Axillary Clearance For Breast Cancer Research Articles

Comparative Study between the Effect of the Ultrasound Dissector (the Harmonic) versus Monopolar and Bipolar Electrocautry in Reducing Seroma Formation Post-Conservative Breast Surgery

Abstract Background Breast cancer, according to national cancer institute, is the commonest cancer in women in Egypt, It represents 37% of all female cancers among Egyptian females cancers, seroma is the most frequent postoperative complication following breast cancer surgery. Our aim was to evaluate the effect of the harmonic focus scalpel versus electrocautery (monoplar and bipolar) in reducing seroma formation post conservative breast surgery. Patients and Methods This prospective randomized study was conducted on female patients with breast tumours at the General Surgery Department at Ain Shams University Hospitals starting from November 2020 to May 2021. Approval of the Ethical Committee and written informed consent from all participants were obtained. Results Our study included 60 patients, in whom a conservative breast surgery and axillary clearance for breast cancer were performed, were randomly allocated to either harmonic dissection (n = 20) or monopolar electrocautery (n = 20) or bipolar electrocautery (n = 20). Our mean age was 45.47±9.14 years (19-60 years). 10/60 patients (16.6%) had positive family history of mammary cancer, 18/60 patients were diabetic (30%), 23/60 patients were hypertensive (38%), 10/60 patients received neoadjuvant chemotherapy (10%). The mean lesional size was 2.9 ±1.03 cm (1.5-6.2 cm).the mean safety margin was 2.23±0.37 (1.5-3 cm). Operation timing was longer in bipolar electrocautry being (91.90 ± 3.14 minute) than monopolar elctrocautery being (83.35± 3.41 minute), while in harmonic group operation timing being (51.65 ± 5.02 minute).in addition intraoprative blood loss was significant large amount in monopolar electrocautery 75.15 ± 3.12 ml, while in harmonic dissection compared with bipolar electrocautery mean intraoprative blood loss was no significant (52.00 ± 4.18 ml vs 55.80 ± 9.89 ml pvalue =0.055). moreover there was asignificant reduction in the mean time of drain removal (2.90 ± 0.64 day in harmonic dissector), while in bipolar electrocautery 4.95 ± 0.69 day and longest mean time in drain removed in monopolar electrocautery 6.85 ± 0.37 day). And the incidence of seroma formation after drain removal is significant in monopola relectrocautery 58.3%. p-value =0.040, while in harmonic dissection compared bipolar electrocautery incidence of seroma formation after drain removal (16.7% vs 25.0%), this mean that harmonic dissector is low incidence of seroma formation. Conclusion Harmonic dissection technique leads to significant decreases in intraoperative blood loss, operative time, mean time of drain removal and postoperative seroma in terms of shorter drain duration and better quality of life. Here, we recommend the use of the harmonic dissection technique in conservative breast surgery.

Abstract P2-14-14: Effect Of Intra-operative And Post-operative Topical Tranexamic Acid On early post-operative complications In Patients Undergoing Axillary Lymph Node Dissection For Breast Cancer- A randomized controlled study

