Modified Radical Mastectomy In Patients Research Articles

Early Outcome of Superomedial Pedicle as Extreme Oncoplastic Procedure versus Modified Radical Mastectomy in Patients with Stage T3 Breast Cancer Not Responding to Neoadjuvant Chemotherapy

Abstract Background Breast cancer, according to national cancer institute, is the most common site of cancer in women in Egypt as it accounts for about 38.8% of total malignancies among Egyptian females; it is an important cause of mortality among women. Aim of the Work To assess the feasibility of extreme oncoplasty (achieving negative margins) for T3 breast cancer patients not responding to neoadjuvant chemotherapy by using a superomedial pedicle flap. Patients and Methods This study was conducted on 30 female patients with stage T3 breast cancer not responding to neoadjuvant chemotherapy with no skin involvement or upper medial quadrant tumor, with large breast size (cup D), accepting both intervention modalities and fit for both anesthesia and radiotherapy. It was performed at the (General Surgery Department) at Ain Shams University Hospitals and El Haram specialized Hospital starting from March 2020. Approval of the Ethical Committee and written informed consent from all participants were obtained. Patients were divided into two groups. Group A includes 15 patients underwent Modified radical mastectomy with axillary clearance. Group B includes 15 patients underwent Superomedial pedicle mammoplasty and axillary clearance. Results Superomedial pedicle mammoplasty is equivalent to modified radical mastectomy in terms of oncological safety, with advantages over mastectomy in terms of quality of life and esthetic outcomes. Thus, Extreme oncoplasty provides an alternative to Modified radical mastectomy, extends the scope of breast conservation, provides better clinical outcomes, and improves quality of life. Conclusion This study showed that superomedial pedicle mammoplasty technique is a feasible extreme oncoplastic approach for patients with large tumors and not responsive to neoadjuvant chemotherapy considered for Modified radical mastectomy with acceptable complication rates, negligible rates of reexcision and no early recurrence in 3 months period.

Modified Radical Mastectomy in De Novo Stage IV Inflammatory Breast Cancer.

There are few studies on surgical management in patients with de novo metastatic inflammatory breast cancer (IBC). The objective of this study is to examine the association between modified radical mastectomy (MRM) and disease-specific survival (DSS) in patients with de novo stage IVIBC. The Surveillance, Epidemiology, and End Result Program was queried for patients ≥18 years old with cT4d/pT4d pathology, histology type 8530 and 8533 with distant disease between 2010 and 2016. The sample was divided into two groups: (1) the MRM group, defined as MRM or mastectomy with at least ten lymph nodes removed, and (2) the no-surgery group. Sociodemographic and clinical variables were compared between the groups on bivariable analysis. After propensity score matching, Kaplan-Meier curves and a Cox proportional-hazards model examined DSS. 1293 patients were included in the study, of whom 240 underwent MRM. A higher percentage in the MRM group had only one metastatic site (69.8% versus 52.2%), received chemotherapy (88.3% versus 66.1%) and radiation (58.8% versus 26.0%) compared with the no-MRM group. MRM was associated with an increase in DSS compared with no MRM [HR 0.63 (95% CI 0.50-0.80), p < 0.001]. Patients with MRM had a 5-year DSS rate of 31.4% compared with 17.7% for patients not undergoing surgery (p = 0.001). Survival time was 38 months (range 27-45 months) for the MRM group versus 27 months (22-29 months) for the no-MRM group. MRM in patients with de novo metastatic IBC may improve DSS in a subset of patients.

A Randomized Controlled Study of Quilting with Axillary Lymphatic Ligation Versus Conventional Modified Radical Mastectomy in Patients with Breast Cancer.

Postmastectomy seroma formation is a common and notorious problem that every treating surgeon frequently faces in the management of patients with breast cancer. Several technical modifications and innovations have been proposed to either overcome or reduce its occurrence. One such method tested in this study in a randomized way was axillary lymphatic vessel ligation and quilting. A total of 120 patients undergoing modified radical mastectomy for breast cancer were randomized to undergo either conventional modified radical mastectomy (MRM) or MRM with axillary lymphatic vessel ligation using a loupe magnification and quilting. Both the groups were identical in terms of baseline characteristics. Compared to conventional MRM, experimental group was associated with statistically significant longer operative time, more blood loss, less seroma aspirations, early drain removal, shorter hospital stay, early start of adjuvant chemotherapy, and better ipsilateral shoulder function. To conclude axillary lymphatic vessel ligation and quilting, the technique needs to be incorporated into the technique of MRM and the relative contribution of each of these strategies needs to be explored further through newer studies.

Anesthetic effect of ultrasound-guided multiple-nerve blockade in modified radical mastectomy in patients with breast cancer.

Introduction:Routine anesthesia modality for modified radical mastectomy (MRM) includes general anesthesia (GA), epidural blockade-combined GA and nerve blockade-combined GA. However, GA has been associated with postoperative adverse effects such as vertigo, postoperative nausea and vomiting and requirement for postoperative analgesia, which hinders recovery and prognosis. Moreover, combined blockade of thoracic paravertebral nerves or intercostal nerves and adjuvant basic sedation for massive lumpectomy provided perfect anesthesia and reduced opioid consumption, whereas the excision coverage did not attain the target of MRM. Regional anesthesia strategies involving supplementation of analgesics in ultrasound-guided multiple nerve blocks have garnered interests of clinicians. Nevertheless, the precise effects of intercostal nerves, brachial plexus and supraclavicular nerves in MRM in patients with breast cancer remain obscure.Methods:Eighty female patients with breast cancer scheduled for MRM were recruited in the present trial between May, 2019 and Dec., 2019 in our hospital. The patients ranged from 30 to 65 years of age and 18∼30 kg/m2 in body-mass index, with the American Society of Anesthesiologists I or II. The patients were randomized to ultrasound-guided multiple nerve blocks group and GA group. The patients in multiple nerve blocks group underwent ultrasound guided multiple intercostal nerve blocks, interscalene brachial plexus and supraclavicular nerve blocks, (local anesthesia with 0.3% ropivacaine: 5 ml for each intercostal nerve block, 8 ml for brachial plexus block, 7 mL for supraclavicular nerve block) and basic sedation and intraoperative mask oxygen inhalation. The variations of hemodynamic parameters such as mean arterial pressure, heart rate (HR) and pulse oxygen saturation were monitored. The visual analog scale scores were recorded at postoperative 0 hour, 3 hour, 6 hour, 12 hour and 24 hour in resting state. The postoperative adverse effects, including vertigo, postoperative nausea, and vomiting, pruritus, and urinary retention and so on, as well as the analgesic consumption were recorded.Conclusions:The ultrasound guided multiple intercostal nerve blocks, brachial plexus and supraclavicular nerve blocks could provide favorable anesthesia and analgesia, with noninferiority to GA and the reduced incidence of adverse effects and consumption of postoperative analgesics.