Flap fixation in preventing seroma formation after mastectomy: an updated meta-analysis

Seroma formation following mastectomy is one of the most experienced complications, with a very variable incidence ranging from 3 to 90%. In recent years, many publications have been realized to define an effective technique to prevent its formation and several approaches have been proposed. Given the potential of flap fixation in reducing seroma formation, we performed a meta-analysis of the literature to investigate the role of this approach as definitive gold standard in mastectomy surgery. Inclusion criteria regarded all studies reporting on breast cancer patients undergoing mastectomy with or without axillary lymph node dissection; studies that compared mastectomy with flap fixation to mastectomy without flap fixation were selected. Papers were eligible for inclusion if outcome was described in terms of seroma formation. As secondary outcome, also surgical site infection (SSI) was evaluated. The included studies were 12, involving 1887 female patients: 221/986 (22.41%) patients experienced seroma formation after flap fixation and 393/901 (43.61%) patients had this complication not receiving flap fixation, with a significant statistical difference between the two groups (OR = 0.267, p = 0.001, 95% CI 0.153, 0.464). About, SSI 59/686 (8.6%) in flap fixation group and 67/686 (9.7%) in patients without flap fixation, with no statistical differences between groups (OR = 0.59, p = 0.056, 95% CI 0.344, 1.013). The heterogeneity between included studies does not allow us to reach definitive conclusions but only to suggest the strong evaluation of this approach after mastectomy in seroma preventing and SSI reduction

Sentinel node biopsy and radical lymph node dissection for advanced melanoma in the elderly

Articolo presente su PubMed Central. Sourcerecord Id Scopus: 28558 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3194399/ Background.The majority of indications for surgery in melanoma are for the treatment of primary tumor and lymph node metastases. During the last decade, the Sentinel Node Biopsy (SNB), from a research procedure, has become standard of care in most institutions. SNB is normally considered for patients with melanoma > 1 mm and generally about 20% are positive; however, the risk of a positive SNB in a melanoma < 1 mm is still 5%. Usually when SNB is positive a complete lymphadenectomy is performed. Materials and methods.In the period 2004-2009, 18 elderly patients (median age 68 years) affected by cutaneous melanoma (mean Breslow’s thickness = 3.77 mm), after SNB histologically confirmed regional lymph node involvement, underwent complete lymph node dissection (CLND). We treated 11 of them with groin dissection, in 3 cases bilateral; 4 patients underwent axillar dissection, in one case bilateral; 2 patients underwent neck dissection and another patient underwent groin-axillar dissection. We treated bilateral groin involvement with laparoscopic access for dissection of lumbar-aortic, iliac and obturator lymph nodes. Results.Disagreeing with literature, 12/18 (67%) of these patients had positive lymph nodes, a high percentage if compared with younger patients’ data. Currently the average follow-up is 25 months. In our sample CLND has a crucial prognostic role (16% vs 41% of deceased in CLND – and CLND + patients respectively). Conclusions.Elderly melanoma patients are characterized by a higher tumor stage and, in patients with nodal metastases, the prognosis is independently affected by older age. In case of positive SNB the CLND plays a notable prognostic role and a presumable therapeutic role

The first case of acinic cell carcinoma of the breast within a fibroadenoma: Case report

AbstractA case of acinic cell carcinoma of the breast is reported in a 26-year-old woman. She presented a lump in her right breast, that seemed to be a fibroadenoma. The open biopsy revealed a well-bordered fibroadenoma, together with a proliferation of cells characterized by serous acinar differentiation and eosinophilic cytoplasmic granules. Tumor cells stained for amylase, lysozyme, α-1-antichymotripsin, epithelial membrane antigen, S-100 protein, pan-cytokeratin, cytokeratin 7 and E-cadherin. Estrogen receptor, progesterone receptor, human epidermal growth factor receptor 2 overexpression, CD10, P63, smooth muscle actin, cytokeratin 5/6 were negative. The sentinel node was negative. 8 months after surgery she is in good clinical conditions without recurrence or metastases

\u201cA randomised factorial trial of sequential doxorubicin and CMF vs CMF and chemotherapy alone vs chemotherapy followed by goserelin plus tamoxifen as adjuvant treatment of node-positive breast cancer\u201d