Abstract TITLE: Effect of intra-operative and post-operative topical tranexamic acid on early post-operative complications in patients undergoing axillary lymph node dissection for breast cancer. Authors: PACHIMATLA AKHIL GOUD1, ISHITHA LARAOIYA2, SIDDHANT KHARE3, R N NAGA SANTHOSH IRRINKI2, GURPREET SINGH4. Affiliation: 1. Junior Resident, Department of General Surgery, Post Graduate Institute of Medical Education & Research (P.G.I.M.E.R.), Chandigarh. 2. Assistant professor, Department of General Surgery, Post Graduate Institute of Medical Education & Research (P.G.I.M.E.R.), Chandigarh. 3. Associate professor, Department of General Surgery, Post Graduate Institute of Medical Education & Research (P.G.I.M.E.R.), Chandigarh. 4. Professor and Head (retired), Department of General Surgery, Post Graduate Institute of Medical Education & Research (P.G.I.M.E.R.), Chandigarh. BACKGROUND: Seroma formation after breast surgery has been a consistent problem with no established causes or risk factors. The role of topical tranexamic acid in reducing the incidence of seroma after axillary clearance in breast cancer is controversial. AIMS & OBJECTIVES: To study the effect of intra-operative and post-operative topical Tranexamic acid on the duration of drain and volume of seroma in patients undergoing axillary lymph node dissection (ALND) for breast cancer. MATERIALS AND METHODS: In this prospective, non-blinded, triple-arm randomized controlled trial conducted at the Department of General Surgery, PGIMER, 154 breast cancer patients were enrolled and studied from July 2020-July 2021. They were randomized into three groups. Group A (n=51) received a single dose of diluted topical tranexamic acid intra-operatively, Group B (n=52) received intra-operative dose and daily post-operative doses till day-5 through the suction drain placed intra-operatively, and Group C(n=51) did not receive any topical tranexamic acid. The study groups were primarily compared for the total drain duration and total drainage volume. Daily drain volume for the first five days, complications like seroma, wound infection and severity of surgical site infections using Southampton score, and adverse reactions of the drug were compared. RESULTS Out of the 154 patients, four have failed to maintain appropriate records and analysis was done with 150 patients. The mean age of the study population was 52.17±8.69 yrs, with a mean BMI of 26.20±4.14. The final analysis showed no significant difference in total drain volume across the three groups, but patients receiving multiple doses of topical tranexamic acid had the lowest total volume drained compared to patients receiving a single dose or no dose (1763ml Vs 1597 Vs 1773ml: p=0.269. There was no significant change in the duration of the post-operative drain (21.6 Vs 19.2 Vs 19.55 days: p=0.54). There was no statistically significant difference in complications between the groups. Seroma was seen in 6 vs 7 vs 4%(p=0.629) patients in groups A, B and C respectively. Wound site infection was noted in 11 vs 13 vs 10% of patients (p= 0.766). None of the patient characteristics like age, BMI, co-morbidities, previous lumpectomy, menopause, and length of history significantly correlated with seroma formation in the study population. CONCLUSION There was no significant reduction in drain volume or duration with either single or multiple doses of topical tranexamic acid after the axillary clearance for breast cancer. Even though not significant, an increasing trend in wound site infections was noted among the patients who received multiple doses of tranexamic acid was noted. Citation Format: AKHIL GOUD PACHIMATLA, R N NAGA SANTOSH IRRINKI, ISHITA LAROIYA, SIDDHANT KHARE. Effect Of Intra-operative And Post-operative Topical Tranexamic Acid On early post-operative complications In Patients Undergoing Axillary Lymph Node Dissection For Breast Cancer- A randomized controlled study. [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P2-14-14.

Efficacy of Single Pre-Operative Dose of Glucocorticoid (125mg of Solumedrol Intravenous) in Terms of Seroma Formation in Patients Undergoing Mastectomy with Axillary Clearance For Breast Cancer: A Randomized Control Trial

Objective: The study aimed to determine the efficacy of single dose of glucocorticoid (125 mg of Solumedrol intravenous) in terms of seroma formation after mastectomy in patient with carcinoma of breast. Study Design: Randomized control trial. Place and Duration of Study: Study was conducted in the Department of General Surgery, Liaquat National Hospital Karachi, Pakistan from july 1 to dec 31, 2010. Patients and Methods: Patients were randomly divided in two groups (study and control) each group consisting of 30 patients. Randomization was done by opening of a sealed envelope which had a slip bearing the name of study medication (solumederol or saline as placebo) to be administered. The study group received a single dose of inj 125mg solumedrol IV half an hour prior to surgery by resident scrub in surgery. A similar procedure was applied to the control group and patients in controlled group were administered an equal volume of saline intravenously. After drain removal patients in both groups were observed for a duration of 2 weeks for sermoa formation. Detection of seroma formation was based on clinical grounds by absence of any fluid collection at mastectomy bed as detected by manual palpation. SPSS 10 was used for analysis. Results: Seroma formation was observed in 66.7% (40/60) women 2 weeks post drain removal. Rate of seroma formation was significantly low in study groups than control groups (33.3% vs. 100%; p=0.0001). Conclusion: Single dose of steroid is efficacious in reducing the post mastectomy seroma formation.

