Patients Undergoing Radical Mastectomy Research Articles

386. SAFETY AND FEASIBILITY OF PERSONALIZED NEOANTIGEN DC VACCINES IN POSTOPERATIVE ESOPHAGUS SQUAMOUS CELL CARCINOMA: A PHASE 1B TRIAL

Abstract Background Immunotherapy, as a neoadjuvant treatment, currently stands at the forefront of esophageal squamous carcinoma research. Yet, the landscape of post-surgery adjuvant therapy remains largely unexplored, especially for patients who experience inadequate responses or develop resistance to initial immunotherapy. Addressing this gap, we have undertaken a single-center, single-arm, prospective, and exploratory clinical study. This study aims to evaluate the efficacy of a personalized neoantigen-loaded dendritic cell vaccine (Neo-DCVac) as a novel adjuvant treatment in ESCC patients who have previously undergone neoadjuvant immunochemotherapy (nICT). Methods Neo-DCVac was designed and administered to 12 ESCC patients undergoing radical mastectomy post-nICT. Tailored adjuvant therapy was based on tumor immune microenvironment (TIME) analysis, following Lam's Stratified Treatment Strategy. The immunization schedule included five doses at weeks 1, 2, 4, 6, and 8, with bi-monthly boosts during the consolidation phase, sustained over a year. Primary endpoints were safety and post-vaccination immune response. Secondary endpoints included 1- and 2-year overall survival (OS) and progression-free survival. T-cell response to neoantigen peptides was assessed using enzyme-linked immunospot (ELISPOT), flow cytometry, and enzyme-linked immunosorbent asssay (ELISA), alongside single-cell sequencing to explore the vaccine's efficacy mechanism. Results From April 2021 to October 2023, a total of 12 ESCC patients were enrolled. The occurrence of all-grade AEs was 38.5% (5/12), all of grade 1-2, with no dose-limiting toxicities. No treatment interruptions or treatment-related deaths were observed. Till October 27 2023, the median follow-up was 31.2 months. Survival analysis revealed 1-year and 2-year disease-free survival (DFS) and overall survival (OS) rates of 88.3%, 66.7%, and 100.0%, 91.7%, respectively. Patients with diver genes had a longer median DFS (not reached) compared with patients without diver genes (10.8 months, P = 0.001). Post-vaccine immunization, all patients showed a marked increase in peripheral blood T cell subtypes (CD3, CD4, CD8), with significant neoantigen peptide response in 75% (9/12) as evidenced by ELISPOT and ELISA tests. Single-cell sequencing coupled with CoNGA analysis revealed a distinct MAIT cell population, displaying 65 clonotypes and 146 cells with consistent GEX profiles and TCR sequences. GLIPH2 analysis on Neo-Vac immunotherapy patients identified shared peptide-MHC specificities, notably in patient ES0-01, and similar patterns in patients ES0-04 and ES0-07, suggesting T cell expansion and neoantigen-specific responses post-vaccination. Conclusions The neoantigen DC vaccine demonstrated favorable safety and exhibited notable efficacy in ESCC.

Efficacy of Ultrasound-Guided Intercostal Nerve Block on Pain Management and Physiological Outcomes in Breast Cancer Mastectomy: A retrospective study.

