14 research outputs found
Oncoplastic Breast Consortium consensus conference on nipple-sparing mastectomy
Purpose Indications for nipple-sparing mastectomy (NSM) have broadened to include the risk reducing setting and locally
advanced tumors, which resulted in a dramatic increase in the use of NSM. The Oncoplastic Breast Consortium consensus
conference on NSM and immediate reconstruction was held to address a variety of questions in clinical practice and research
based on published evidence and expert panel opinion.
Methods The panel consisted of 44 breast surgeons from 14 countries across four continents with a background in gynecology, general or reconstructive surgery and a practice dedicated to breast cancer, as well as a patient advocate. Panelists
presented evidence summaries relating to each topic for debate during the in-person consensus conference. The iterative
process in question development, voting, and wording of the recommendations followed the modified Delphi methodology.
Results Consensus recommendations were reached in 35, majority recommendations in 24, and no recommendations in the
remaining 12 questions. The panel acknowledged the need for standardization of various aspects of NSM and immediate
reconstruction. It endorsed several oncological contraindications to the preservation of the skin and nipple. Furthermore, it
recommended inclusion of patients in prospective registries and routine assessment of patient-reported outcomes. Considerable heterogeneity in breast reconstruction practice became obvious during the conference.
Conclusions In case of conflicting or missing evidence to guide treatment, the consensus conference revealed substantial
disagreement in expert panel opinion, which, among others, supports the need for a randomized trial to evaluate the safest
and most efficacious reconstruction techniques
Oncoplastic Breast Consortium consensus conference on nipple-sparing mastectomy.
Purpose
Indications for nipple-sparing mastectomy (NSM) have broadened to include the risk reducing setting and locally advanced tumors, which resulted in a dramatic increase in the use of NSM. The Oncoplastic Breast Consortium consensus conference on NSM and immediate reconstruction was held to address a variety of questions in clinical practice and research based on published evidence and expert panel opinion.
Methods
The panel consisted of 44 breast surgeons from 14 countries across four continents with a background in gynecology, general or reconstructive surgery and a practice dedicated to breast cancer, as well as a patient advocate. Panelists presented evidence summaries relating to each topic for debate during the in-person consensus conference. The iterative
process in question development, voting, and wording of the recommendations followed the modified Delphi methodology.
Results
Consensus recommendations were reached in 35, majority recommendations in 24, and no recommendations in the remaining 12 questions. The panel acknowledged the need for standardization of various aspects of NSM and immediate reconstruction. It endorsed several oncological contraindications to the preservation of the skin and nipple. Furthermore, it recommended inclusion of patients in prospective registries and routine assessment of patient-reported outcomes. Considerable heterogeneity in breast reconstruction practice became obvious during the conference.
Conclusions
In case of conflicting or missing evidence to guide treatment, the consensus conference revealed substantial disagreement in expert panel opinion, which, among others, supports the need for a randomized trial to evaluate the safest
and most efficacious reconstruction techniques
The role of preoperative blood parameters to predict the risk of surgical site infection
Routine preoperative blood work is not recommended but selected biochemical markers may predict the risk of surgical site infection (SSI). This study examines the association between preoperative biochemical markers and the risk of SSI.; This observational cohort study, nested in a randomized controlled trial, was conducted at two tertiary referral centers in Switzerland.; 122 (5.8%) of 2093 patients experienced SSI. Preoperative increasing levels of albumin (OR 0.93), CRP (OR 1.34), hemoglobin (OR 0.87) and eGFR (OR 0.90) were significantly associated with the odds of SSI. The same accounts for categorized parameters. The highest area under the curve from ROC curves was 0.62 for albumin. Positive predictive values ranged from 6.4% to 9.5% and negative predictive values from 94.8% to 95.7%. The association of CRP, mildly and moderately decreased eGFR and hemoglobin with the odds of SSI remained significant on multivariate analysis.; Our results do not support generally delaying elective surgery based on preoperative blood results. However, it may be considered in situations with potentially severe sequelae of SSI
