Surgery In Breast Cancer Patients Research Articles

The Usefulness of Magnetic Resonance Imaging (MRI) for the Detection of Local Recurrence after Mastectomy with Reconstructive Surgery in Breast Cancer Patients.

The purpose of this study is to investigate the usefulness of magnetic resonance imaging (MRI) for the detection of local recurrence after nipple-sparing mastectomy (NSM) or skin-sparing mastectomy (SSM) with immediate reconstructive surgery for breast cancer. Two hundred and eighty-six NSM or SSM procedures and immediate reconstruction cases between August 2015 and February 2020 were reviewed. The detectability rates of for local recurrence using MRI and ultrasound were assessed, and the characteristics of recurrent and primary cancers were evaluated. The patients with multifocal or multicentric primary cancer and a dense parenchymal pattern showed a higher recurrence rate (p < 0.001). A total of 22 cases showed recurrence, and due to multifocal recurrence, a total of 27 recurrent lesions were identified in the reconstructed breast, of which 12 were symptomatic and 15 were asymptomatic (p < 0.001). With the exception of skin recurrence (n = 6), MRI showed a significantly higher detectability rate (95.2%, 20 of 21) than ultrasound (38.1%, 8 of 21) for the recurrence of cancer in the reconstructed breast (p < 0.001), especially for small-sized (<1 cm) asymptomatic lesions. In addition, the mean recurrence interval of MRI-detected asymptomatic lesions was 21.7 months (SD ± 17.7), which was significantly longer than that of symptomatic recurrence. In conclusion, postoperative MRI can be useful for identifying small-sized (<1 cm) asymptomatic recurrence lesions in reconstructed breast tissue after NSM or SSM, which can be implemented within two years of surgery.

What Is the Optimal Strategy for Drain Removal After Mastectomy and Axillary Surgery in Breast Cancer Patients? A Multicenter, Three-Arm Randomized Clinical Trial.

The best strategy for drain removal after mastectomy and axillary surgery in breast cancer patients has remained controversial. We conducted a multicenter, three-arm randomized clinical trial to determine the optimal strategy. A total of 187 eligible breast cancer patients who underwent mastectomy and axillary surgery were randomized into 10mL (n=62), 20mL (n=63), and 30mL (n=63) groups for drain removal on the first day when the output decreased to a corresponding volume in 24h. The drain duration, total drain duration, incidence of seroma, quality of life, outpatient visit times, healthcare costs, and postoperative complications were evaluated. The median axillary drain durations and total drain durations were all significantly different between three groups (both P<0.001). The incidences of seroma were 31.1%, 38.3%, and 52.1%, and the difference between the 30mL and 10mL groups was significant (RR=2.41). The 20mL group reported significantly better quality of life (QoL) in terms of physical functioning (PF) at the 2-week (30mL versus 20mL, HR:-14.18) and 3-week (20mL versus 10mL, HR: 11.65) follow-up and role functioning (RF) at the 2-week follow-up (20mL versus 10mL, HR: 18.15). No between-group differences were found in G-QoL, outpatient visits, costs, or complications. The 20mL group had a moderate drain duration, total drain duration, and incidence of seroma but a significant advantage over the other two groups in terms of PF and RF, with relatively low outpatient costs and comparable postoperative complication rates. These findings could aid in clinical decision-making regarding drain removal timing (http://www.chictr.org.cn/: ChiCTR2000028729).

Comparison of Wound Closure Using Acellular Dermal Matrix With Primary Wound Closure After Breast Conserving Surgery in Breast Cancer Patients

