Radical Mastectomy For Breast Cancer Research Articles

Factors Influencing the Occurrence of Psychological Imbalance in Patients Undergoing Chemotherapy After Modified Radical Mastectomy for Breast Cancer

Objective: To analyze the factors affecting the occurrence of psychological imbalance in chemotherapy patients after modified radical surgery for breast cancer. Methods: Retrospectively analyzed the clinical data of 285 post-chemotherapy patients with breast cancer who received chemotherapy treatment in a hospital between November 2022 and December 2023 and applied to analyze the incidence rate of psychological imbalance and influencing factors by using logistic regression analysis. Results: Psychological imbalance occurred in 178 cases of 285 post-chemotherapy patients after modified radical mastectomy for breast cancer, accounting for 62.46%. Comparing the patients in the occurrence group and the non-occurrence group in terms of age, family history, marital status, place of residence, and per capita monthly income of the family, the differences were not statistically significant (P > 0.05), whereas in terms of high school or lower education level, low social support, and having a burden of self-feeling, the proportion of the occurrence group was higher than that of the non-occurrence group, and the differences were statistically significant (P < 0.05). Conclusion: The risk of psychological imbalance is higher in patients undergoing chemotherapy after modified radical mastectomy for breast cancer, while high school and below educational background, low social support, and having self-perceived burdens are the main risk factors (OR > 1, P < 0.05).

Clinical application of endoscopic radical mastectomy for breast cancer combined with total pectoral muscle reconstruction with breast implants

To investigate the effectiveness of endoscopic radical mastectomy for breast cancer combined with total pectoral muscle reconstruction with breast implants. The clinical data of 138 female patients with breast cancer who met the selection criteria between April 2019 and December 2023 were retrospectively analyzed. The mean age of the patients was 43.8 years (range, 27-61 years). The maximum diameter of the tumors ranged from 1.00 to 7.10 cm, with an average of 2.70 cm. Pathological examination showed that 108 cases were positive for both estrogen receptor and progesterone receptor, and 40 cases were positive for human epidermal growth factor receptor 2. All patients underwent endoscopic radical mastectomy for breast cancer combined with total pectoral muscle reconstruction with breast implants. The operation time, intraoperative blood loss, prosthesis size, and occurences of nipple-areola complex (NAC) ischemia, flap ischemia, infection, and capsular contracture were recorded. The Breast-Q2.0 score was used to evaluate breast aesthetics, patient satisfaction, and quality of life (including the social mental health score, breast satisfaction score, and chest pain score). Patients were divided into two groups based on the time of operation after the technique was implemented: group A (within 1 year, 25 cases) and group B (after 1 year, 113 cases). The above outcome indicators were compared between the two groups. Furthermore, based on the postoperative follow-up duration, patients were classified into a short-term group (follow-up time was less than 1 year) and a long-term group (follow-up time was more than 1 year). The baseline data and postoperative Breast-Q2.0 scores were compared between the two groups. The average operation time was 120.76 minutes, the average intraoperative blood loss was 23.77 mL, and the average prosthesis size was 218.37 mL. Postoperative NAC ischemia occurred in 21 cases (15.22%), flap ischemia in 30 cases (21.74%), infection in 23 cases (16.67%), capsular contracture in 33 cases (23.91%), and prosthesis removal in 2 cases (1.45%). The operation time of group A was significantly longer than that of group B ( P<0.05), and there was no significant difference in intraoperative blood loss, prosthesis size, and related complications between the two groups ( P>0.05). All patients were followed up 3-48 months (mean, 20 months). There were 33 cases in the short-term group and 105 cases in the long-term group. There was no significant difference in baseline data such as age, body mass index, number of menopause cases, number of neoadjuvant chemotherapy cases, number of axillary lymph node dissection cases, breast cup size, degree of breast ptosis, and postoperative radiotherapy constituent ratio between the two groups ( P>0.05). At last follow-up, the breast satisfaction score in the patients' Breast-Q2.0 score ranged from 33 to 100, with an average of 60.9; the social mental health score ranged from 38 to 100, with an average of 71.3; the chest pain score ranged from 20 to 80, with an average of 47.3. The social mental health score of the long-term group was significantly higher than that of the short-term group ( P<0.05); there was no significant difference in breast satisfaction scores and chest pain scores between the two groups ( P>0.05). No patient died during the follow-up, and 2 patients relapsed at 649 days and 689 days postoperatively, respectively. The recurrence-free survival rate was 98.62%. Endoscopic radical mastectomy for breast cancer combined with total pectoral muscle reconstruction with breast implants has fewer complications and less damage, and the aesthetic effect of reconstructed breast is better.

Comparing the effectiveness of full-vacuum and half-vacuum drainage in reducing seroma after modified radical mastectomy: a meta-analysis.