To evaluate the efficacy of ultrasound-guided intercostal nerve block in managing pain and physiological responses in patients undergoing radical mastectomy for breast cancer. A retrospective study analyzed 120 patients scheduled to undergo radical mastectomy in our hospital between January 2022 and December 2023. Depending on the type of anesthesia received, participants were assigned to the experimental group (60 patients) to receive ultrasound-guided intercostal nerve block and intravenous general anesthesia, or the control group (60 patients) to receive intravenous general anesthesia only. Both groups will utilize patient-controlled intravenous analgesia (PCIA) postoperatively. We will monitor and compare hemodynamic parameters, SpO2, and bispectral index (BIS) at multiple time points, and assess postoperative pain, inflammatory markers, PCIA utilization, and adverse reaction incidence. Comparative analysis showed distinct trends in heart rate, mean arterial pressure (MAP), BIS, and SpO2 across various surgical stages between groups. Notably, MAP values were consistently higher and less variable in the experimental group during surgery (P < .05). Pain assessments at 4, 12, and 24 hours postoperatively in both quiet and coughing states revealed significantly milder pain in the experimental group (P < .05). Preoperative inflammatory markers (PGE2, TNF-α, IL-6, MCP-1) were similar between groups; however, 24 hours post-surgery, the experimental group showed significantly lower levels of PGE2, IL-6, and MCP-1 (P < .05). Sufentanil consumption during surgery and PCIA use were notably lower in the experimental group (P < .05). The experimental group also experienced fewer anesthesia-related adverse reactions (8.33%) compared to the control group (25.00%) (P < .05). Ultrasound-guided intercostal nerve block significantly improves hemodynamic stability, reduces postoperative inflammatory markers, lowers the need for sufentanil, and minimizes adverse reactions in patients undergoing radical mastectomy for breast cancer.

Tomotherapy in synchronous and metachronous bilateral breast cancer: Clinical experience.

The objective of this research is to present our firsthand experience and provide up-to-date data for the further study of cases involving simultaneous breast irradiation using helical Tomotherapy, ©Accuray Inc. The radical treatment options for bilateral breast cancer are surgery, chemotherapy, and radiation therapy. Being that radiotherapy for bilateral breast cancer is challenging due to limitations in the geometry of modern radiotherapy equipment, helical Tomotherapy was chosen as an appropriate technique of irradiation. The retrospective review focused on the records of patients who underwent bilateral irradiation of the breast or chest wall and regional lymph nodes using helical Tomotherapy. Only four patients with bilateral breast cancer completed a radiation therapy course in our center from 2018 to 2023. Two patients underwent radical mastectomy with lymph node dissection on both sides before irradiation. For the other two patients, radical mastectomy was done after neoadjuvant chemotherapy. Acute radiation toxicity scoring was based on Common Terminology Criteria for Adverse Events (CTCAE) version 5.0. Only mild adverse effects, such as general weakness and slight skin irritation below Grade 3, were observed, with no instances of skin swelling, dryness, or pigmentation noted. Evaluation of late complications revealed tissue fibrosis in the area of the internal mammary nodes and respiratory failure with various severity. Complications and deterioration in the cardiovascular system were not observed during the follow-up period, which varied from 3 to 48months. Our results show the efficacy of using helical Tomotherapy considering positive outcomes, being that three out of four patients are in remission with low acute toxicity and late complications. There are a small number of articles describing bilateral breast cancer treatment with helical Tomotherapy. On this occasion, our data could contribute to the studies of tolerant doses for organs at risk and improve the parameters of treatment plans for bilateral breast cancer. Since the small sample of patients with bilateral breast cancer limits the study, a larger cohort of patients is essential to obtain statistically reliable results.

Clinical comparative study of remimazolam tosilate and propofol on anesthesia effect in patients undergoing radical mastectomy

Clinical comparative study of remimazolam tosilate and propofol on anesthesia effect in patients undergoing radical mastectomy

Extremely Rare Type of Breast Cancer-Dedifferentiated Breast Liposarcoma-Diagnosis and Treatment.

Primary liposarcoma of the breast is an uncommon soft tissue malignant tumor, comprising only 0.003% of all malignant breast tumors. The main differential diagnosis of this mass consists of malignant phyllodes tumor and metaplastic breast carcinoma. The objective of this paper is to report a case of dedifferentiated breast liposarcoma, therapeutic approach and outcome. We present a case of a 79-year-old woman complaining of a large mass in her left breast which had increased in size over the last 6 months. Physical examination revealed an enlarged left breast, and a total body CT scan showed a large tumor in contact with the musculature of the anterior thoracic wall, with no metastatic lesions. The histopathology report of a fine needle biopsy described a high-grade sarcoma. The Oncological Tumor Board recommended neoadjuvant radiotherapy sessions and reevaluation by MRI and CT scans. The patient underwent radical mastectomy with latissimus dorsi myo-cutaneous flap reconstruction. The final histopathology diagnosis was a grade 3 dedifferentiated liposarcoma (FNCLCC), with certain response to radiotherapy and positive MDM2, CDK4 markers. The postoperative period was uneventful; 12 months after surgery, the follow-up CT scan showed multiple pulmonary lesions with metastatic characteristics. Liposarcoma is a very rare type of breast cancer, and the most important treatment for breast sarcoma is surgery, the role of axillary lymph node removal, chemotherapy and radiotherapy still being controversial. Considering such cases are scarce and the development of surgical guidelines is difficult, reporting any new case is crucial.