Purpose: As breast-conserving surgery has become a standard treatment for patients with breast cancer, several approaches have been devised to achieve desirable cosmetic results, including a method using a patient’s own tissues or organs or a mesh to resolve defects. However, its application has been limited due to the associated complications. Accordingly, breast reconstruction using an acellular dermal matrix (ADM) has been introduced to improve patients’ cosmetic satisfaction. However, the comparison of reconstruction and primary sutures using this method has not been well-studied. Therefore, this study surveyed patients who underwent breast cancer surgery based on cosmetic indicators to study the efficacy of ADM after breast-conserving surgery.Methods: This retrospective study included 68 patients diagnosed with breast cancer who underwent breast-conserving surgery at a single institution by a single surgeon from April 2019 to December 2020.Results: This study included 68 patients who underwent breast-conserving surgery. Among them, 22 patients underwent breast-conserving surgery using ADM, while 46 patients received only primary sutures without ADM. Among the items of the Breast Cancer Treatment Outcome Scale-12 (BCTOS-12), patient satisfaction was significantly higher in the group using ADM, than that in the control group in terms of breast shape (1.86±0.89 vs. 2.39±0.80, p=0.017). Regarding breast tenderness, the result also confirmed the group treated using ADM experienced less tenderness than the control group not treated with ADM (1.68±0.78 vs. 2.22±1.03, p=0.035). The two groups exhibited no significant differences in breast texture, arm heaviness, nipple appearance, shoulder discomfort, arm discomfort, scar tissue, arm swelling, breast swelling, fit of the bra, and breast sensitivity.Conclusion: Breast reconstruction using ADM in patients with breast cancer was effective from a cosmetic perspective. Prospective multicenter studies should be conducted to provide clear guidelines.

Effect of radiotherapy sequence on long-term outcome in patients with node-positive breast cancer: a retrospective study

The optimal sequence of chemotherapy (CT) and radiotherapy (RT) after surgery in breast cancer patients is unclear. There is a lack of literature on RT given between anthracycline and taxane administration. We evaluated the effect of RT sequence on long-term outcome in breast cancer. Two hundred patients who underwent surgery between January 2009 and December 2012 for node-positive breast cancers were evaluated retrospectively. All patients were treated with doxorubicin and cyclophosphamide (AC) followed by taxane. Sandwich RT group that received RT between AC and taxane was compared to the group that received RT after CT. The mean follow-up period was 105.4 months. The locoregional recurrence (LRR) rate was lower in sandwich RT group (P = 0.012) and there was no significant difference in distant metastasis between the two groups. The RT sequence was an important predictor for LRR in multivariable analysis (P = 0.017). For luminal A subtype, disease-free survival (DFS) was better in sandwich RT group than in CT followed by RT group (P = 0.001). The overall survival did not correlated with RT sequence regardless of subtype. Sandwich RT can offer DFS benefit in luminal A subtype breast cancer. A tailored approach of sequencing chemotherapy and radiotherapy would be needed considering the factors that can influence outcome.

T024 The plasma levels and diagnostic utility of vascular endothelial growth factor (VEGF) and metalloproteinase 9 (MMP-9) before and after surgery of breast cancer patients

T024 The plasma levels and diagnostic utility of vascular endothelial growth factor (VEGF) and metalloproteinase 9 (MMP-9) before and after surgery of breast cancer patients

Retrospective audit on time to surgery delays following the completion of neoadjuvant chemotherapy in breast cancer patients

The ideal time to surgery interval in breast cancer patients following neoadjuvant chemotherapy according to published literature is as low as 21 days, 40 days and up to 8 weeks. The authors' hospital multidisciplinary team (MDT) accepted 28 days as a reasonable time interval to allow recovery from the side‑effects of neoadjuvant chemotherapy. The present retrospective clinical audit presents a review of all breast cancer cases that received neoadjuvant chemotherapy and examined the conformity to the set audit standards. The primary aim of the present audit was to investigate the time interval from the conclusion of neoadjuvant chemotherapy to surgery in breast cancer patients, and to determine the causes of potential delays and identifying means to improve the outcomes of the current process. The secondary objectives were to investigate the timing of tumour coil insertion, the timing of surgical planning multidisciplinary team meeting, the time to addition to the surgical waiting list and whether these patients had adequate tumour monitoring for effective surgical planning. A total of 59 breast cancer patients who had received neoadjuvant chemotherapy from November 1, 2011 to October 31, 2016 were identified. In total, one primary audit standard and six secondary audit standards were derived from the MDT consensus agreement and reasons for non‑conformity to these standards were audited. The primary standard was described as ‘surgery should be performed within 28 days of completion of last cycle of neoadjuvant chemotherapy’. The results revealed that conformity to this standard was 14%. The conformity of secondary standards was also poor, ranging from 20 to 98%. The results of the present audit were not very encouraging. Recommendations were drawn with a plan for a re‑audit following the implementation of changes agreed upon by the multidisciplinary team and a plan of action was prepared. It was concluded that achieving a time to surgery interval of &lt;28 days following the completion of neoadjuvant chemotherapy is an achievable challenging task and only possible with an efficient multidisciplinary team work.

