCM associated with oncological treatment, mostly chemotherapy. Recent data from large registries indicate a surprisingly high incidence of malignancy in TCM, significant differences in clinical characteristics and unfavorable short- and long-term clinical outcomes in this specific group of patients. Therefore, we present two case reports of TCM that occurred during active anticancer therapy. Both women were admitted with suspicion of acute coronary syndrome. The first patient underwent mastectomy two years before due to hormone receptor-positive breast cancer and on admission she was during adjuvant hormonotherapy with tamoxifen. The admission of the second patient was preceded by fifteen fractions of adjuvant external beam radiotherapy due to intermediate-risk endometrial cancer after radical hysterectomy. Based on coronary angiography type I of acute coronary syndrome was excluded. Both patients negated stressful situations in the period immediately before the symptoms onset. Within hospital course baseline apical ballooning observed in both cases fully recovered and enabled subsequent completion of oncological treatment in accordance with adopted treatment protocols without recurrence of TCM. To our knowledge, presented cases are the first reports showing direct relationship between TCM and adjuvant hormonotherapy with tamoxifen or pelvic radiotherapy.


Assuntos
Antineoplásicos/efeitos adversos , Neoplasias da Mama/tratamento farmacológico , Neoplasias da Mama/radioterapia , Neoplasias da Mama/cirurgia , Mastectomia/efeitos adversos , Radioterapia/efeitos adversos , Cardiomiopatia de Takotsubo/etiologia , Tamoxifeno/efeitos adversos , Idoso , Feminino , Humanos , Recidiva Local de Neoplasia/diagnóstico , Recidiva Local de Neoplasia/terapia , Cardiomiopatia de Takotsubo/diagnóstico , Cardiomiopatia de Takotsubo/fisiopatologia
8.
Medicine (Baltimore) ; 99(29): e21201, 2020 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-32702884

RESUMO

RATIONALE: We hypothesize that with the determination of lymph fistula location 3-dimensionally, application of appropriate pressure would promote fistula healing, and a secondary surgery may be avoided. Ga-labeled 1,4,7-triazacyclononane-N, N', N"-triacetic acid (NOTA) conjugated with truncated Evan blue (NEB) forms a complex with serum albumin in the interstitial fluid after it is locally injected and allows rapid visualization of the lymphatic system. PATIENT CONCERNS: A 44-year-old woman had a chief complaint of left nipple discharge. A 38-year-old woman came to the hospital after sensing a right breast mass. DIAGNOSES: The 2 patients were diagnosed with chylous fistula after breast cancer surgery based on the findings of a novel method, Ga-NOTA-Evans Blue (NEB) positron emission tomography/computed tomography. INTERVENTIONS: We successfully obtained clear images to locate the fistula using Ga-NEB positron emission tomography/computed tomography (PET/CT) for both patients. The lymphatic vessels and lymph nodes could be clearly visualized owing to the Ga-NEB activity during PET/CT. OUTCOMES: Three-dimensional positioning to locate the fistula could direct the application of the pressure dressing and reduce drainage markedly. LESSONS: Ga-NEB PET/CT may be a new method for diagnosing chylous fistula and providing guidance for treatment.


Assuntos
Axila/diagnóstico por imagem , Neoplasias da Mama/cirurgia , Fístula/etiologia , Mastectomia/efeitos adversos , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/normas , Adulto , Axila/anormalidades , Axila/cirurgia , Neoplasias da Mama/complicações , Feminino , Fístula/cirurgia , Humanos , Mastectomia/métodos , Derrame Papilar , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos , Complicações Pós-Operatórias/fisiopatologia , Complicações Pós-Operatórias/cirurgia
9.
Medicine (Baltimore) ; 99(27): e21134, 2020 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-32629748

RESUMO

Implant ruptures may be diagnosed by physical examination, ultrasound (US), and magnetic resonance imaging (MRI). The absence of standard guidelines to approach to implant ruptures may cause unnecessary surgical revisions in the absence of radiological confirmation of prosthetic damages.The purpose of this study was to analyze the diagnostic procedures applied to patients with suspected prosthetic rupture and surgeon choices to perform a revision or to plan a clinical and radiological follow-up.We conducted a retrospective study on 62 women submitted to revision surgery due to radiological diagnosis of suspected implant rupture, following mastectomy or aesthetic reconstruction, and admitted to a Plastic Surgery Department between 2008 and 2018.Seventy-three implants, believed to be ruptured, were explanted. One-third of these were intact and unnecessarily explanted. US associated with MRI evaluation resulted in the most helpful diagnostical method.A standardized clinical and radiological approach is essential to manage breast implant ruptures successfully. An innovative protocol is proposed in order to: ensure the appropriate management of implant ruptures and prevent unnecessary surgical revisions; reduce the risk of claims for medical malpractice in cases of unsatisfactory final aesthetic results or worse than before.