Efficacy of Single Pre Operative Dose of Glucocorticoid (125 mg of Solumedrol Intravenous) in terms of Seroma Formation in Patients Undergoing Mastectomy with Axillary Clearance for Breast Cancer: A Randomized Controlled Trial

Patients were randomly divided in two groups (study and control) each group consisting of 30 patients. Randomization was done by opening of a sealed envelope which had a slip bearing the name of study medication (solu-medrol or saline as placebo) to be administered. The study group received a single dose of inj 125 mg solu-medrol IV half an hour prior to surgery by resident scrub in surgery.

Surgical Technique can Prevent Arm Lymphoedema After Level III Clearance for Breast Cancer

Clearance of the axillary tissue during operation is still the mainstay of treatment for node positive breast cancer. Level III axillary nodal clearance is supposed to increase the risk of lymph edema of arm, along with other factors. However, preservation of the fascia over the axillary vein during surgery reduces the risk of lymph edema greatly. In this study we measured the incidence of armlymphoedema that occured after Level III axillary clearance for breast cancer. During surgery, dissection over the anterior surface of axillary vein was limited to preserve the fascia covering axillaryvein. Other factors commonly implicated in the development of post-operative arm lymphoedema were also documented and their effect analysed. Forty three patients underwent operation for breast cancer including complete axillary clearance up to Level III. The incidence of lymphoedema was 25.5% (11 out of 43 patients). None of these patients had severe lymphoedema. On multivariate analysis, no other associated factors like BMI, chemotherapy and nodal metastases had any bearing on the development of lymph edema. We conclude that Level III axillary clearance of axilla is safe and not excessively morbid in terms of developing arm lymphoedema provided the fascia over axillary veinis preserved.

A novel technique of harmonic tissue dissection reduces seroma formation after modified radical mastectomy compared to conventional electrocautery: a single-blind randomized controlled trial

BackgroundSeroma is the most frequent postoperative complication following breast cancer surgery. Our aim was to evaluate the effect of the harmonic focus scalpel versus electrocautery in reducing seroma formation post-mastectomy and axillary clearance.MethodsA prospective randomized controlled trial study was conducted at the Department of Surgery of Suez Canal University Hospital from April 26th 2014 to 30th June 2016. Seventy-two women, in whom a mastectomy and axillary clearance for breast cancer were performed, were randomly allocated to either harmonic dissection (n = 36) or electrocautery (n = 36).ResultsThe mean operative time was significantly longer for harmonic dissection compared with electrocautery (2.63 ± 0.41 vs. 1.75 ± 0.26 h; p < 0.0001). In addition, a significantly smaller amount of intraoperative blood loss (69.4 ± 25.1 vs. 255.5 ± 41.6 ml; p = 0.002) and total drainage volume (1277.8 ± 172.5 ml vs. 3300 ± 167.5 ml; p = 0.002) were found in the harmonic group. Moreover, there was a significant reduction in the time of drain removal (10.9 ± 1.12 vs. 15.9 ± 1.44; p = 0.001) and the incidence of seroma formation after drain removal [8.3% vs 33.3%; p = 0.003] in the harmonic group compared with those in the electrocautery group.ConclusionHarmonic dissection technique leads to significant decreases in intraoperative blood loss, total drainage volume and postoperative seroma in terms of shorter drain duration with a minimal increase in the operative time and better quality of life. Here, we recommend the use of the harmonic dissection technique in mastectomy and axillary clearance.