Effects of intraoperative Magnesium sulfate infusion on emergency agitation during general anesthesia in patients undergoing radical mastectomy: a randomized controlled study

BackgroundEmergency agitation is a common postoperative complication in patients under general anesthesia, which can lead to unpredictable damages such as shedding of drainage tube and bleeding from the wound. The purpose of the study is to investigate whether intraoperative infusion of Magnesium Sulfate reduces the incidence of emergency agitation (EA) in patients undergoing radical mastectomy, and to evaluate its safety and efficacy.MethodsA total of 70 patients were randomly assigned to two groups: the Magnesium group (M group) and the control group (C group). After a routine intravenous anesthetic induction, patients in the M group received a 30 mg/kg bolus of intravenous magnesium during the first hour and then a continuous infusion of 10 mg/kg ×h until the end of the surgery, patients in the C group received 0.9% saline at the same volume and rate. The sedation-agitation scale (SAS) and the visual analogue scale were used to assess agitation and pain, respectively.ResultsCompared to the C group, the M group reduced the incidence of EA significantly (odds ratio 0.26, 95% confidence interval 0.09–0.71, P = 0.009). The postoperative pain score of the magnesium sulfate group(0(0,1)) was lower than that of the control group(2(0,3)) at T0 (P = 0.011). Additionally, the M group required a lower dosage of remifentanil during surgery compared to the C group(300.4 ± 84 versus 559.3 ± 184 µg, respectively, P<0.001).Conclusionsthe intraoperative infusion of magnesium sulfate is a safe and effective method for reducing the incidence of emergency agitation in patients undergoing radical mastectomy.Trail registrationThe study was registered in Chictr.org with the identifier: ChiCTR2300070595 on 18/04/2023.

Data-based analysis of psychological and emotional changes in breast cancer patients at different ages before and after surgery

ABSTRACT To analyze psychological and emotional changes in breast cancer patients at different ages before and after surgery based on data. The clinical data of 363 patients undergoing radical mastectomy for breast cancer in our hospital from December 2019 to December 2021 were selected for retrospective analysis. The patients’ psychological and emotional changes before and after surgery were evaluated with the mental health symptom self-rating scale, and patients’ quality of life was assessed by World Health Organization Quality of Life (WHOQOL)-BREF. On a whole, no significant differences in the patients’ scores on somatization, interpersonal sensitivity, dreadness and others before and after surgery were observed (P > 0.05), while their scores on obsessive-compulsive symptom, depression, anxiety, hostility, paranoid ideation and psychopathy as well as the total scores were significantly different (P < 0.05); before and after surgery, patients’ psychological scores were not significantly different among the five groups (P > 0.05), but various WHOQOL-BREF scores were significantly different (P < 0.05). Surgical treatment has little impact on the psychological mood of breast cancer patients, obvious difference in quality of life is presented among patients at different ages before and after surgery, and therefore targeted clinical intervention should be given.

Ultrasound-guided thoracic paravertebral nerve block in patients undergoing radical mastectomy

Ultrasound-guided thoracic paravertebral nerve block in patients undergoing radical mastectomy

Research on body image cognition, social support and illness perception in breast cancer patients with different surgical methods.