Dosimetric Evaluation of Incidental Irradiation to the Internal Mammary Chain After Surgery in Breast Cancer Patients.

Background and PurposeThe low rate of internal mammary node (IMN) recurrence was attributed to systemic therapy and internal mammary chain (IMC) coverage by the tangential fields of irradiation. This study aimed to evaluate the incidental irradiation dose to the IMC in breast cancer patients after surgery and to estimate the clinical predictive parameters affecting the magnitude of the IMC.Materials and MethodsA total of 138 patients treated with postmastectomy radiotherapy and 210 patients undergoing radiotherapy after breast-conserving surgery (BCS) in our hospital were retrospectively analyzed. The mean dose (Dmean) to the IMC and the first to third intercostal spaces of IMC levels (ICS1–3) were evaluated. We evaluated the IMC coverage according to the type of surgery and whether the ipsilateral supraclavicular fossa (SCF) was included in the irradiation field.ResultsThe incidental radiation dose to the IMC was 29.69 Gy, and the dose delivered to the IMC, ICS1, and ICS2 showed a greater coverage in the modified radical mastectomy (MRM) group when compared with the BCS group (32.85 vs. 27.1 Gy, 26.6 vs. 12.5 Gy, 34.63 vs. 30.42 Gy). The dose delivered to ICS3 showed no difference between the MRM and BCS groups (37.41 vs. 36.24 Gy). Furthermore, 131 patients (37.64%) received radiotherapy to the chest wall and ipsilateral SCF. In the univariate analysis, both surgery type and SCF irradiation were parameters affecting the Dmean of incidental radiation to the IMC (r = −0.179, P = 0.001; r = −0.175, P = 0.001). In the multivariate analysis, surgery type was the only correlative factor that affected incidental radiation dose to the IMC (r = –3.534, P = 0.000).ConclusionThe real influencing factor of incidental dose to the IMC was the surgery form rather than the accession of SCF irradiation.

Trends in axillary surgery and clinical outcomes among breast cancer patients with sentinel node metastasis

BackgroundThere is a lack of studies examining the long-term trend and survival of axillary surgery for breast cancer patients with sentinel node metastasis, especially for the patients with 3–5 node metastases. MethodsBreast cancer patients with 1–5 sentinel node metastases from the Surveillance, Epidemiology, and End Results (SEER) database from 2000 to 2016. Our study presented the trend of axillary surgery and assessed the long-term survival of sentinel lymph node biopsy (SLNB) alone vs axillary lymph node dissection (ALND) for those patients. ResultsOf the 41,996 patients diagnosed with T1-2 breast cancer after lumpectomy and radiation included, 34,940 had 1-2 sentinel node metastases and 7056 had 3-5 sentinel node metastases. The percentage of patients undergoing SLNB alone increased from 22.4% in 2000 to 81.0% in 2016 for patients with 1–2 sentinel node metastases, and quadrupled from 5.2% in 2009 to 20.6% in 2016 for those with 3–5 sentinel node metastases. Completion of ALND did not benefit the long-term survival of 1–2 sentinel node metastasis patients (hazard ratio [HR] = 1.02, P = 0.539), but improved the long-term survival of 3–5 node metastasis patients (HR = 0.73, P < 0.001). Subgroup analysis demonstrated the inferiority of SLNB to ALND in all subgroups of 3–5 sentinel node metastases. ConclusionFor patients with T1-2 breast cancer after lumpectomy and radiation, SLNB alone was an efficient and safe surgical choice for 1–2 sentinel node metastases but not for 3–5 sentinel node metastases. It is worth noting that for patients with 3–5 node metastasis, the proportion of omitted ALND quadrupled after 2009.