Assuntos
Implantes de Mama/efeitos adversos , Comportamento de Escolha/fisiologia , Mastectomia/efeitos adversos , Cirurgia Plástica/efeitos adversos , Feminino , Hospitalização , Humanos , Responsabilidade Legal/economia , Imagem por Ressonância Magnética/métodos , Imperícia/estatística & dados numéricos , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Ruptura/complicações , Ruptura/diagnóstico por imagem , Ruptura/cirurgia , Cirurgiões/psicologia , Ultrassonografia/métodos
10.
J Surg Oncol ; 122(2): 155-163, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32497273

RESUMO

OBJECTIVES: To identify the association between cording and breast cancer-related lymphedema (BCRL); describe time course, location, symptoms and functional impairments. METHODS: A total of 1181 patients were prospectively screened for BCRL after breast cancer (BC) surgery, including patient-reported outcome measures (4193) and perometric arm volume measurements (BCRL defined as relative or weight-adjusted volume change [RVC or WAC] ≥10% ≥3 months postoperatively). RESULTS: A total of 374/1181 patients (31.7%) reported cording first a median of 4.5 months postoperatively, and were more likely to: have body mass index less than 30 kg/m2 ; be less than 55 years of age; have had mastectomy, axillary lymph node dissection, regional lymph node radiation, neoadjuvant chemotherapy (all P < .001), or RVC/WAC ≥10% (P = .002). Patients who reported cording had 2.4 times the odds of developing BCRL compared to those who did not (odds ratio = 2.40; 95% confidence interval = 1.40-4.11; P = .002), and most frequently reported these symptoms: tenderness (61.2%), aching (60.7%), and firmness/tightness (59.8%). On multivariable analysis, cording was significantly correlated with functional difficulty for 17 actions. CONCLUSIONS: Patients frequently present with cording, potentially months after BC surgery. Risk factors for and symptoms of cording are identified, and treatment is recommended. Patients reporting cording are at higher risk of BCRL, therefore, cording should be incorporated into BCRL risk stratification.


Assuntos
Linfedema Relacionado a Câncer de Mama/epidemiologia , Neoplasias da Mama/epidemiologia , Neoplasias da Mama/cirurgia , Axila/patologia , Linfedema Relacionado a Câncer de Mama/etiologia , Linfedema Relacionado a Câncer de Mama/patologia , Neoplasias da Mama/patologia , Estudos de Coortes , Detecção Precoce de Câncer , Feminino , Humanos , Excisão de Linfonodo/efeitos adversos , Excisão de Linfonodo/estatística & dados numéricos , Massachusetts/epidemiologia , Mastectomia/efeitos adversos , Mastectomia/estatística & dados numéricos , Pessoa de Meia-Idade , Síndromes Paraneoplásicas/epidemiologia , Síndromes Paraneoplásicas/etiologia , Síndromes Paraneoplásicas/patologia , Medidas de Resultados Relatados pelo Paciente , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/patologia , Estudos Prospectivos
11.
BMC Surg ; 20(1): 108, 2020 May 19.
Artigo em Inglês | MEDLINE | ID: mdl-32430021

