The desire to utilize postmastectomy breast reconstruction in Saudi Arabian women. Predictors and barriers.

OBJECTIVES: To study factors that influence the desire to utilize breast reconstruction after mastectomy, and to investigate the barriers to reconstruction among women in Saudi Arabia. METHODS: We conducted a cross-sectional study at 2 surgical centers in Jeddah, Saudi Arabia. A self-administered questionnaire was distributed to all breast cancer patients attending the surgery clinics for follow-up after mastectomy between January and March 2013. Ninety-one patients met the study inclusion criteria. The first part of the questionnaire covered the demographic and socioeconomic information regarding factors that might influence the desire to utilize breast reconstruction including possible barriers. Multivariate logistic regression was used to determine the significant predictors of the desire to undergo reconstruction. RESULTS: Overall, 16.5% of patients underwent breast reconstruction after mastectomy. Young age and high educational attainment were significantly associated with an increased desire to undergo reconstruction. The main barriers to reconstruction were the lack of adequate information on the procedure (63%), concerns on the complications of the procedure (68%), and concerns on the reconstruction interfering with the detection of recurrence (54%). CONCLUSION: Age and educational level were significant predictors of the desire to utilize breast reconstruction. Furthermore, modifiable barriers included the lack of knowledge and misconceptions on the procedure. Addressing these issues may increase the rate of breast reconstruction in Saudi Arabia.

Management of postoperative gastrointestinal leakage with autologous stromal vascular fraction.

To assess the efficacy of using autologous stromal vascular fraction (SVF) to promote healing of controlled fistula tracts in the management of postoperative upper gastrointestinal leakage. This is an experimental study conducted on 10 experimental rabbits. Animal models were divided into the SVF group which received an autologous SVF and the control group which did not receive the implantation. Surgery was performed on both groups to induce a gastric leak and create a controlled fistula tract between the leakage site in the stomach and the skin. After 2 weeks, surgery was performed on the SVF group to harvest, process and then implant the autologous SVF in the fistula tract. Animal models were followed up and their fistula tracts were evaluated for healing by gross and microscopic examination of the fistula tracts before the SVF implantation and at 24 hours, 1 week, 2 weeks and 3 weeks after implantation. The control group revealed no closure of fistula tracts by the 3(rd) week after implantation and there were no signs of inflammation or drainage. On the other hand, the SVF group showed signs of healing process with progressive closure of the fistula tract to about 95% by the 3(rd) week after implantation. The use of autologous SVF implantation to promote the healing of controlled fistula tracts seems to be a novel, safe and effective method in the management of postoperative upper gastrointestinal leakage. It could prevent reoperation and reduce hospital stay, morbidity and mortality. These results are promising and provide support for further clinical studies.

Primary mucosa-associated lymphoid tissue lymphoma of the esophagus masquerading as a benign tumor.

We report a case of primary esophageal low-grade B-cell lymphoma of MALT type in a 50-year-old Saudi male patient who presented to our hospital with a history of dysphagia and heartburn for more than 2 years. Endoscopy showed a large esophageal mass with an intact mucosa located in the distal esophagus, 28 cm-35 cm from the incisor teeth. Endoscopic ultrasonography (EUS) showed a large well demarcated sub-epithelial lesion 4 cm in width and 10 cm in length arising from the muscularis mucosa with mixed echogenicity consistent with benign leiomyoma. Subsequently, the patient underwent surgical resection of the tumor; the histopathology confirmed the diagnosis of esophageal lymphoma. The tumor was considered to be completely resected and therefore additional treatment was not administered. The patient was doing well on follow up after treatment. Clinically and radiologically he did not reveal any signs of recurrence. Surgical resection is beneficial as a primary treatment option in incipient primary low grade MALT esophageal lymphomas.

Phase II study on the use of intraoperative radiotherapy in early breast cancer.

OBJECTIVE: To report our early experience using the Intrabeam radiotherapy delivery system for intraoperative radiotherapy (IORT) in early breast cancer. METHODS: This is a prospective phase 2 study carried out at the Department of Surgery and Radiology, King Abdulaziz University Hospital, Jeddah, Kingdom of Saudi Arabia from December 2010 to November 2012. Females eligible for breast-conserving surgery with biopsy-proven invasive duct carcinoma, and with a mass of 3 cm, with lymphovascular invasion, multifocal lesion, extensive intraductal carcinoma, and positive nodes. Early and late toxicity were recorded using the Radiation Therapy Oncology Group (RTOG) criteria. RESULTS: Forty-five patients were included with a median age of 54 (range: 27-79 years). Thirty-six cases (80%) had tumor <3 cm in diameter, and 36 (67%) have pathologically negative axillary lymph node metastases. None of the patients developed delayed wound healing, postoperative infection requiring intravenous antibiotic, or breast seroma requiring aspiration. Sixteen (36%) received EBRT after IORT. Twelve patients developed radiologically proved fat necrosis. CONCLUSION: The IORT for early stage breast cancer patients using the Intrabeam delivery system was easily implemented in our center with an acceptable toxicity profile and cosmetic outcome.