Owing to limited outpatient support for drain management, delayed discharge after mastectomy is more prevalent in developing countries. Utilising half-vacuum (HV) suction drains for routine drainage after mastectomy could lead to a reduced incidence of seroma and a shorter hospital stay. This systematic review and meta-analysis compared the outcomes of HV against full-vacuum (FV) suction drains in patients who underwent modified radical mastectomy for breast cancer. Differences between the two groups in length of hospital stay, total volume of drain effluent and incidence of seroma were assessed. RevMan 5.4 was used to calculate the odds ratio (OR) and relative risk (RR) for dichotomous data, and the mean difference (MD) for continuous data. Nine randomised controlled trials were included in this review. Using HV drains reduced both the mean length of hospital stay (MD: -2.30 days, 95% confidence interval [CI]: -4.10 to -0.49 days, I2=97%) and the mean total volume of effluent (MD: -132.61ml, 95% CI: -207.32ml to -57.91ml, I2=88%) compared with FV drains. However, there was no statistically significant difference in incidence of seroma between the two groups (RR: 0.67, 95% CI: 0.30 to 1.46, I2=65%). Likewise, there was no difference in rate of seroma occurrence on sensitivity analysis (OR: 1.29, 95% CI: 0.72 to 2.33, I2=74%). There was no difference in the incidence of seroma between HV and FV suction drainage. Conversely, a reduction in the length of hospital stay and the total volume of drain effluent was observed for mastectomy patients with a HV drain.

Abstract PO5-20-11: Synchronous Breast Cancer and Pheochromocytoma: A Case Series

Abstract Background: Pheochromocytomas are rare, although literature suggests a rising incidence due to the widespread use of sensitive imaging modalities. Synchronous presentation of breast cancer with a pheochromocytoma is exceedingly rare with only one case documented in the literature. We present two cases of malignancy in the breast in which pheochromocytomas were incidentally detected during workup and management with vastly different presentations. Case Presentation: Two patients presented with breast cancer and were secondarily diagnosed with pheochromocytoma. Patient 1 is a 48-year-old postmenopausal female with a history of intraductal papilloma four years prior, who presented with right breast nipple discharge. Diagnostic mammogram showed a right breast mass and biopsy confirmed an intraductal papilloma with intermediate-grade DCIS, ER+/PR-. She had no family history of cancer or PGL/PPC. During a scheduled lumpectomy, she developed hypoxia, hypotension, and flash pulmonary edema requiring intubation and ECMO with prolonged ICU stay and long recovery with tracheostomy for four months. Contrast-enhanced CT of her abdomen showed a 9 cm right adrenal mass. Serum and urine metanephrines were markedly elevated, and it was determined that she had an adrenal crisis secondary to undiagnosed pheochromocytoma. She completed treatment for DCIS with lumpectomy and radiation and is currently on adjuvant anastrozole. She additionally had an adrenalectomy for pheochromocytoma, which was found to be stage PASS 2. Subsequent genetic testing confirmed the absence of germline mutations associated with hereditary PGL/PPC or breast cancer. Patient 2 is a 57-year-old female presenting with a history of left breast mass she first noted a year ago, with newly found nipple retraction and skin changes. Biopsy showed invasive ductal carcinoma of the breast, G3, Stage IIIA, pT3N2aM0, ER 95%/PR-/Her2- (IHC 0). Staging PET scan showed a 3.4 cm hypermetabolic left adrenal mass in addition to the breast mass and left axillary adenopathy. Serum and urine metanephrines were elevated, and pheochromocytoma was diagnosed. Family history was positive only for pancreatic cancer in a maternal aunt. Comprehensive genotype testing was negative for hereditary breast cancer and PGL/PCC syndromes. She was concomitantly treated with a radical mastectomy for breast cancer and a left adrenalectomy and tolerated the procedure well as she received perioperative alpha-adrenergic blockade with doxazosin. She has received chemotherapy and radiation for breast cancer treatment and is currently on adjuvant anastrozole. The adrenal mass was confirmed to be a pheochromocytoma PASS 2-3. Discussion: We present two unique cases of breast cancer and pheochromocytomas discovered in tandem with variable clinical manifestations. It is extremely uncommon to have a presentation of primary breast malignancy concomitantly with pheochromocytoma, and we demonstrate two cases that occurred within months of one another at our facility. During the first case, metastatic workup was not indicated for DCIS. However, during the seemingly benign lumpectomy procedure, the patient experienced significant complications, leading to intense ICU management, intubation, and tracheostomy. In the second case, a metastatic workup was completed due to locally advanced breast cancer where the adrenal mass was detected and a pheochromocytoma was diagnosed prior to surgery. This allowed both cancers to be resected simultaneously and safely. This series demonstrates the importance of keeping pheochromocytomas in the differential during the workup of adrenal masses prior to surgical interventions. Additionally, they demonstrate how the usual workup and management of breast cancer does not take into account these rare but significant diagnoses, and that can result in fatal consequences. Citation Format: Nikita Dahake, Abhimanyu Tushir, Aruna Padmanabhan. Synchronous Breast Cancer and Pheochromocytoma: A Case Series [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO5-20-11.