RESUMO

BACKGROUND: Breast cancer is the most common cancer in women worldwide. Major breast cancer surgery especially with axillary lymph node dissection (ALND), is associated with upper limb functional decline. Majority of studies are conducted in Western population and may not be applicable to Asians. This pilot study aims to evaluate whether major breast surgery results in upper limb functional impairment in a cohort of Asian women with breast cancer. METHODS: This is a prospective cohort study of 41 patients who underwent 44 major breast surgeries from April 2018 to August 2019. Main inclusion criteria were patients over 21 years of age undergoing major breast surgery for breast cancer. Major breast surgery was defined as wide local excision (WLE) or mastectomy. Main exclusion criteria were patients with pre-existing neurological or rheumatological co-morbidities affecting upper limb function or previous trauma with resulting deformities to the upper limbs. Patients underwent early rehabilitation from post-operative day 1. Shoulder flexion and abduction active range of motion (AROM) and QuickDASH disability score were assessed 1 week before surgery, post-operative week 2 and week 6. Baseline demographics and peri-operative data were also collected. RESULTS: Median age was 62.5 years. There were 16 (36.4%) wide local excisions and 28 (63.6%) simple mastectomies. Two (4.5%) cases had neoadjuvant chemotherapy. Fifteen (34.1%) cases had ALND. At post-operative week 6, shoulder flexion was comparable to baseline (p = 0.775), while abduction improved from baseline (p = 0.016). However, QuickDASH disability score was significantly worse at post-operative week 6 compared to baseline (median score 2.5 vs 0, p = 0.027). Subgroup analysis of patients with ALND demonstrated significantly worse QuickDASH disability score at post-operative week 6 (p = 0.010) but not for patients with only sentinel lymph node biopsy (p = 0.396). CONCLUSION: This pilot study in an Asian cohort found that patients were able to regain AROM of shoulder after major breast surgery at post-operative week 6 but had a worse QuickDASH disability score, especially in the subgroup with ALND. Aggressive and early rehabilitation should be encouraged. However, a longer follow-up is required to evaluate long term functional outcomes.


Assuntos
Neoplasias da Mama/cirurgia , Mastectomia/efeitos adversos , Extremidade Superior/fisiopatologia , Idoso , Grupo com Ancestrais do Continente Asiático , Axila/patologia , Axila/cirurgia , Neoplasias da Mama/terapia , Feminino , Humanos , Excisão de Linfonodo , Pessoa de Meia-Idade , Terapia Neoadjuvante , Medidas de Resultados Relatados pelo Paciente , Projetos Piloto , Complicações Pós-Operatórias/fisiopatologia , Estudos Prospectivos , Amplitude de Movimento Articular , Biópsia de Linfonodo Sentinela
12.
Plast Reconstr Surg ; 145(6): 1371-1379, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32459767

RESUMO

BACKGROUND: Evidence is limited for BREAST-Q scores in women without breast cancer or breast surgery to establish baseline values for clinical interpretation. The primary aim of this study was to compare differences in breast satisfaction and quality of life in women without breast cancer and without breast surgery to patients undergoing breast reconstruction using the BREAST-Q. METHODS: The authors performed a single-center, patient-reported outcomes comparative study. A sample of 300 women attending gynecology appointments completed a study-specific demographics form and preoperative BREAST-Q reconstruction module. Eligible women had no history of breast cancer or breast surgery and were not currently pregnant (control group). The authors compared prospectively collected control group data to demographics and preoperative and 12-month postoperative BREAST-Q scores in 300 breast reconstruction patients, retrospectively selected from a prospectively collected registry. RESULTS: Control group BREAST-Q scores were higher in Satisfaction with Breasts (mean, 59.3 versus 55.3; p < 0.042) and Physical Well-being Chest scores (mean, 84.1 versus 78.8; p < 0.001), and lower for Physical Well-being Abdomen scores (mean, 81.9 versus 88.7; p < 0.001) when compared to breast reconstruction patients' preoperative scores. When compared with breast reconstruction patients' 12-month postoperative scores, control group scores were lower in Satisfaction with Breasts (mean, 59.3 versus 65.5; p < 0.002) and Psychosocial Well-being (mean, 69.5 versus 76.2; p < 0.001) and higher in Physical Well-being Chest (mean, 84.1 versus 78.2; p < 0.001). CONCLUSIONS: The authors found differences in preoperative and 12-month postoperative BREAST-Q scores between breast reconstruction patients and a comparable control population. Establishing normative BREAST-Q data could serve as an important baseline for breast outcomes research and better understanding of patients' ability to recover quality of life following reconstruction. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.