Myofascial techniques have no additional beneficial effects to a standard physical therapy programme for upper limb pain after breast cancer surgery: a randomized controlled trial

Objective: To investigate the effects of myofascial techniques, in addition to a standard physical therapy programme for upper limb pain shortly after breast cancer surgery. Design: Double-blinded (patient and assessor) randomized controlled trial with two groups. Setting: University Hospitals Leuven, Belgium Patients: A total of 147 patients with unilateral axillary clearance for breast cancer. Intervention: All participants received a standard physical therapy programme starting immediately after surgery for four months. The intervention group received additionally eight sessions of myofascial therapy from two up to four months after surgery. The control group received eight sessions of a placebo intervention, including static hand placements at the upper body region. Main measurements: The primary outcome was prevalence rate of upper limb pain. Additionally, pain intensity (Visual Analogue Scale (VAS, 0–100)), pressure hypersensitivity (pressure pain thresholds (PPTs; kg/cm2)) and pain quality (McGill Pain Questionnaire) were evaluated. All measurements were performed at 2 (=baseline), 4, 9 and 12 months post-surgery. Results: At 4, 9 and 12 months post-surgery, prevalence rates of pain, pain intensity and pain quality were comparable between the intervention and control group. PPT of the upper trapezius muscle was significantly higher in the intervention group at four months with a difference of −1.2 (−1.9 to −0.4) kg/cm2, P = 0.012). PPT of the supraspinatus muscle was significantly higher in the intervention group at four months (−0.7 (−1.4 to −0.1) kg/cm2, P = 0.021) and at nine months (−0.5 (−1.1 to 0.0), P = 0.040). Conclusion: Myofascial therapy has no added beneficial effect as standard physical therapy modality in the postoperative stage.

What should be used for lower pole coverage in immediate two-stage expander / implant based breast reconstruction?

What should be used for lower pole coverage in immediate two-stage expander / implant based breast reconstruction?

Selection for axillary clearance in breast cancer (ultrasound negative, sentinel node positive patients have low rates of further metastases)

BackgroundThe aim of this study was to determine whether we could identify a subset of axillary clearance patients in whom the procedure yielded negative nodes and was therefore of no therapeutic benefit. MethodsOver a three year period 138 patients underwent axillary clearance at our unit. The axillae of all patients were assessed preoperatively with clinical examination, ultrasound (USS) and FNAC if suspicious nodes identified. Patients with clinically malignant nodes or positive FNAC underwent axillary node clearance where appropriate, whilst completion axillary node clearance was performed in those who had no preoperative evidence of metastatic axillary disease but positive sentinel node biopsy (SNB)/axillary node sample (ANS). ResultsOf the 138 patients, the indications for axillary clearance were positive FNAC or clinically malignant nodes in 89 and positive SNB/ANS in the remaining 49. Patients with preoperative evidence of axillary metastases had significantly more positive nodes compared to those who underwent SNB and completion ANC 4.6 vs. 3.1 p = 0.037. Of the patients with ultrasonographically normal axillae but positive SNB, 8.7% had further nodal metastases at completion ANC. This was significantly less than in those with abnormal USS (negative FNAC) and positive SNB (41.7%); p = 0.033. ConclusionsPreoperative ultrasound in conjunction with FNAC and clinical judgement identifies most patients with positive axillary nodes and such patients have more widespread disease. The additional value of completion axillary ANC in patients with ultrasonographically normal axillae but positive SNB appears small as sentinel node ‘biopsy’ serves to clear the axilla of metastases in most of these patients.