Comparison of excised breast volume, re-excision rate and margin positivity in breast-conserving surgery in breast cancer patients using and not using neoadjuvant chemotherapy

Background/Aim: One of the purposes of using neoadjuvant chemotherapy (NAC) is to evaluate the patients according to tumor-to-gland ratio, save them from mastectomy by reducing tumor dimension, and get more beautiful results cosmetically with less volume excision during breast-conserving surgery (BCS). Is it possible to achieve the goal of less volume excision after NAC? We aimed to compare the excised volume with BCS, margin positiveness and re-excision rates between the patients who received NAC and the ones who didn’t receive NAC in patients with breast cancer and to calculate the increase in BCS performability with NAC. Methods: Among 306 patients diagnosed with breast cancer between 2013 and 2021 at Gaziosmanpasa Training and Research Hospital, 105 patients who underwent BCS were included in this retrospective cohort study. Excised breast volume, surgical margin positiveness, re-excision and mastectomy rates were retrospectively compared in breast cancer patients underwent BCS with and without NAC. The patients who received BCS following NAC were named the primary chemotherapy (PC), and the patients whose treatment was initiated with BCS were named the primary surgery (PS) groups. Results: BCS was performed to 105 breast cancer patients, of which 28 (26.7%) received NAC, and 77(73.7%) started the treatment with surgery. There were no significant differences between the PC and PS groups with respect to excision volume (755.86 (725.69) and 709 (637.36), P=0.822). Re-excision was more common in PS than in the PC group (39.0% vs 10.7%, P=0.008). Fourteen patients who were candidates for mastectomy at the beginning, became eligible for BCS by receiving NAC, which caused a 15.38% increase in BCS applicability. Surgical margin positivity was seen in only 3 patients, which is why a statistical comparison wasn’t made. Conclusions: Although the tumor size was higher in the PC group, the excised breast volume did not show a significant difference between the two groups. PC decreased the re-excision rates in the chemotherapy candidate group. This data shows that patients who are candidates for adjuvant chemotherapy might be considered for PC to increase BCS success with lower re-excision rates and equivalent excised breast volume.

The Systemic Inflammation Response Index as an Independent Predictor of Survival in Breast Cancer Patients: A Retrospective Study

There is a close relationship between inflammatory cells and tumors, but the pathways that connect the two remain unclear. This research explores the clinical and prognostic value of the systemic inflammation response index (SIRI) in breast cancer patients. The study included 477 breast cancer patients who underwent neoadjuvant chemotherapy and 308 breast cancer patients who did not in our center between January 1998 and December 2016. Optimal SIRI threshold values were determined using the receiver operating characteristic curve (ROC). Patients were then reclassified as SIRI ≥0.80 group (High SIRI group) and SIRI <0.80 group (Low SIRI group). The outcomes were analyzed by statistical methods. The univariate and multivariate analyses demonstrated that SIRI independently predicted survival in breast cancer. The disease-free survival (DFS) and overall survival (OS) in patients with low SIRI scores were significantly longer in contrast to those with high SIRI scores (41.50 vs. 37.63 months, and 64.57 vs. 58.42 months). Further subgroup analyses revealed that low SIRI score patients who also had either early breast cancer, advanced breast cancer, or different molecular subtypes also possessed longer mean survival time of DFS and OS in contrast to those with high SIRI levels (χ2 = 2.379, p = 0.123, and χ2 = 5.153, p = 0.023; χ2 = 11.080, p = 0.0009 and χ2 = 15.900, p < 0.0001; χ2 = 16.020, p < 0.0001 and χ2 = 22.050, p < 0.0001, respectively). SIRI serves as an easily accessible, replicable, and minimally invasive prognostic tool in breast cancer patients. Lower SIRI scores were predictive of a longer DFS and OS after surgery in breast cancer patients. SIRI may serve as a marker to guide clinical management and prognostication of breast cancer.

Impact of adding opioids to paravertebral blocks in breast cancer surgery patients: A systematic review and meta-analysis.

BACKGROUNDSeveral breast cancer studies have reported the use of adjuvant opioids with the paravertebral block (PVB) to improve outcomes. However, there is no level-1 evidence justifying its use. AIMTo elucidate if the addition of opioids to PVB improves pain control in breast cancer surgery patients.METHODSWe conducted an electronic literature search across PubMed, Embase, Scopus, and Google Scholar databases up to October 20, 2020. Only randomized controlled trials (RCTs) comparing the addition of opioids to PVB with placebo for breast cancer surgery patients were included.RESULTSSix RCTs were included. Our meta-analysis indicated significantly reduced 24-h total analgesic consumption with the addition of opioids to PVB as compared to placebo [standardized mean difference (SMD) -1.57, 95% confidence interval (CI): -2.93, -0.21, I2 = 94%]. However, on subgroup analysis, the results were non-significant for studies using single PVB (SMD: -1.76, 95%CI: -3.65, 0.13 I2 = 95.09%) and studies using PVB infusion (SMD: -1.30, 95%CI: -4.26, 1.65, I2 = 95.49%). Analysis of single PVB studies indicated no significant difference in the time to first analgesic request between opioid and placebo groups (mean difference -11.28, 95%CI: -42.00, 19.43, I2 = 99.39%). Pain scores at 24 h were marginally lower in the opioid group (mean difference -1.10, 95%CI: -2.20, 0.00, I2 = 0%). There was no difference in the incidence of postoperative nausea and vomiting between the two groups.CONCLUSIONCurrent evidence suggests a limited role of adjuvant opioids with PVB for breast cancer surgery patients. Further homogenous RCTs with a large sample size are needed to clarify the beneficial role of opioids with PVB.