Assuntos
Neoplasias da Mama/cirurgia , Mamoplastia , Mastectomia/efeitos adversos , Medidas de Resultados Relatados pelo Paciente , Qualidade de Vida , Adulto , Estudos de Casos e Controles , Feminino , Voluntários Saudáveis , Humanos , Pessoa de Meia-Idade , Satisfação do Paciente , Período Pós-Operatório , Período Pré-Operatório , Estudos Retrospectivos
13.
Medicine (Baltimore) ; 99(20): e19834, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32443289

RESUMO

Postmastectomy pain syndrome (PMPS) is a frequent complication of breast surgery, and is considered a chronic neuropathic pain in the side of surgery which persists more than 3 months. We conducted a retrospective analysis of the largest reported cohort to investigate the prevalence of PMPS and to analyze its associated risk factors as well as the influence on quality of life (QoL). Two thousand thirty-three surgically-treated female patients diagnosed between 2012 and 2017 with early-stage breast cancer were asked to complete a questionnaire survey about their current chronic neuropathic pain problems and quality of life. Multivariate logistic regression analyses were applied to determine the associated risk factors of PMPS. Results have shown that 1983 (97.5%) patients responded and completed a questionnaire survey. Among them, PMPS was found in 28.2% of patients. In univariate analysis, age≤35 years, tumor staging, history of chronic pain, total mastectomy, and axillary lymph node dissection (ALND) were significantly correlated with PMPS (P < .05). Multivariate analysis showed that age≤35 years, history of chronic pain, total mastectomy, and ALND were the independent risk factors of PMPS. QoL outcomes have shown that the global QoL score, physical function score, role function score, and social function score in the PMPS group were reduced in the PMPS group (P < .05), while the difference in emotional function score and cognitive function score showed no statistical significance (P > .05). Besides, patients with PMPS have worse body image, sexual enjoyment, and more breast symptoms. In conclusion, PMPS is linked with a high incidence among breast cancer patients, and has a considerable negative influence on the quality of life. In addition, age, total mastectomy, ALND, and history of chronic pain are the independent risk factors of PMPS.


Assuntos
Mastectomia/efeitos adversos , Dor Pós-Operatória/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , China/epidemiologia , Humanos , Pessoa de Meia-Idade , Dor Pós-Operatória/etiologia , Prevalência , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
14.
Anticancer Res ; 40(5): 2801-2812, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32366427

RESUMO

BACKGROUND/AIM: The influence of a polyurethane-based tissue adhesive (TissuGlu®) on common complications following breast surgery was investigated. PATIENTS AND METHODS: Within a Randomized-Controlled-Trial 70 women (n=35 TissuGlu®, n=35 drain) underwent a mastectomy with or without sentinel lymph node excision (SLNE), followed by a 90-day postoperative follow-up. RESULTS: Postoperative interventions: Non-inferiority of the application of TissuGlu® was seen. Pain-Level/ Hospitalization: A statistically significant pain reduction from day four onwards (p<0.001) and a shorter hospitalization period (p<0.001) was observed. In contrast, the TissuGlu® group showed increased mean puncture incidence (p=0.013), and increased puncture volume (p=0.021). CONCLUSION: Application of the polyurethane-based tissue adhesive TissuGlu® after mastectomy, with or without SLNE, showed potential for improvement of the clinical outcome. In contrast, high intervention rates and increased puncture volume, caused by recurring seromas following application of the surgical adhesive TissuGlu®, have a negative impact on the patient-specific convalescence.


Assuntos
Adesivos/efeitos adversos , Lisina/efeitos adversos , Mastectomia/efeitos adversos , Uretana/efeitos adversos , Feminino , Humanos , Mastectomia/métodos , Período Pós-Operatório , Estudos Prospectivos , Estudos Retrospectivos , Resultado do Tratamento
15.
J Clin Nurs ; 29(13-14): 2521-2534, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32243029