In parallel with the rapid rise in breast cancer incidence, there is also a noticeable rise in the number of patients who experience persistent negative body image cognition after breast cancer surgery. This study aimed to explore the differences in illness perception, social support, and body image cognition among breast cancer patients with different surgical methods, and the correlation, regression, and mediation among the three variables. The Brief Illness Perception Questionnaire (BIPQ), the Social Support Rating Scale (SSRS) and the Body Image Cognition after Breast Cancer Questionnaire (BIBCQ) were used to evaluate breast cancer patients’ illness perception, social support and body image cognition. Data analyses were performed by descriptive statistics, independent samples t-test, analysis of variance (ANOVA), Pearson correlation, and linear regression. The mediation was explored by the PROCESS V3.3. The study found that breast cancer patients undergoing radical mastectomy (RM) and modified radical mastectomy (MRM) demonstrated more negative illness perception, body image cognition, and lower social support compared with the patients receiving nipple-sparing mastectomy (NSM; p < 0.05). The subscale cognitive representation (CR) of BIPQ was strongly positively correlated with BIBCQ (p < 0.05). Illness perception positively predicted body image cognition (p < 0.01), while social support negatively predicted body image cognition. Social support partially mediated illness perception and body image cognition, exhibiting a positive role in post-operative body image cognition.

Clinical Value of Total Intravenous Anesthesia with Sufentanil and Propofol in Radical Mastectomy.

Objective To investigate the clinical value of sufentanil combined with propofol for total intravenous anesthesia (TIVA) in radical mastectomy. Methods The data of 120 patients undergoing radical mastectomy of breast cancer in our hospital from February 2020 to February 2021 were retrospectively analyzed, and they were randomly assigned to the experimental group (EXG) (n = 60) and the control group (COG) (n = 60). The anesthesia maintenance scheme was 0.01–0.03 μg/(kg·min) of sufentanil + 80–100 μg/(kg·min) of propofol in EXG and 3 μg/(kg·h) of fentanyl + 80–100 μg/(kg·min) of propofol in COG. The hemodynamic indices, stress indexes, postoperative pain scores, and incidence of adverse reactions were compared between EXG and COG. Results The heart rates (HR) and mean arterial pressure (MAP) after tracheal intubation (T2) and at separation of deep tissues (T3), tracheal extubation (T4), and the end of surgery (T5) were markedly lower in EXG than in COG (P < 0.001). The stress indexes and postoperative pain scores at 1 h (T6), 6 h (T7), and 12 h (T8) after surgery were lower in EXG than in COG (P < 0.001). The incidence of dizziness, headache, pruritus, and emergence agitation in EXG was lower compared with that in COG (P < 0.05). Conclusion Sufentanil combined with propofol for TIVA can stabilize intraoperative hemodynamic indices of patients undergoing radical mastectomy, alleviate perioperative stress response, and reduce pain perception. Therefore, this anesthesia method is safe and merits clinical promotion.

Prevention of lymphocele or seroma after mastectomy and axillary lymphadenectomy for breast cancer: systematic review and meta-analysis

Seroma or lymphocele remains the most common complication after mastectomy and lymphadenectomy for breast cancer. Many different techniques are available to prevent this complication: wound drainage, reduction of the dead space by flap fixation, use of various types of energy, external compression dressings, shoulder immobilization or physical activity, as well as numerous drugs and glues. We searched MEDLINE, clinicaltrials.gov, Cochrane Library, and Web of Science databases for publications addressing the issue of prevention of lymphocele or seroma after mastectomy and axillary lymphadenectomy. Quality was assessed using Hawker’s quality assessment tool. Incidence of seroma or lymphocele were collected. Fifteen randomized controlled trials including a total of 1766 patients undergoing radical mastectomy and axillary lymphadenectomy for breast cancer were retrieved. The incidence of lymphocele or seroma in the study population was 24.2% (411/1698): 25.2% (232/920) in the test groups and 23.0% (179/778) in the control groups. Neither modification of surgical technique (RR 0.86; 95% CI [0.72, 1.03]) nor application of a medical treatment (RR 0.96; 95% CI [0.72, 1.29]) was effective in preventing lymphocele. On the contrary, decreasing the drainage time increased the risk of lymphocele (RR 1.88; 95% CI [1.43, 2.48). There was no publication bias but the studies were of medium to low quality. To conclude, despite the heterogeneity of study designs, drainage appears to be the most effective technique, although the overall quality of the data is low.