The sequential doxorubicin \u2192 CMF (CMF = cyclophosphamide, methotrexate, fluorouracil) regimen has never been compared to CMF in a randomised trial. The role of adding goserelin and tamoxifen after chemotherapy is unclear. In all, 466 premenopausal node-positive patients were randomised to: (a) CMF 7 6 cycles (CMF); (b) doxorubicin 7 4 cycles followed by CMF 7 6 cycles (A \u2192 CMF); (c) CMF 7 6 cycles followed by goserelin plus tamoxifen 7 2 years (CMF \u2192 GT); and (d) doxorubicin 7 4 cycles followed by CMF 7 6 cycles followed by goserelin plus tamoxifen 7 2 years (A \u2192 CMF \u2192 GT). The study used a 2 7 2 factorial experimental design to assess: (1) the effect of the chemotherapy regimens (CMF vs A 7 CMF or arms a + c vs b + d) and (2) the effect of adding GT after chemotherapy (arms a + b vs c + d). At a median follow-up of 72 months, A \u2192 CMF as compared to CMF significantly improved disease-free survival (DFS) with a multivariate hazard ratio (HR) = 0.740 (95% confidence interval (CI): 0.556-0.986; P = 0.040) and produced a nonsignificant improvement of overall survival (OS) (HR = 0.764; 95% CI: 0.489-1.193). The addition of GT after chemotherapy significantly improved DFS (HR = 0.74; 95% CI: 0.555-0.987; P = 0.040), with a nonsignificant improvement of OS (HR = 0.84; 95% CI: 0.54-1.32). A \u2192 CMF is superior to CMF. Adding GT after chemotherapy is beneficial for premenopausal node-positive patients. \ua9 2005 Cancer Research UK

The current treatment of ductal carcinoma in situ of the breast

Ductal carcinoma in situ (DCIS) is a proliferation of presumably malignant epithelial cells within the ducto-lobular units of the breast without evidence by light microscopy of invasion trough the basement membrane in to the surrounding stroma. DCIS presents as a heterogeneous group of lesions with different clinical presentation, histologic features and malignant potential. DCIS patients have an increased risk of developing an ipsilateral invasive breast cancer, generally within the same quadrant as the initial DCIS. Before the mammographic era the frequency of DCIS was 1-5% of all breast cancer, now DCIS represents between 15-25% of newly reported breast cancer diagnosis. For most of the 20 century the major of patients with DCIS were symptomatic, palpable mass or nipple discharge, bloody or serous.With development and utilization of high quality mammography during the last 20 years the number of new cases of DCIS is increased rapidly and presentation changes. Today most patients with DCIS present with nonpalpable lesions (microcalcifications) and without symptoms. Percutaneous core biopsy with dedicated table represent the most important option to detecting DCIS. It is clearly less invasive, offers better cosmesis and is less expensive than open surgical biopsy. Diagnosis of DCIS by core biopsy offers the opportunità for planning the treatment of choice for DCIS patients. The goal of treatment of DCIS is breast conservation with optimal cosmesis and a minimum risk of subsequent invasive or in situ recurrence. There are some for whom mastectomy remains the optimal treatment but most women with DCIS are candidate for breast conservation. A minority of patients with DCIS requires mastectomy, probably less than 25% but mastectomy could be performed if it were the patient’s preference. Breast conservation for DCIS implies: • post excision mammographic control, this step could be avoided only if the specimen radiograph performed at the time of the initial surgery show that all the suspicious calcifications are well within the excised tissue and that the margins are widely clear macroscopically; • radiation therapy, follow-up alone or tamoxifen is an optimal treatment. Clinical trials have shown that local excision and radiation therapy in patients with negative margins provides excellent rates of local control. Patients treated by excision alone have grater chance of local failure. The available data indicate that the likelihood of developing invasive cancer of the breast following breast conservation with or without radiation is approximately 1% or less for year following the initial diagnosis and treatment of DCIS. Although adding radiation therapy to wide local excision benefits all groups of DCIS patients the magnitude of that benefit may be small. However patients who may avoid radiation therapy have not be reproducibly and really identified by any clinical trials. Clear surgical margins are a major criterion for treatment of DCIS (whether or not RT is employed). 10 mm margin represents the best compromise between removal of so match tissue that the cosmetic result would be less than desirable and the likelihood of local recurrence. An axillary dissection is not requie in patients with DCIS; the incidence of axillary metastases is so infrequent that this possibility should not provoke a therapeutic option to dissect the axilla. The role of sentinel node biopsy is controversial. If, by definition, DCIS does not spread to lymph nodes, a procedure to address lymph nodes status should not be necessary. The addition of tamoxifen, 20 mg daily decreases the incidence of both in situ or invasive cancer recurrence. No overall survival benefits were observed in patients with DCIS related any form of treatment. In conclusion the treatment of DCIS is constantly being refined, and the observations and recommendations, made at any time may be influenced by new data reported almost contemporaneously as well as in the future