Abstract P3-18-09: Refusal of breast surgery in breast cancer patients with clinical complete response (cCR) after neoadjuvant systemic therapy and vacuum-assisted biopsy (VAB) and sentinel lymph node biopsy (SLNB) confirmed pathological complete response (pCR). A first report of the prospective non-randomized trial results. NCT04293796

Abstract Introduction The aim of the study was to prove efficacy and safety of refusal of traditional breast surgery in BC patients who develop cCR after neoadjuvant chemotherapy. Refusal of surgery was offered to exceptional responders after vacuum-assisted tumor bed biopsy and sentinel lymph node biopsy confirmed absence of residual disease (pCR). Materials and methods A single-center prospective study was run in the NMRC n.a. N.N. Petrov. Starting from August of 2020 20 patients with early сT1-2N0-1M0 (stage Ia-IIb) triple-negative and HER2-positive (both ER+ and ER-) unifocal tumours without in situ component in core-biopsy specimen enrolled in the study. Primary lesions were marked with a single clip in the centre. In cases with nodal involvement (cN1) the affected lymph nodes were also clipped. Patients with triple-negative breast cancer received 4 cycles of AC q21d followed by 12 cycles of weekly paclitaxel and carboplatinum AUC 2.0. HER2-positive patients received 4 cycles of AC followed by 4 cycles of docetaxel combined with trastuzumab and pertuzumab q21d. Breast US, mammography and SPECT were used at baseline and at response evaluation. Vacuum-assisted biopsy was performed with 7G needle and US-guidance in the OR simultaneously with the SLNB under general anesthesia. VAB protocol included retrieval of the tumor clip as first stage. Subsequently surrounding tissues were sampled, and markers were placed to guide radiotherapy. In case residual tumor was found patients received standard breast-conserving surgery. In case the sentinel lymph nodes were found to be positive, standard level II axillary clearance was performed. HER2-positive patients with pCR confirmed by VAB and SLNB received adjuvant trastuzumab up to one year. HER2-positive patients with residual breast or nodal involvement received trastuzumab-emtanzine up to one year. In case ER-positive, all patients received appropriate endocrine-therapy. In case of residual in-breast or nodal involvement patients with triple-negative breast cancer received 6 cycles of capecitabine. Results cCR was achieved in 8 of 10 patients in the HER2-positive group. VAB and SLNB were performed in 7 cases and confirmed pCR in 5 patients. 2 had residual in-breast disease with &amp;lt;10% cellularity. One patient with cCR requested standard surgical approach that confirmed pCR. 2 patients failed to obtain cCR. Both received standard surgery. In one of the cases no residual disease was found, in another one - a residual in-breast tumor was found at section. All HER2-positive patients were found to be sn ypN0. In the triple-negative group cCR was achieved in 6 of 10 patients. 4 patients went on to receive VAB and SLNB. After VAB and SLNB pCR was confirmed in three of them. 1 patient had residual tumor with less than 5% cellularity. Two patients with cCR after NAT opted for standard surgery. In both cases pCR was confirmed. 4 patients with clinically detectable residual in-breast tumor received standard surgery. All turned out to have pCR. All the patients in the TNBC group were also found to be sn ypN0.ConclusionVisualization modalities fail to provide reliable information on the true rate of pCR. Contemporary systemic therapy regimens provide the rate of pCR up to 60-70%. In all cases of NAT tumor bed marking at baseline is an essential procedure to guide future interventions and confirm their success. Discrepancies between radiologic assessment and true rates of pCR are a substrate for further search for the techniques that would challenge the role of surgery in exceptional responders developing cCR. The trial continues to enrol patients. Citation Format: Petr Krivorotko, Sergey Yerechshenko, Alexander Emelyanov, Ekaterina Busko, Alexander Bessonov, Viktoriya Gukova, Alexander Komyahov, Elena Zhiltsova, Kirill Nikolaev, Tengiz Tabagua, Larisa Gigolaeva, Roman Pesotsky, Sergey Novikov, Zhanna Bryantseva, Anna Artemyeva, Viktoriya Smirnova, Vladimir Kushnarev, Alexey Belyaev, Tatiana Semiglazova, Vladimir Semiglazov. Refusal of breast surgery in breast cancer patients with clinical complete response (cCR) after neoadjuvant systemic therapy and vacuum-assisted biopsy (VAB) and sentinel lymph node biopsy (SLNB) confirmed pathological complete response (pCR). A first report of the prospective non-randomized trial results. NCT04293796 [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P3-18-09.