RESUMO

BACKGROUND: Lymphedema is an important morbidity due to its physical and psychological restrictions and financial burden in women having breast cancer surgery. The study was performed to examine effects of Health Belief Model (HBM) based nursing interventions given at home visits on prevention of lymphedema in women having breast surgery. DESIGN: The study had an experimental design. METHODS: The study included 72 women receiving radiotherapy after breast surgery, of whom 37 formed the intervention group and 35 formed the control group. The sample was based on Consolidated Standard of Reporting Trials (CONSORT). Data were collected with a personal information questionnaire, Quick-Disabilities of the Arm, Shoulder and Hand Score (Q-DASH), European Organization for Research and Treatment of Cancer Quality of Life for Breast Cancer 23 (EORTC QLQ-BR23), Strategies Used by Patients to Promote Health (SUPPH), Arm Circumference Form at three home visits at 3-month intervals. RESULTS: HBM based nursing interventions regularly offered at home visits were found to create positive changes in behaviour of lymphedema prevention and improve upper extremity functions, reduce side-effects, relieve arm and breast symptoms, enhance the quality of life, increase self-efficacy and lower the frequency of lymphedema and costs. CONCLUSION: The HBM based nursing interventions regularly offered at home visits can create positive changes in behaviour of lymphedema prevention and prevent lymphedema in women receiving radiotherapy after breast surgery. Considering costs of treatment for lymphedema, these interventions can be considered as cost-effective. RELEVANCE TO CLINICAL PRACTICE: Nursing interventions directed towards behaviour of preventing lymphedema and follow-ups in the long-term should be supported by home visits and reminders through phone calls. Nurses should perform HBM based interventions regularly at home visits to prevent lymphedema. These interventions were found to reduce financial burden and were cost-effective.


Assuntos
Neoplasias da Mama/enfermagem , Visita Domiciliar , Linfedema/prevenção & controle , Adulto , Neoplasias da Mama/psicologia , Feminino , Humanos , Mastectomia/efeitos adversos , Pessoa de Meia-Idade , Qualidade de Vida , Autoeficácia , Inquéritos e Questionários
16.
Medicine (Baltimore) ; 99(14): e19614, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32243387

RESUMO

BACKGROUND: Breast cancer is the most commonly diagnosed cancer in women, and more than half of breast surgery patients experience severe acute postoperative pain. This meta-analysis is designed to examine the clinical analgesic efficacy of Pecs block in patients undergoing breast cancer surgery. METHODS: An electronic literature search of the Library of PubMed, EMBASE, Cochrane Library, and Web of Science databases was conducted to collect randomized controlled trials (RCTs) from inception to November 2018. These RCTs compared the effect of Pecs block in combination with general anesthesia (GA) to GA alone in mastectomy surgery. Pain scores, intraoperative and postoperative opioid consumption, time to first request for analgesia, and incidence of postoperative nausea and vomiting were analyzed. RESULTS: Thirteen RCTs with 940 patients were included in our analysis. The use of Pecs block significantly reduced pain scores in the postanesthesia care unit (weighted mean difference [WMD] = -1.90; 95% confidence interval [CI], -2.90 to -0.91; P < .001) and at 24 hours after surgery (WMD = -1.01; 95% CI, -1.64 to -0.38; P < .001). Moreover, Pecs block decreased postoperative opioid consumption in the postanesthesia care unit (WMD = -1.93; 95% CI, -3.51 to -0.34; P = .017) and at 24 hours (WMD = -11.88; 95% CI, -15.50 to -8.26; P < .001). Pecs block also reduced intraoperative opioid consumption (WMD = -85.52; 95% CI, -121.47 to -49.56; P < .001) and prolonged the time to first analgesic request (WMD = 296.69; 95% CI, 139.91-453.48; P < .001). There were no statistically significant differences in postoperative nausea and vomiting and block-related complications. CONCLUSIONS: Adding Pecs block to GA procedure results in lower pain scores, less opioid consumption and longer time to first analgesic request in patients undergoing breast cancer surgery compared to GA procedure alone.


Assuntos
Analgesia/estatística & dados numéricos , Anestesia Geral/efeitos adversos , Neoplasias da Mama/cirurgia , Mastectomia/efeitos adversos , Bloqueio Nervoso/efeitos adversos , Dor Pós-Operatória/tratamento farmacológico , Analgesia/métodos , Analgésicos Opioides/uso terapêutico , Feminino , Humanos , Manejo da Dor/métodos , Manejo da Dor/estatística & dados numéricos , Medição da Dor , Dor Pós-Operatória/etiologia , Nervos Torácicos , Resultado do Tratamento
17.
Ann R Coll Surg Engl ; 102(6): e122-e124, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32326743

RESUMO

A 42-year-old woman was referred for consideration of left-sided mastectomy and immediate reconstruction. She previously had a bilateral breast augmentation using silicone implants. She desired to maintain her breast size and natural appearance. Owing to the availability of sufficient abdominal tissue, the option of an immediate unilateral breast reconstruction and contralateral augmentation with a differentially split deep inferior epigastric perforator flaps was offered to the patient. The patient had a successful reconstructive and contralateral symmetrising procedure with an uneventful postoperative recovery. She was satisfied with her breast size, which was achieved without the use of implants. In selected patients the free deep inferior epigastric perforator flap provides an appropriate option for unilateral breast reconstruction and contralateral breast augmentation. It has numerous advantages including making use of available excess abdominal tissue and avoiding implant related complications.