Correlation between perioperative parecoxib use and postoperative acute kidney injury in patients undergoing radical mastectomy: a retrospective cohort analysis

BackgroundNon-steroidal anti-inflammatory drugs (NSAIDs) are among the most widely prescribed drugs worldwide. However, the effect of NSAIDS on postoperative renal function is still unclear. Few studies have assessed the effects of parecoxib on renal function. Our aim is to investigate a correlation between parecoxib and the presence or absence of AKI postoperatively after a breast cancer surgery operation.MethodsThis was a retrospective cohort study that we performed on our hospitalized database. From January 2012 to August 2021, 3542 female patients undergoing radical mastectomy were enrolled, all data including the patients' information and laboratory results were obtained from electronic medical system. The main outcome was the incidence of AKI postoperatively. AKI was defined in accordance with the KDIGO criteria. Study groups were treated with or without parecoxib. Univariable and multivariable logistic regression analyses were performed.ResultsIn our study, about 5.76% experienced AKI. The incidence rate of postoperative AKI (3.49%) within 7 days in the parecoxib group was lower than that in the control group (6.00%, P = 0.05). Compared to the control group, the AKI’s incidence was reduced by 49% (OR = 0.46; 95%CI 0.27–0.97) in parecoxib group in multivariable logistic regression analysis. There was a reduction in the incidence of postoperative AKI in other three subgroups: preoperative eGFR < 90 mL/min·1.73/m2 (OR = 0.52; 95%CI 0.27–0.97), blood loss < 1000 ml (OR = 0.48; 95%CI 0.24–0.96) and non-diabetes (OR = 0.51; 95%CI 0.26–0.98).ConclusionsParecoxib was associated with incidence of postoperative acute kidney injury.

Clinical case of torpid course of metastatic triple negative breast cancer

Background. Breast cancer is the most common cancer and the leading cause of cancer death in women worldwide. The presence of an unfavorable molecular biological subtype significantly worsens the prognosis, making it necessary to individualize treatment strategy for each patient.The aim of the study was to demonstrate the achievement of long-term remission in the treatment of metastatic triple-negative breast cancer. Case description. A 42-year-old patient presented to Ryazan Oncologic Dispensary in October 2006 with complaints of lump in her left breast. She was diagnosed with stage cT2N0M0 triple-negative carcinoma of the left breast. She underwent radical mastectomy for left breast cancer (October, 2006). Disease progression (metastases to lungs and mediastinal lymph nodes) occurred in June 2009. The patient received 6 courses of polychemotherapy according to the FAC regimen with a favorable response. In February 2011, the patient was found to have metastatic lesion in the brain, which was surgically removed in March, 2011. She received metronome chemotherapy. Recurrence of brain metastasis occurred 6 months after chemotherapy. The patient received external beam radiation therapy, which resulted in tumor regression, and metronomic chemotherapy was continued with a positive effect. The patient was followed up for 6 years with no evidence of disease progression. In July 2019, the follow-up examination revealed stage cT2N0M0 triple-negative cancer in the right breast. The patient underwent radical mastectomy for the right breast and 8 courses of adjuvant polychemotherapy (4 courses of AC + 4 courses of paclitaxel). The patient is alive with no signs of disease progression.Conclusion. This clinical case demonstrated personalized approach to the treatment of patients with triple-negative breast cancer. Fifteen years had passed since the detection of the primary tumor. During this time, the disease progressed three times, and breast cancer was diagnosed on the opposite side. Combined modality treatment including chemotherapy, surgery and radiotherapy allowed satisfactory results to be achieved. The patient is still alive with no signs of disease progression.