Abstract P3-21-01: A higher locoregional recurrence rate of nipple areolar complex sparing mastectomy with immediate implant reconstruction

Abstract Background The rate of Nipple Areolar Complex (NAC) sparing mastectomy with implant reconstruction is rapidly increasing as the Korean National Health Insurance reimbursed reconstructive surgery for breast cancer patients from 2015. However, only a few reports about oncologic safety have been reported in the absence of large-scale data. We have analyzed the oncologic outcomes of all consecutive breast cancer patients who had NAC sparing mastectomy with immediate implant reconstruction. Methods We used the data from prospectively collected clinical data of patients who underwent immediate implant reconstruction after NAC sparing mastectomy at the National Cancer Center between January 2012 and December 2017. Demographics, clinicopathological characteristics and the follow-up results were analyzed. The statistical analysis was done to infer relations between risk factors and oncologic outcomes such as death, distant metastasis or locoregional recurrence. Results: A total of 538 breasts was analyzed in 486 patients. The mean age of the patients was 44.6 years. The mean BMI was 22.48 kg/m2. The number of bilateral cases was 52 (10.7%) and 135 patients (27.8%) had multiple tumors. Median follow-up was 4.5 years. Molecular subtypes were 373 HR(+)/HER2(-) (69.3%), 31 HR(+)/HER2(+) (5.8%), 76 HR(-)/HER2(+) (14.1%) and 35 HR(-)/HER2(-) (6.5%). Chemotherapy was performed in a total of 212 (43.6%) patients, of which 68 (32.1%) were neoadjuvant and 144 (67.9%) were adjuvant purposes. Trastuzumab was administered to 53 (10.9%) of patients whose tumor size are larger than 1cm under guideline of reimbursement. Postoperative radiotherapy was performed in 131 patients (26.9%). Distant metastasis occurred in 20 patients (3.7%), and seven (1.4%) died. Locoregional recurrence occurred in 43 cases (8.0%) of 538 breasts, including 14 nipples (2.6%) and 12 subareolar lesions (2.2%). Analyzing risk factors related to locoregional recurrence, HR(-)/HER2(+) type showed the highest incidence of 11/76 (14.7%) among four subtypes. The incidence was statistically significantly lower in the group that received postmastectomy radiotherapy than in the group that did not. (6/131 (4.6%) vs 37/355 (10.4%), p=0.001). The node negative group who did not have postmastectomy radiotherapy (31/377 (8.2%)) showed a numerically higher incidence than the node positive group (8/121 (6.6%)). Conclusion Our results showed that NAC sparing mastectomy with immediate implant reconstruction had similar oncologic outcome in terms of overall survival or distant metastasis, however the locoregional recurrence was rather high. Even this is remediable problems we would admit that NAC sparing mastectomy is a bit different from traditional mastectomy. In case that we inevitably apply this operation to relatively young women with multifocal breast cancer, careful consideration would be needed. In addition, identifying risk factors of locoregional recurrence and tailored post-operative radiation therapy are expected to improve the disease-free survival of breast cancer. Citation Format: Ji Young You, Eun-Gyeong Lee, Soo Jin Park, Byeong Nam Kim, Seeyoun Lee, Eun Sook Lee, So-Youn Jung, Youngmi Kwon, Yun Ju Kim, Chan Wha Lee, Tae Hyun Kim. A higher locoregional recurrence rate of nipple areolar complex sparing mastectomy with immediate implant reconstruction [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P3-21-01.