Late Intravascular Embolization of a Chemo Port Catheter

A 51-year-old woman was referred for angiographic extraction of a foreign body. She underwent left mastectomy with axillary clearance for breast cancer followed by chemotherapy and radiotherapy 8 years before this. A chemotherapy port was implanted below the right clavicle with catheter access into the right subclavian vein at that time. After she had completed chemotherapy, she was lost to follow-up, until she represented 8 years later with persistent cough. The chest x-ray (Figure 1A) showed a foreign body comprising an ellipsoid head and a flagellating tail on fluoroscopy (see video, Supplemental Digital Content 1 [http:// links.lww.com/JTO/A86]; see video, Supplemental Digital Content 2 [http://links.lww.com/JTO/A87] for a close-up; and see video, Supplemental Digital Content 3 [http://links. lww.com/JTO/A88] for a 180° surround view). A computed tomography scan of chest demonstrated embolization of the fractured chemo port catheter. The catheter segment (Figure 1B, arrow) was lodged between the pulmonary artery trunk and a branch of the left pulmonary artery. The distal end of the catheter was surrounded by a 3.7-mm-diameter calcified tissue mass (Figure 1B, arrowhead). The patient declined angiography in view of the risks associated with extracting a heavily calcified and embedded catheter tip. The chemo port was still located below the right clavicle with a stump of the catheter connected to it. We hypothesize that entrapment (“pinch off”) and friction of the catheter between clavicle and first rib over many years resulted in fracture and embolization of the catheter. Increasingly, specialist nurses are responsible for the care of patients with central venous catheters and the removal of the devices.1 Current guidelines recommend the removal of unused ports.2 Case reports of embolized port catheters or so-called totally implanted venous devices are rare. Only about a third of the embolic events reported were localized in the pulmonary arteries, and about a quarter of patients were asymptomatic at the time of diagnosis.3 Catheter embolism may go undetected for prolonged periods of time and is often diagnosed incidentally. The risk of serious complications for patients with asymptomatic catheter embolism is unknown. Embolized catheter fragments should be removed to prevent further complications.

Perioperative diagnosis of the positive axilla in breast cancer: A safe, time efficient algorithm

BackgroundThis study evaluates the combined role of axillary ultrasound (Ax US), fine needle aspiration (FNAC) and intraoperative frozen section analysis of the sentinel node (FS SN) in a practical, time efficient algorithm to reduce the requirement for reoperation for axillary clearance in breast cancer in a busy tertiary unit. MethodsBetween October 2007 and June 2009 188 women underwent Ax US as a first investigation for nodal status. Suspicious nodes were biopsied, negative axillae proceeded to FS SN at time of primary breast surgery. All confirmed positive cases proceeded to immediate axillary clearance. Results93 women had positive axillary nodes at final histology. Ax US + FNAC identified 59 positive axillae and had a sensitivity of 63.4% and specificity of 100%. FS SN identified a further 26 cases with a sensitivity of 76.5% and specificity of 100%. Overall, only 8 women required reoperation for axillary clearance. Sensitivity for the combined procedures was 91.4%. Commencement of adjuvant therapy was significantly less in those women identified earlier compared to those requiring a second operation (23.3 days vs 49.0 days, p < 0.005). Conclusion95.7% of cases were diagnosed accurately in the perioperative period, preventing delay to triage to definitive oncological care and reducing requirement for costly reoperation.

Paravertebral anesthesia: how substance P and the NK-1 receptor could be involved in regional block and breast cancer recurrence

In a retrospective study, Exadaktylos et al. [1] reported a beneficial relationship between paravertebral block and cancer recurrence in women undergoing mastectomy and axillary clearance for breast cancer. In fact, these authors concluded that ‘‘breast cancer patients undergoing surgery with paravertebral anesthesia and analgesia combined with general anesthesia have a lower incidence of cancer recurrence or metastasis during the initial years of followup than patients undergoing surgery with general anesthesia and patient-controlled morphine analgesia’’ [1]. These authors speculated that regional anesthesia might attenuate the perioperative factors that enhance tumor growth and spreading [1]. In this sense, regional anesthesia may help to maintain normal perioperative immune function by attenuating the surgical stress response by blocking noxious inputs mediated by substance P [2]. It is known that the stress response induces an inhibition of the immune function (i.e., there is a marked attenuation of natural killer cells, these cells being involved in preventing tumor dissemination) [3]. Paravertebral anesthesia also spares patients from postoperative opioids (e.g., morphine), which inhibit both cellular and humoral immune function [4, 5]; in addition, it is known that morphine exerts a proangiogenic effect [6]. In sum, the authors surmised that regional anesthesia and analgesia may help to preserve immune function by attenuating the surgical stress response and diminishing the need for opioids. However, until now the underlying mechanisms remain unknown. The reason for this letter is to provide additional data that could support and explain the relationship between regional anesthesia, analgesia, and the recurrence of cancer. Many reports have clearly established an overexpression of neurokinin-1 (NK-1) receptors in tumor cells and others have reported the roles in which substance P (SP) is involved [7]. Summing up these investigations, it could be stated that:

Tumour-Positive Axillary Sentinel Nodes and Their Association with Non-sentinel Node Involvement in Subsequent Axillary Clearance in Breast Cancer

Introduction: This study is based on our observation that more than half of the breast cancer patients with only one tumourpositive axillary sentinel node are found to have regional disease limited to the sentinel node after completion of axillary clearance. These patients are exposed to the morbidity of axillary clearance with no tangible additional therapeutic benefit.Methods: Axillary clearance was performed in all tumour-positive sentinel node patients.Results: Out of 38 consecutive patients with tumour-positive sentinel nodes, 23 patients had one tumour-positive sentinel lymph node involved and the other 15 patients had more than one tumour-positive sentinel lymph nodes; 13.04% of single tumour-positive sentinel node patients (Group1) and 33.3% of more than one tumour-positive sentinel node patients (Group2) had metastasis to the non-sentinel nodes. Conclusions: More than one tumour-positive sentinel nodes patients are 2.56 times more likely to have positive nonsentinel lymph nodes than patients with only one tumour-positive sentinel node. As this association is not statistically significant, the current practice of axillary dissection following positive sentinel nodes should be continued.

Use of Multiple Drains After Mastectomy Is Associated With More Patient Discomfort and Longer Postoperative Stay

Background Seromas constitute a common complication following surgery for breast cancer, and closed drainage is used routinely to reduce its incidence. The aim of this study was to evaluate the influence of number of drains on patient discomfort, seroma formation, and hospital stay during the immediate postoperative period after mastectomy for breast cancer. Patients and Methods Based on a retrospective review of our clinical database, 110 consecutive patients from January 2004 through January 2006 who had undergone a mastectomy and axillary clearance for breast cancer were sent a simple postal questionnaire for collection of data. Results A total of 70 patients responded (all women; mean age, 69.4 ± 11.4 years). Twenty-seven patients (38.57%) had 3 drains implanted unilaterally, 24 (34.28%) had 2, and 19 (27.14%) had 1 drain. They were divided into 2 groups: the first group with 1 drain (19 patients) and the other with 2 or 3 drains (51 patients). Median postoperative hospital stay was 2 days (range, 1–8 days); patients with 1 drain had a significantly shorter postoperative hospital stay (median, 2 days [range, 1–4 days] vs. 2 days [range, 1–8 days]; Mann-Whitney U test, P = .02). A total of 15 patients (21.43%) complained of a seroma. There was no difference in seroma rates between groups. Patients who had a single drain implanted had a significantly lower rate of discomfort (median, 2 [range, 1-5] vs. 3 [range, 1–7]; Mann-Whitney U test; P = .04). Conclusion The number of drains used after a mastectomy for breast cancer did not significantly affect the rate or amount of seromas in this study, but the use of a single drain after mastectomy was significantly associated with less discomfort and shorter postoperative hospital stay.

Patent Blue Dye in Lymphaticovenular Anastomosis

Lymphaticovenular anastomosis (LVA) has been described as a treatment of chronic lymphoedema. This microsurgical technique is new and technically difficult. The small caliber and thin wall lymphatic vessels are difficult to identify and easily destroyed during the dissection. We describe a technique of performing lymphaticovenular anastomosis with patent blue dye enhancement. Our patient is a 50-year-old lady who suffers from chronic lymphoedema of the upper limb after mastectomy and axillary clearance for breast cancer 8 years ago. Patent blue dye is injected subdermally and is taken up readily by the draining lymphatic channels. This allows for easy identification of their course. The visualisation of the lumen of the lymphatic vessel facilitates microsurgical anastomosis. The patency of the anastomosis is also demonstrated by the dynamic pumping action of the lymphatic within the vessels. Patent blue dye staining during lymphaticovenular anastomosis is a simple, effective and safe method for mapping suitable subdermal lymphatics, allowing for speedier dissection of the lymphatic vessels intraoperatively. This technique also helps in the confirmation of the success of the lymphaticovenular anastomosis.