Efficacy of serratus anterior plane block versus thoracic paravertebral block for postoperative analgesia after breast cancer surgery - a randomized trial

BackgroundBreast cancer surgery is associated with considerable acute post-surgical pain and restricted mobility. Various regional and neuraxial anesthesia techniques have been used to alleviate post-mastectomy pain. Ultrasound-guided serratus anterior plane block (SAPB) has been considered a simple and safe technique. This randomized control study was performed to compare the efficacy of SAPB with the thoracic paravertebral block (TPVB) for postoperative analgesia after breast cancer surgery. MethodsA total of 40 adult ASA physical status I - II female patients undergoing radical mastectomy were randomly allocated into two groups to receive either ultrasound-guided TPVB or SAPB with 0.4 mL.kg-1 0.5% ropivacaine, 30 min before surgery. All patients received standardized general anesthesia for surgery. Injection diclofenac and tramadol were used for postoperative rescue analgesia. The time to first rescue analgesia, total analgesic consumption in the first 24 hours, postoperative pain scores, and any adverse effects were recorded. ResultsThe time to first rescue analgesia was significantly longer in the SAPB group (255.3 ± 47.8 min) as compared with the TPVB group (146.8 ± 30.4 min) (p < 0.001). Total diclofenac consumption in 24 hours was also less in the SAPB group (138.8 ± 44.0 mg vs 210.0 ± 39.2 mg in SAPB and TPVB group respectively, p < 0.001). Postoperative pain scores were significantly lower in the SAPB group as compared with TPVB group (p < 0.05). The incidence of PONV was also less in the SAPB group (p = 0.028). No block-related adverse effects were reported. ConclusionWe found that the serratus anterior plane block was more effective than the thoracic paravertebral block for postoperative analgesia after breast cancer surgery.

Effects of ultrasound-guided erector spinae plane block on the immune function and postoperative recovery of patients undergoing radical mastectomy.

To explore the effects of ultrasound-guided erector spinae plane (ESP) block on the immune function and postoperative recovery of patients undergoing radical mastectomy. One hundred and four patients with breast cancer were randomly divided into the observation group and control group, with 52 cases in each group. The control group underwent induction of routine general anesthesia and thoracic paravertebral block, while the observation group underwent ultrasound-guided ESP block combined with general anesthesia. The recovery of autonomous respiration, eye opening, extubation time, postoperative eating, first anal exhaust, leaving bed and hospitalization time in both groups were statistically analyzed after surgery. The immune function indexes [CD4+, CD8+, interferon-γ (IFN-γ)] and the expression levels of serum neuropeptide Y (NPY), prostaglandin E2 (PGE2) and serotonin (5-HT) were compared between the two groups at 24 and 48 h before and after surgery. The visual analog scale (VAS) scores at rest and during exercise were recorded at 6, 12, 24, and 48 h after surgery. There was no significant difference in the recovery of autonomous respiration, eye opening, and extubation time between the two groups (P>0.05). However, postoperative eating, first anal exhaust, leaving bed, and hospitalization time in the observation group were shorter than those in the control group (P<0.05). At 24 and 48 h after surgery, compared with the control group, CD4+ and IFN-γ levels were increased significantly (P<0.05), CD8+ and levels of serum NPY, PGE2, 5-HT and the incidence of postoperative complications was decreased significantly in the observation group (P<0.05). VAS scores at rest and during exercise in the observation group were lower than those in the control group (P<0.05). At 5 and 10 min after intubation, the observation group had higher epinephrine (E) level and lower serum cortisol (Cor) level than the control group (P<0.05). The analgesic effect of ultrasound-guided ESP block is significant after radical mastectomy. There are few adverse reactions and few effects on immune function, and it can promote the postoperative recovery of patients.

Pigmentary mammary Paget disease: Clinical, dermoscopical and histological challenge.

A very rare variant of mammary Paget disease (MPD) is the pigmented MPD, first described in 1956. It is very difficult to distinguish this variant from melanoma both clinically and dermoscopically. The diagnosis is confirmed by histopathology and immunohistochemistry. Correct diagnosis is crucial for surgical treatment, which is different for these two diseases. We report the case of a 92-year-old woman, who presented an asymptomatic pigmented lesion of the right nipple and areola. The lesion was arisen for about 6 months and was suspected for melanoma because of clinical and dersmoscopic characteristics. Incisional biopsy revealed tumor cells, that proliferate in the major mammary ducts, and tumor cells in the overlying epidermis of the nipple, thus diagnosing pigmented mammary Paget disease. The patient underwent radical mastectomy.