Oncoplastic Surgery and the Clinical Features of Breast Cancer-Relevant Factors Associated with Reoperation in Breast Oncoplastic Surgery.

Oncoplastic breast surgery slowly becomes a part of routine breast cancer surgical management but evidence with regard to oncological safety remains limited. The aim of this study was to compare relevant factors associated with the particular type of breast carcinoma and the applied surgical techniques either with or without oncoplastic surgery. This retrospective study enrolled the breast cancer female patients who underwent breast-conserving therapy alone or with the oncoplastic surgery in the Department of Surgical Oncology at the Center of Oncology of the Lublin Region St. Jana from Dukli in the years 2008–2011. The study involves 679 breast cancer patients who underwent oncoplasty (n = 81) and the control group (n = 598). There is a significant relationship between the histological type of breast cancer (p = 0.00000) along with the expression of estrogen and/or progesterone receptors (p = 0.01285) and the usage of oncoplastic surgery in breast cancer patients. Interestingly, in the majority of cases, there was no need to conduct a reoperation. Oncoplastic surgery is an effective and safe strategy that might be favorable especially for those patients who are potential candidates for more invasive surgical methods. High-quality evidence to support the oncological safety and benefits of oncoplastic breast surgery is lacking.

Results of Sentinel lymph node biopsy post Neoadjuvant chemotherapy in clinically node-negative breast cancer patients: A retrospective, observational study

Background: Axillary surgery for breast cancer serves as a staging procedure. Improved systemic therapies have helped in the de-escalation of breast and axillary surgery for breast cancer patients in the last two decades.

Questions of axillary region surgery in breast cancer patients after systemic neoadjuvant therapy

As a consequence of the advances in systemic neoadjuvant therapy of breast cancer is the de-escalation of surgical treatment. The study of a limited number of axillary lymph nodes after neoadjuvant therapy and refusal of lymphadenectomy in the absence of metastatic lesions is becoming more common. The published studies have proven the informativeness and safety of standard techniques of sentinel lymph node biopsy after neoadjuvant treatment for cN0 patients. For group cN1 and regression of metastases after neoadjuvant treatment, standard sentinel lymph node biopsy techniques have failed. The use of combined methods of double detection and an increase in the number of examined lymph nodes to 3 and more increased the detection rate of sentinel node biopsy after neoadjuvant therapy and reduced false-negative rate. Long-term results, questions of methodology lymph nodes evaluation, radiation therapy in this group of patients require further investigation.

Long‐term analysis of irradiated skin after breast‐conserving surgery in breast cancer patients using noninvasive imaging

AbstractAimsIn patients with breast cancer, skin assessment is useful for the treatment and prevention of postoperative adverse effects of radiotherapy. This study was designed to clarify the long‐term changes in the irradiated skin of patients after breast‐conserving surgery using visual inspection and noninvasive imaging.MethodsWe compared changes in the irradiated skin over time between evaluations, based on visual inspection and noninvasive imaging in 31 patients receiving postmastectomy radiation therapy. The condition of the skin was evaluated by visual inspection of the thermogram, and analysis of skin surface temperature, intensity of erythema, intensity of melanin, and hydration level.ResultsSkin surface temperature remained higher at the irradiation site after 11 months, despite the absence of erythema per visual inspection. The intensity of erythema was higher at the irradiated site until 17–19 months after completion of irradiation. Similarly, the intensity of melanin tended to be higher at the irradiated site compared with the nonirradiated site until 17–19 months. The hydration level at the irradiated site was lower at 6 months but recovered to match the nonirradiated site at 11–13 months. Impaired skin conditions assessed by noninvasive objective procedures persist longer than the assessment made by visual inspection.ConclusionsAdverse effects should be treated or prevented in the long term in patients receiving postmastectomy radiation therapy.

Factors Affecting Time to Surgery in Breast Cancer Patients.