Assuntos
Mamoplastia/métodos , Retalho Perfurante/transplante , Parede Abdominal/irrigação sanguínea , Parede Abdominal/cirurgia , Adulto , Mama/patologia , Mama/cirurgia , Neoplasias da Mama/patologia , Neoplasias da Mama/cirurgia , Artérias Epigástricas/transplante , Feminino , Humanos , Mastectomia/efeitos adversos , Pessoa de Meia-Idade , Satisfação do Paciente , Retalho Perfurante/irrigação sanguínea , Resultado do Tratamento
18.
Plast Reconstr Surg ; 145(5): 1109-1123, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32332522

RESUMO

BACKGROUND: This review aimed to meta-analyze the quality of life of alloplastic versus autologous breast reconstruction, when measured with the BREAST-Q. METHODS: An electronic PubMed and EMBASE search was designed to find articles that compared alloplastic versus autologous breast reconstruction using the BREAST-Q. Studies that failed to present BREAST-Q scores and studies that did not compare alloplastic versus autologous breast reconstruction were excluded. Two authors independently extracted data from the included studies. A standardized data collection form was used. Quality was assessed using the Newcastle-Ottawa Scale. The mean difference and 95 percent confidence intervals between breast reconstruction means were estimated for each BREAST-Q subscale. Forest plots and the I statistic were used to assess heterogeneity and funnel plot publication bias. The Z test was used to assess overall effects. RESULTS: Two hundred eighty abstracts were found; 10 articles were included. Autologous breast reconstruction scored significantly higher in the five subscales than alloplastic breast reconstruction. The Satisfaction with Breasts subscale indicated the greatest difference, with a mean difference of 6.41 (95 percent CI, 3.58 to 9.24; I = 70 percent). The Satisfaction with Results subscale displayed a mean difference of 5.52. The Sexual Well-Being subscale displayed a mean difference of 3.85. The Psychosocial Well-Being subscale displayed a mean difference of 2.64. The overall difference in physical well-being was significant, with high heterogeneity (mean difference, 3.33; 95 percent CI, 0.18 to 6.48; I = 85). CONCLUSION: Autologous breast reconstruction had superior outcomes compared with alloplastic breast reconstruction as measured by the BREAST-Q.


Assuntos
Implantes de Mama/efeitos adversos , Mamoplastia/métodos , Mastectomia/efeitos adversos , Qualidade de Vida , Retalhos Cirúrgicos/transplante , Mama/cirurgia , Neoplasias da Mama/cirurgia , Feminino , Humanos , Mamoplastia/efeitos adversos , Mamoplastia/instrumentação , Mamoplastia/psicologia , Medidas de Resultados Relatados pelo Paciente , Satisfação do Paciente , Retalhos Cirúrgicos/efeitos adversos , Transplante Autólogo/efeitos adversos , Transplante Autólogo/métodos , Resultado do Tratamento
19.
Plast Reconstr Surg ; 145(5): 898e-908e, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32332523