A randomised trial: effects of different anesthesia methods on early perioperative pain sensitivity and cellular immune function in patients undergoing radical mastectomy.

This study sought to investigate the effects of transversus thoracic muscle plane-pectoral nerves (TTP-PECS) block combined with propofol anesthesia on early perioperative pain sensitivity and cellular immune function in patients undergoing radical mastectomy. A total of 115 patients who underwent radical mastectomy for breast cancer at our hospital from January 2019 to January 2021 were selected as the study subjects. The patients were allocated to the control group (n=57) or observation group (n=58) using a random number method. The control group was given simple general anesthesia, and the observation group was given TTP-PECS block combined with propofol anesthesia. The recovery time, pain [visual analogue scoring (VAS)] scores, and incidences of adverse reactions were compared between the 2 groups. Hemodynamic indicators [i.e., heart rate (HR), mean arterial pressure (MAP)], stress indicators [i.e., blood glucose (GLU), epinephrine (E), cortisol (Cor)], and the cellular immune function ofthe2 groups before anesthesia (T0), at the end of operation (T1), 1day after operation (T2) and 3days after operation (T3) were recorded. The spontaneous respiration recovery time, time to full wakefulness and the extubation time of the observation group were shorter than those of the control group (P<0.05). The observation group had lower VAS scores than the control group at 2, 8, 12, and 24 h after operation (P<0.05). The levels of MAP, HR, GLU, E and Cor in the observation group at T1, T2, and T3 were lower than those in the control group (P<0.05). Compared to the control group, the observation group had increased cluster of differentiation (CD)3+, CD4+, and CD4+/CD8+ cells (P<0.05), but there were no significant differences in CD8+ and natural killer (NK) cells between the 2 groups (P>0.05). The incidence of adverse reactions in the observation group was lower than that in the control group (8.62% vs. 24.56%) (P<0.05). TTP-PECS block combined with propofol anesthesia can relieve pain, shorten the recovery time, stabilize the hemodynamic level, and alleviate the stress responses of patients undergoing radical mastectomy with a slight suppression of cellular immune function and high safety. Chinese Clinical Trial Registration Center ChiCTR2100048438.

Serratus Anterior Plane Block Combined with General Analgesia and Patient-Controlled Serratus Anterior Plane Block in Patients with Breast Cancer: A Randomized Control Trial.

Anterior serratus muscle plane block is a novel regional block technique for blockade of the sensory plane of the lateral cutaneous branch of the intercostal nerve (T2-T9), which effectively relieves the pain of patients and improves the quality of recovery. This study aimed to observe the early effectiveness and safety of serratus anterior plane block combined with general anesthesia and patient-controlled serratus anterior plane block in early postoperative recovery in breast cancer. The study involved a total of 84 patients undergoing radical mastectomy in our hospital. The patients were randomly divided into three groups: the serratus anterior block + general anesthesia + patient-controlled serratus anterior plane block group (PCSAPB group), the serratus anterior block + general anesthesia + patient-controlled intravenous analgesia group (PCIA group), and the general anesthesia + PCIA group (control group), with n = 28 cases in each group. The visual analogue scale (VAS) scores of the three groups were compared before and after the operation (P < 0.001), and the anxiety visual analogue scale (AVAS) scores after operation were compared among the three groups (P < 0.001). The total number of postoperative analgesic pumps in the PCSAPB group was significantly lower than that in the control group (P < 0.05). The incidence of adverse reactions in the three groups was statistically significant (P < 0.05). The combination of anterior serratus plane block and general anesthesia and patient-controlled anterior serratus plane block reduced pain and adverse events, alleviating anxiety, improving the quality of early postoperative recovery among patients with breast cancer after modified radical mastectomy.