Associations of Hospital Length of Stay with Surgical Site Infections
Surgical site infections (SSI) are a major cause of morbidity and mortality in surgical patients. Postoperative and total hospital length of stay (LOS) are known to be prolonged by the occurrence of SSI. Preoperative LOS may increase the risk of SSI. This study aims at identifying the associations of pre- and postoperative LOS in hospital and intensive care with the occurrence of SSI.; This observational cohort study includes general, orthopedic trauma and vascular surgery patients at two tertiary referral centers in Switzerland between February 2013 and August 2015. The outcome of interest was the 30-day SSI rate.; We included 4596 patients, 234 of whom (5.1%) experienced SSI. Being admitted at least 1Â day before surgery compared to same-day surgery was associated with a significant increase in the odds of SSI in univariate analysis (OR 1.65, 95% CI 1.25-2.21, pâ<â0.001). More than 1Â day compared to 1Â day of preoperative hospital stay did not further increase the odds of SSI (OR 1.08, 95% CI 0.77-1.50, pâ=â0.658). Preoperative admission to an intensive care unit (ICU) increased the odds of SSI as compared to hospital admission outside of an ICU (OR 2.19, 95% CI 0.89-4.59, pâ=â0.057). Adjusting for potential confounders in multivariable analysis weakened the effects of both preoperative admission to hospital (OR 1.38, 95% CI 0.99-1.93, pâ=â0.061) and to the ICU (OR 1.89, 95% CI 0.73-4.24, pâ=â0.149).; There was no significant independent association between preoperative length of stay and risk of SSI while SSI and postoperative LOS were significantly associated
Expression of RET is associated with Oestrogen receptor expression but lacks prognostic significance in breast cancer
Abstract Background The Rearranged during Transfection (RET) protein is overexpressed in a subset of Estrogen Receptor (ER) positive breast cancer, with both signalling pathways functionally interacting. This cross-talk plays a pivotal role in the resistance of breast cancer cells to anti-endocrine therapies, and RET expression is assumed to correlate with poor prognosis based on findings in small patient cohorts. The aim of our study was to investigate the impact of RET expression on patient outcome in human breast cancer. Methods We performed an immunohistochemical analysis of RET protein expression on a tissue microarray encompassing 990 breast cancer patients and correlated its expression with clinicopathological parameters and survival data. Results Expression of RET was detected in 409 out of 990 cases (41.3%). RET and ER expression significantly correlated (pâ<â0.0001). The Luminal B HER2-positive subtype showed the highest expression rate (48.9%). In univariate and multivariate survival analyses, RET expression had no impact on overall survival. Conclusion We confirmed the co-expression of RET and ER, but we did not find RET expression to be an independent prognostic factor in human breast cancer. Clinical trials with newly developed RET inhibitors are needed to evaluate if RET inhibition has a beneficial impact on patient survival in ER positive breast cancer
Endoscopic Superficialisation of Haemodialysis Arteriovenous Fistulas in Obese Patients â Safety, Feasibility, and Outcomes
The association of surgical drains with surgical site infections - A prospective observational study
Surgical drains are widely used despite limited evidence in their favor. This study describes the associations between drains and surgical site infections (SSI).; This prospective observational double center study was performed in Switzerland between February 2013 and August 2015.; The odds of SSI in the presence of drains were increased in general (OR 2.41, 95%CI 1.32-4.30, pâŻ=âŻ0.004), but less in vascular and not in orthopedic trauma surgery. In addition to the surgical division, the association between drains and SSI depended significantly on the duration of surgery (pâŻ=âŻ0.01) and wound class (pâŻ=âŻ0.034). Furthermore, the duration of drainage (OR 1.24, 95%CI 1.15-1.35, pâŻ<âŻ0.001), the number (OR 1.74, 95%CI 1.09-2.74, pâŻ=âŻ0.019) and type of drains (open versus closed: OR 3.68, 95%CI 1.88, 6.89, pâŻ<âŻ0.001) as well as their location (overall pâŻ=âŻ0.002) were significantly associated with SSI.; The general use of drains is discouraged. However, drains may be beneficial in specific surgical procedures
Impact of a Surgical Sealing Patch on Lymphatic Drainage After Axillary Dissection for Breast Cancer: The SAKK 23/13 Multicenter Randomized Phase III Trial.