RESUMO

BACKGROUND: Continued evolution of implant-based breast reconstruction involves immediate placement of the implant above the pectoralis muscle. The shift to prepectoral breast reconstruction is driven by goals of decreasing morbidity such as breast animation deformity, range-of-motion problems, and pain, and is made possible by improvements in mastectomy skin flap viability. To define clinical factors to guide patient selection for direct-to-implant prepectoral implant reconstruction, this study compares safety endpoints and risk factors between prepectoral and subpectoral direct-to-implant breast reconstruction cohorts. The authors hypothesized that prepectoral direct-to-implant breast reconstruction is a safe alternative to subpectoral direct-to-implant breast reconstruction. METHODS: Retrospective chart review identified patients who underwent prepectoral and subpectoral direct-to-implant breast reconstruction, performed by a team of five surgical oncologists and two plastic surgeons. Univariate analysis compared patient characteristics between cohorts. A penalized logistic regression model was constructed to identify relationships between postoperative complications and covariate risk factors. RESULTS: A cohort of 114 prepectoral direct-to-implant patients was compared with 142 subpectoral direct-to-implant patients. The results of the penalized regression model demonstrated equivalence in safety metrics between prepectoral direct-to-implant and subpectoral direct-to-implant breast reconstruction, including seroma (p = 0.0883), cancer recurrence (p = 0.876), explantation (p = 0.992), capsular contracture (p = 0.158), mastectomy skin flap necrosis (p = 0.769), infection (p = 0.523), hematoma (p = 0.228), and revision (p = 0.122). CONCLUSIONS: This study demonstrates that prepectoral direct-to-implant reconstruction is a safe alternative to subpectoral direct-to-implant reconstruction. Given the low morbidity and elimination of animation deformity, prepectoral direct-to-implant reconstruction should be considered when the mastectomy skin flap is robust. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.


Assuntos
Implante Mamário/efeitos adversos , Mastectomia/efeitos adversos , Recidiva Local de Neoplasia/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Retalhos Cirúrgicos/transplante , Derme Acelular , Adulto , Mama/patologia , Mama/cirurgia , Implante Mamário/instrumentação , Implante Mamário/métodos , Neoplasias da Mama/epidemiologia , Neoplasias da Mama/patologia , Neoplasias da Mama/cirurgia , Feminino , Seguimentos , Humanos , Mastectomia/métodos , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/prevenção & controle , Seleção de Pacientes , Músculos Peitorais/cirurgia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
20.
Plast Reconstr Surg ; 145(5): 909e-916e, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32332527

RESUMO

BACKGROUND: The abdomen is a common donor site in autologous breast reconstruction. The authors aimed to determine whether pregnancy following autologous breast reconstruction increases the risk of incisional hernia repair. METHODS: All women younger than 50 years who underwent abdominally based autologous breast reconstruction between 2005 and 2016 were identified. Patients with less than 20 months of follow-up were excluded. Demographics, operative details, outcomes, incisional hernia repair occurrence, and pregnancy history were analyzed. RESULTS: Five hundred nineteen patients underwent autologous breast reconstruction with 890 free flaps [free transverse rectus abdominis musculocutaneous, n = 645 (72.5 percent); deep inferior epigastric perforator, n = 214 (24.0 percent); pedicled transverse rectus abdominis musculocutaneous, n = 18 (2.0 percent); and superficial inferior epigastric artery, n = 13 (1.5 percent)]. Average follow-up was 57.2 months (range, 9.5 to 312.8 months). Fourteen women became pregnant, with mean postpregnancy follow-up of 31.2 months (range, 5.4 to 70.8 months; pregnancies, n = 18). Age of nonpregnant patients (mean, 43.1 years; range, 20.6 to 50.0 years) was higher than that of pregnant patients (mean, 32.1 years; range, 27.1 to 37.9 years) (p < 0.0001); in univariate analysis, age was not associated with incisional hernia repair. Twelve pregnant patients (66.7 percent) underwent cesarean delivery. No statistically significant differences existed between groups regarding flap type and closure technique. Zero pregnant patients underwent incisional hernia repair, compared with a 6.1 percent incisional hernia repair rate in nonpregnant patients (p = 0.339). In multivariate analysis, prior incisional hernia, hematoma, fascial dehiscence, and reoperation predicted incisional hernia repair. CONCLUSION: The authors' results demonstrate that there may not be an increased risk of incisional hernia repair associated with pregnancy following autologous breast reconstruction despite additional weakening of the abdominal wall. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.


Assuntos
Parede Abdominal/cirurgia , Hérnia Incisional/epidemiologia , Mamoplastia/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Complicações na Gravidez/epidemiologia , Retalhos Cirúrgicos/efeitos adversos , Adulto , Neoplasias da Mama/cirurgia , Feminino , Seguimentos , Humanos , Hérnia Incisional/etiologia , Hérnia Incisional/cirurgia , Mamoplastia/métodos , Mastectomia/efeitos adversos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Gravidez , Complicações na Gravidez/etiologia , Complicações na Gravidez/cirurgia , Estudos Retrospectivos , Medição de Risco , Retalhos Cirúrgicos/transplante
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