We sought to determine factors affecting time to surgery (TTS) to identify potential modifiable factors to improve timeliness of care. Patients with clinical stage 0-3 breast cancer undergoing partial mastectomy in 2 clinical trials, conducted in ten centers across the US, were analyzed. No preoperative workup was mandated by the study; those receiving neoadjuvant therapy were excluded. The median TTS among the 583 patients in this cohort was 34days (range: 1-289). Patient age, race, tumor palpability, and genomic subtype did not influence timeliness of care defined as TTS ≤30days. Hispanic patients less likely to have a TTS ≤30days (P = .001). There was significant variation in TTS by surgeon (P < .001); those practicing in an academic center more likely to have TTS ≤30 days than those in a community setting (55.1% vs 19.3%, P < .001). Patients who had a preoperative ultrasound had a similar TTS to those who did not (TTS ≤30days 41.9% vs 51.9%, respectively, P = .109), but those who had a preoperative MRI had a significantly increased TTS (TTS ≤30days 25.0% vs 50.9%, P < .001). On multivariate analysis, patient ethnicity was no longer significantly associated with TTS ≤30 (P = .150). Rather, use of MRI (OR: .438; 95% CI: .287-.668, P < .001) and community practice type (OR: .324; 95% CI: .194-.541, P < .001) remained independent predictors of lower likelihood of TTS ≤30days. Preoperative MRI significantly increases time to surgery; surgeons should consider this in deciding on its use.

Survival With Surgery Is Superior to Survival Without Surgery in Breast Cancer Patients Aged 85 years or Older: A Retrospective Study.

Surgical treatment of breast cancer patients aged 85years or older is still controversial. A series of surgically treated breast cancer patients aged 85years or older was evaluated. The clinicopathological features and outcomes of these patients were compared with the features and outcomes of breast cancer patients in the same age group who were managed without surgery. A total of 45 patients (75%) received surgical treatment, and 15 patients (25%) were managed without surgery. Significantly more patients treated by surgery underwent systemic treatment than patients managed without surgery (P = .003). The 5-year disease-free survival rate of patients treated by surgery was 80.7% (95% confidence interval: 66.2-98.5%), which was significantly higher than that of the patients managed without surgery (P = .001). The surgical treatment of breast cancer patients aged 85years or older is warranted. This outcome was achieved with the use of hormonal therapy.

Postoperative analgesic effect of parecoxib sodium local anesthesia in patients with breast cancer through systematic review and meta-analysis.

Postoperative pain can seriously affect a patient's recovery, and parecoxib sodium has a good analgesic effect. However, there is a lack of clinically systematic analyses of the effects of parecoxib sodium on postoperative pain in breast cancer patients. The aim of the present study was to systematically evaluate the efficacy and safety of parecoxib sodium local anesthesia in the treatment of postoperative pain in breast cancer patients. Literature published from January 2010 to December 2020 was searched in the China National Knowledge Infrastructure database, Wanfang database, PubMed, and Cochrane Library. Literature on randomized controlled trials of parecoxib sodium local anesthesia in patients with breast cancer was collected. Method of treatment was extracted and literature quality was assessed. Meta-analyses of included literature were performed using RevMan 5.3. A total of 17 randomized controlled trials were included, with a total of 1,032 breast cancer surgery patients. The experimental group was treated with parecoxib sodium anesthesia, and the control group was treated with other anesthesia methods. The meta-analysis results showed that there were obvious differences among visual analogue scale (VAS) score of the experimental group and control group 2 h after surgery [mean difference (MD): -0.79; 95% confidence interval (CI): -1.29 to -0.29; P=0.002], 4 h (MD =-0.77; 95% CI: =-1.51 to -0.03; P=0.04), 6 h (MD: -1.10; 95% CI: -1.41 to -0.80; P<0.00001), 8 h (MD: -0.66; 95% CI: -1.00 to -0.33; P=0.0001), 12 h (MD: -0.92; 95% CI: -1.24 to -0.60; P<0.00001), 24 h (MD: -0.86; 95% CI: -1.15 to -0.58; P<0.00001), and 48 h (MD: -0.90; 95% CI: -1.47 to -0.33; P=0.002). Moreover, visual analog scale score and the postoperative controlled analgesia frequency of patients in the experimental group (MD: -2.08; 95% CI: -2.88 to -1.27; P<0.00001) and the incidence of adverse reactions (odds ratio: 0.52; 95% CI: 0.34-0.80; P=0.002) were significantly reduced. Parecoxib sodium local anesthesia for breast cancer patients has good postoperative analgesia and treatment safety.