Exercise OK After Axillary Clearance in Breast Cancer

Exercise OK After Axillary Clearance in Breast Cancer

Should we follow western guidelines for axillary clearance in breast cancer in developing countries?

Should we follow western guidelines for axillary clearance in breast cancer in developing countries?

Can Anesthetic Technique for Primary Breast Cancer Surgery Affect Recurrence or Metastasis?

Regional anesthesia is known to prevent or attenuate the surgical stress response; therefore, inhibiting surgical stress by paravertebral anesthesia might attenuate perioperative factors that enhance tumor growth and spread. The authors hypothesized that breast cancer patients undergoing surgery with paravertebral anesthesia and analgesia combined with general anesthesia have a lower incidence of cancer recurrence or metastases than patients undergoing surgery with general anesthesia and patient-controlled morphine analgesia. In this retrospective study, the authors examined the medical records of 129 consecutive patients undergoing mastectomy and axillary clearance for breast cancer between September 2001 and December 2002. Fifty patients had surgery with paravertebral anesthesia and analgesia combined with general anesthesia, and 79 patients had general anesthesia combined with postoperative morphine analgesia. The follow-up time was 32 +/- 5 months (mean +/- SD). There were no significant differences in patients or surgical details, tumor presentation, or prognostic factors. Recurrence- and metastasis-free survival was 94% (95% confidence interval, 87-100%) and 82% (74-91%) at 24 months and 94% (87-100%) and 77% (68-87%) at 36 months in the paravertebral and general anesthesia patients, respectively (P = 0.012). This retrospective analysis suggests that paravertebral anesthesia and analgesia for breast cancer surgery reduces the risk of recurrence or metastasis during the initial years of follow-up. Prospective trials evaluating the effects of regional analgesia and morphine sparing on cancer recurrence seem warranted.

Incidence of arm swelling following axillary clearance for breast cancer.

Arm swelling was measured using volume determination in 118 patients following mastectomy (n = 60) or wide excision (n = 58), both with axillary clearance. The mean age was 60.5 years and the median follow-up was 22.5 months. Axillary clearance removed level III nodes. Axillary irradiation was given to only three patients with extensive (more than 75 per cent) nodal involvement. The incidence of early postoperative complications was 18.6 per cent. The incidence of lymphoedema was 7.6 per cent (nine patients). Three of these patients had early lymphoedema within 6 months of treatment. Arm circumference differences correlated poorly with volume differences. The incidence of lymphoedema following axillary clearance is low and comparable to that for sampling or no axillary surgery.

Sentinel node biopsy versus complete axillary clearance in breast cancer: The patients' point of view. Results of a prospective survey

750 Background: Sentinel node biopsy (SNB) seems to be associated with less morbidity than axillary clearance (AC) in early breast cancer. The aim of this study is to evaluated the patients' self-perception of SNB as compared to AC. Methods: Two different questionnaires were built, one for SNB and one for AC patients (pts). Each one contained 3 different domains : pts knowledge, perception of the different technique outcomes, consequences on the day-to-day life : psychological and physical morbidity.Questionnaires were mailed to pts operated on from 01.2001 to 03.2003 (mean delay after surgery : 15 months, range : 7–34 months). Results: Questionnaires were returned by 272/368 pts ( 74%). Three groups of pts were evaluated : group A (n=143) : pts with SNB without AC, group B (n=50) : pts with SNB followed by AC, group C (n= 79) : pts with AC only. Conclusions: Although uncontrolled, this prospective study shows that pts' point of view is significantly more negative after SNB with AC than after SNB or AC alone. No significant financial relationships to disclose.