Several studies and a meta-analysis showed that fibrin sealant patches reduced lymphatic drainage after various lymphadenectomy procedures. Our goal was to investigate the impact of these patches on drainage after axillary dissection for breast cancer.
In a phase III superiority trial, we randomized patients undergoing breast-conserving surgery at 14 Swiss sites to receive versus not receive three large TachoSil <sup>Âź</sup> patches in the dissected axilla. Axillary drains were inserted in all patients. Patients and investigators assessing outcomes were blinded to group assignment. The primary endpoint was total volume of drainage.
Between March 2015 and December 2016, 142 patients were randomized (72 with TachoSil <sup>Âź</sup> and 70 without). Mean total volume of drainage in the control group was 703Â ml [95% confidence interval (CI) 512-895Â ml]. Application of TachoSil <sup>Âź</sup> did not significantly reduce the total volume of axillary drainage [mean difference (MD) -110Â ml, 95% CI -316 to 94, pâ=â0.30]. A total of eight secondary endpoints related to drainage, morbidity, and quality of life were not improved by use of TachoSil <sup>Âź</sup> . The mean total cost per patient did not differ significantly between the groups [34,253 Swiss Francs (95% CI 32,625-35,880) with TachoSil <sup>Âź</sup> and 33,365 Swiss Francs (95% CI 31,771-34,961) without, pâ=â0.584]. In the TachoSil <sup>Âź</sup> group, length of stay was longer (MD 1Â day, 95% CI 0.3-1.7, pâ=â0.009), and improvement of pain was faster, although the latter difference was not significant [2Â days (95% CI 1-4) vs. 5.5Â days (95% CI 2-11); pâ=â0.2].
TachoSil <sup>Âź</sup> reduced drainage after axillary dissection for breast cancer neither significantly nor relevantly
Timing of surgical antimicrobial prophylaxis: a phase 3 randomised controlled trial.
BACKGROUND
Based on observational studies, administration of surgical antimicrobial prophylaxis (SAP) for the prevention of surgical site infection (SSI) is recommended within 60 min before incision. However, the precise optimum timing is unknown. This trial compared early versus late administration of SAP before surgery.
METHODS
In this phase 3 randomised controlled superiority trial, we included general surgery adult inpatients (age â„18 years) at two Swiss hospitals in Basel and Aarau. Patients were randomised centrally and stratified by hospital according to a pre-existing computer-generated list in a 1:1 ratio to receive SAP early in the anaesthesia room or late in the operating room. Patients and the outcome assessment team were blinded to group assignment. SAP consisted of single-shot, intravenous infusion of 1·5 g of cefuroxime, a commonly used cephalosporin with a short half-life, over 2-5 min (combined with 500 mg metronidazole in colorectal surgery). The primary endpoint was the occurrence of SSI within 30 days of surgery. The main analyses were by intention to treat. The trial is registered with ClinicalTrials.gov, number NCT01790529.
FINDINGS
Between Feb 21, 2013, and Aug 3, 2015, 5580 patients were randomly assigned to receive SAP early (2798 patients) or late (2782 patients). 5175 patients (2589 in the early group and 2586 in the late group) were analysed. Median administration time was 42 min before incision in the early group (IQR 30-55) and 16 min before incision in the late group (IQR 10-25). Inpatient follow-up rate was 100% (5175 of 5175 patients); outpatient 30-day follow-up rate was 88·8% (4596 of 5175), with an overall SSI rate of 5·1% (234 of 4596). Early administration of SAP did not significantly reduce the risk of SSI compared with late administration (odds ratio 0·93, 95% CI 0·72-1·21, p=0·601).
INTERPRETATION
Our findings do not support any narrowing of the 60-min window for the administration of a cephalosporin with a short half-life, thereby obviating the need for increasingly challenging SAP timing recommendations.
FUNDING
Swiss National Science Foundation, Hospital of Aarau, University of Basel, Gottfried und Julia Bangerter-Rhyner Foundation, Hippocrate Foundation, and Nora van Meeuwen-HĂ€fliger Foundation