Effects of transcutaneous electrical acupoint stimulation on perioperative immune function and postoperative analgesia in patients undergoing radical mastectomy: A randomized controlled trial.

Radical mastectomy may lead to suppression of cellular immune function in patients with malignant tumors. Transcutaneous electrical acupoint stimulation (TEAS) is widely used in clinical practice. However, there have been relatively few studies on the effects of TEAS on postoperative analgesia and immune function. The present study aimed to evaluate the effects of TAES on postoperative pain and immune function in patients undergoing radical mastectomy. A total of 65 patients were enrolled and allocated to either receive TEAS or sham TEAS. TEAS was implemented on bilateral Hegu (LI4), Neiguan (PC6) and Zusanli (ST36) acupoints simultaneously for 30 min before induction of anesthesia at 4 and 12 h post-operation. The primary outcomes included visual analogue scale (VAS) scores at 4 h (T1), 12 h T2), 24 h (T3) and 48 h (T4) post-operation, and serum levels of IL-2, IL-4, IFN-γ and the IL-2/IL-4 ratio at 30 min before TEAS (T0), T1, T2, T3 and T4. Secondary outcomes included the cumulative time of rescue analgesia within 48 h post-surgery, as well as the incidence of postoperative nausea and vomiting (PONV) and pruritus. Compared with the sham TEAS group, postoperative VAS scores at T2 and T3, the total consumption of opioids in the patient-controlled analgesia (PCA) pump, pressing times of the PCA pump and the incidences of PONV and headache were significantly lower in the TEAS group. The serum levels of IFN-γ at T3 and T4, and the serum levels of IL-2 and the IL-2/IL-4 ratio at T2, T3 and T4 were higher in the TEAS group compared with the sham TEAS group. By contrast, the serum levels of IL-4 were lower at T2, T3 and T4 in the TEAS group compared with the sham TEAS group. The results indicated that TEAS could improve postoperative analgesia, reduce postoperative consumption of opioids and alleviate postoperative side effects. Simultaneously, TEAS was able to reverse decreased serum levels of IL-2 and IFN-γ, reduce the level of IL-4 and restore the balance of Th1/Th2, thereby partially attenuating perioperative immune function depression in patients with breast cancer. The current trial was registered prior to participant enrollment at www.chictr.org.cn (Clinical Trial no. ChiCTR1800017768).

Quality of life in patients with multicentric breast cancer

One of the main issues in the treatment of multicentric breast cancer (BC) is to choose the type of surgery (paying attention to the tendency to reduce the volume of surgical interventions). Many studies have demonstrated an adverse effect of this form of BC on long‑term survival outcomes (increased risk of recurrence, decreased overall survival rates, etc.). However, none of the studies examined the effect of surgery extent on the quality of life of these patients.Objective. To assess the effect of the surgery type on the quality of life of patients with multicentric BC.Materials and methods. 190 patients were included in the study. The median follow‑up was 72 (7–116) months. Age ranged from 27 to 76 years. The majority of patients (150 women, 78.9 %) had luminal HER2‑negative tumors, while «aggressive» (HER2‑overexpressing, triple negative) subtypes were detected in 40 (21.1 %) of them. 134 patients underwent radical mastectomy (40 of which also had immediate breast reconstruction), 56 received breast‑conserving surgery. Statistically significant differences were not observed among stages III and I–II BC (p = 0.125). The quality of life was assessed with the use of EORTC QLQ-C30 and EORTC QLQ-BR23 scales at ≥ 12 months after performing surgical treatment.Results. The quality of life was assessed depending on the type of surgical intervention. The patients after breastconserving surgery and immediate breast reconstruction demonstrated a significant advantage, primarily in the general perception of one's own health (p &lt; 0.05) and emotional status (p &lt; 0.05). Also, there were no significant differences in quality of life between the groups of patients after breast‑ conserving surgery and immediate breast reconstruction.Conclusion. Due to the increase in the life expectancy of breast cancer patients, the issues of maintaining a high quality of life are becoming increasingly important. From this point of view, performing breast‑ conserving and reconstructive surgeries is preferable for patients with multicentric BC.