A módosított Regnault „B” emlőmegtartó műtét mint II. szintű standard onkoplasztikus emlősebészeti technika

Bevezetés és célkitűzés: A szerzők a Regnault „B” típusú emlőfelvarrás sebészi technikájának módosításával végzett onkoplasztikus műtéti technikát és az új emlősebészeti módszer alkalmazásához kapcsolódó retrospektív klinikopatológiai vizsgálat eredményeit mutatják be. Módszer: 2012. április és 2018. október között, emlőrák miatt, módosított Regnault „B” technikával operált 215 nőbeteg klinikopatológiai adatait prospektíven vezetett adatbázis alapján retrospektív módon vizsgáltuk. A betegek életminőségét validált kérdőív segítségével mértük fel, míg a műtétek esztétikai eredményét a szintén validált Breast Cancer Conservative Treatment (BCCT.core) számítógépes program és az 5 pontos Likert-skála alapján értékeltük. Eredmények: A betegek átlagéletkora 53 év (szórás: 29–81 év) volt. A medián utánkövetési idő 47 hónap (szórás: 7–85 hónap) volt. Az átlag műtéti idő 47 perc (szórás: 35–85 perc) volt, míg a patológiai tumorméret átlagosan 33 mm-nek (szórás: 18–58 mm) bizonyult. Pozitív sebészi szél miatt 13 (6%) esetben irányított reexcisióra, míg 3 (1,4%) esetben mastectomiára kényszerültünk. Az összesített szövődményarány 7,4% (n = 16) volt. Az esztétikai eredmények Likert-skála szerinti átlagértéke 4,2 (szórás: 2–5), míg a BCCT.core program alapján 1,3 pont (szórás: 1–4 pont) volt. Az életminőséggel kapcsolatos kérdőívek eredményei magas betegelégedettséget igazoltak. Következtetés: A módosított Regnault „B” emlőmegtartó technika biztonságos és hatékony standard ’level II.’ onkoplasztikus emlősebészeti technika. A műtét magas betegelégedettséggel, illetve kozmetikai eredménnyel képes a közepes vagy nagyobb térfogatú emlők külső, illetve külső-felső negyedeinek T1–T3-as tumorai miatt az emlők akár 20–50%-ának eltávolítására, majd egyidejű parenchymaáthelyezéssel történő rekonstrukciójára. A módszer előnye, hogy nem igényel ellenoldali szimmetrizációs műtétet, míg hátránya, hogy az emlő bőrpalástján vezetett metszések komplettáló mastectomia esetén az azonnali rekonstrukciót nehezítik

A magyar emlőrákos betegek igényei a korszerű onkoplasztikus emlősebészeti ellátásra

The significant need for breast reconstruction resulting from the spread of oncoplastic breast surgery raises a number of systemic issues. Clarification and regulation of the indications are needed for aesthetic changes of the reconstructed breast due to oncotherapy treatments, ageing and technical problems of implants; a number of operations, targeted aesthetic goals as well as surgical capacities and financial background should also be determined.Our aim was to conduct a survey on the opinions and needs of the Hungarian breast cancer population about a modern breast reconstruction system.A study was conducted enrolling 500 patients who underwent mastectomy with immediate or delayed reconstruction. A structured questionnaire containing eleven questions was used to measure the attitude for loss and reconstruction of breast, the expectation of cosmetic outcome and qualification of the operating surgeon and the needs relating to the health system and funding.The median age was 47 years (min.-max.: 26-73), 59% (n = 294) was married and 52% (n = 260) had graduated in university. The majority of women (70%; n = 348) would like to have nakedly also similar breasts after the reconstruction process. To achieve this, 43% (n = 217) and 37% (n = 184) would undergo maximum two or four procedures, respectively, supported by the national health insurance company. 86% (n = 430) would like to choose qualified breast surgeon for her treatment.The modern oncoplastic treatment raises complex, systemic issues. Women with breast cancer would like to have qualified breast surgeons restoring their breasts by two operations, all funded by the national health insurance company. Orv Hetil. 2020; 161(29): 1221-1228

Modern Breast Cancer Surgery 1st Central-Eastern European Professional Consensus Statement on Breast Cancer

This text is based on the recommendations accepted by the 4th Hungarian Consensus Conference on Breast Cancer, modified on the basis of the international consultation and conference within the frames of the Central-Eastern European Academy of Oncology. The recommendations cover non-operative, intraoperative and postoperative diagnostics, determination of prognostic and predictive markers and the content of cytology and histology reports. Furthermore, they address some specific issues such as the current status of multigene molecular markers, the role of pathologists in clinical trials and prerequisites for their involvement, and some remarks about the future

Clinical experiences with the use of ULTRAPRO(R) mesh in single-stage direct-to-implant immediate postmastectomy breast reconstruction in 102 patients: A retrospective cohort study.

BACKGROUND: Acellular dermal matrices have been used for direct-to-implant (DTI) breast reconstruction (BR), eliminating the load of the lower pole skin envelope. However, the available allograft matrices add considerable health care costs. This study examined the long-term follow-up of synthetic ULTRAPRO(R) mesh as a low-cost potential alternative to biological matrices. PATIENTS AND METHODS: A retrospective cohort study was performed between January 2013 and January 2016, involved 112 early-stage breast cancer and/or BRCA 1/2 patients, and evaluated 189 immediate DTI BRs following skin-, areola- or nipple-sparing mastectomy using ULTRAPRO(R) mesh. Patient characteristics and postoperative complications were recorded, and quality of life was rated by the patients using the EORTC-QLQ-C30-BR23 questionnaire. Aesthetic outcomes and palpability of the implants were evaluated by four breast surgeons on a 5-point Likert scale. All recorded parameters were statistically analysed. RESULTS: Ten patients were lost-to-follow-up, resulting in 102 patients and 174 breast surgery cases analysed. The mean age was 43 years, with 23.4 months of follow-up on average. Forty-six patients (45.1%) had previous radiotherapy with pre-existing scars. In total, 32 complications (18.3%) were recorded, including 12 minor (6.9%) and 20 major (11.4%) complications requiring revision. All median quality of life scores were above 83 points, representing a high score, with an average 4-point rating for the aesthetic outcome and natural consistency of the breast. CONCLUSION: Partially absorbable ULTRAPRO(R) mesh could be used successfully in DTI BR, offering a safe, less expensive alternative to biological matrices. Adequate indications and patient selection are necessary

IV. Emlőrák Konszenzus Konferencia – Az emlőrák korszerű sebészi kezelése

The surgical treatment is still the most effective method in curing of early breast cancer. Breast preservation and the application of oncoplastic principles became generally accepted, the sentinel lymph node biopsy in the surgical treatment of the axilla is primary, and the indication for axillary block dissection (ABD) is narrowing further. The neoadjuvant oncological treatment that is applied more and more widely presented surgery with new challenges. Hereunder we summarise our recommendations on the surgical treatment of breast cancer based on the content of the 3rd Breast Cancer Consensus Conference and considering the latest international studies and professional recommendations