The impact of ultrasound-guided erector spinae plane block on hemodynamic stability and postoperative pain in patients undergoing modified radical mastectomy for breast cancer.

Breast cancer, a prevalent global malignancy in women, necessitates a comprehensive treatment approach, with surgery playing a crucial role. Severe acute pain is common post-radical breast cancer surgery, emphasizing the significance of hemodynamic stability and postoperative pain control for optimal outcomes. This study evaluates the impact of ultrasound-guided erector spinae plane block (ESPB) on these parameters in ASA scores 1-2 patients undergoing modified radical breast cancer surgery with general anesthesia. Forty-eight patients were divided into two groups: a general anesthesia group, with erector spinae plane block (GA+ESPB), and a control group receiving only general anesthesia (GA). Hemodynamic parameters were continuously monitored, and postoperative pain was assessed using the visual analog scale (VAS) at various time points. Ultrasound-guided ESPB effectively maintained hemodynamic stability and reduced postoperative pain in breast cancer surgery patients. Statistically significant differences were observed in heart rate, systolic and diastolic blood pressure, and mean arterial pressure between the GA and GA+ESPB groups at multiple time points (p < 0.05). VAS scores showed a significant interaction time*group (p < 0.001), with consistent differences between the groups at all time points (p ≤ 0.001). Ultrasound-guided ESPB application proved effective in preserving hemodynamic stability and managing postoperative pain in modified radical breast cancer surgery. The technique demonstrates promise in minimizing complications related to hemodynamic variations and postoperative pain, contributing to a comprehensive approach to breast cancer surgical treatment.

Effect of ultrasound-guided continuous erector spinae plane block on postoperative pain and inflammatory response in patients undergoing modified radical mastectomy for breast cancer: study protocol for a randomised controlled trial

BackgroundA single injection of local anaesthetic (LA) in the erector spinae plane block (ESPB) can reduce pain after modified radical mastectomy (MRM) surgery, but the duration of analgesia is affected by the duration of the LA. The aim of this study is to investigate the effect of continuous ESPB on acute and chronic pain and inflammatory response after MRM surgery.MethodsIn this prospective, randomised, controlled trial, we will recruit 160 patients, aged 18–80 years, scheduled for elective MRM surgery under general anaesthesia. They will be randomly assigned to two groups: a continuous ESPB group (group E) and a sham block group (group C). Both groups of patients will have a nerve block (group C pretended to puncture) and an indwelling catheter fixed prior to surgery. Electronic pumps containing LA are shielded. The primary outcome is the total consumption of analgesic agents. The secondary outcomes include the levels of inflammation-related cytokines; the occurrence of chronic pain (post-mastectomy pain syndrome, PMPS); static and dynamic pain scores at 2, 6, 12, 24 and 48 h postoperatively; and post-operative and post-puncture adverse reactions.DiscussionAnalgesia after MRM surgery is important and chronic pain can develop when acute pain is prolonged, but the analgesic effect of a nerve block with a single injection of LA is limited by the duration of drug action. The aim of this trial is to investigate whether continuous ESPB can reduce acute pain after MRM surgery and reduce the incidence of chronic pain (PMPS), with fewer postoperative analgesic drug-related complications and less inflammatory response. Continuous ESPB and up to 12 months of follow-up are two innovations of this trial.Trial registrationChinese Clinical Trial Registry (https://www.chictr.org.cn/) ChiCTR2200061935. Registered on 11 July 2022. This trial is a prospective registry with the following registry names: Effect of ultrasound-guided continuous erector spinae plane block on postoperative pain and inflammatory response in patients undergoing modified radical mastectomy for breast cancer.

Differences in vacuum suction drainage pressure following mastectomy and its impact on the clinical outcome of breast cancer patients

Background: Vacuum suction drainage is an obligatory practice for long past following mastectomy for breast cancer. But recent studies are showing that the pressure of the vacuum suction drain is of value in determining the volume of seroma formation and thereby the drain indwelling time, duration of hospital stays and patient morbidity. Half vacuum suction may be of greater value in this regard comparing full vacuum suction drainage. Objectives were to assess and compare the clinical outcome of half versus full vacuum suction drainage following modified radical mastectomy for breast cancer. Methods: Forty patients of histologically proven breast cancer had been chosen purposively and systematically randomized in two equal groups. Group A with half vacuum suction (device was squeezed up to half of its vertical length) and group B with full vacuum suction (device was squeezed to its maximum). The outcome measured were postoperative drainage, drain indwelling time and post-surgery length of hospital stay. Results: Patients having half vacuum suction had a significantly reduced mean total drainage volume (364.25±128.52 ml versus 822.00±251.30 ml), drain indwelling time (5.50±1.32 days versus 9.05±1.90 days) and post-surgery hospital stay (7.15±2.58 days versus 10.25±2.55 days) in comparison to the full vacuum suction group. No significant difference found in regards to postoperative pain and other wound related complications. Conclusions: We concluded that half vacuum suction drain ensures a lower drain collection and were removed earlier and hence reduced the hospital stay significantly than full vacuum suction drains.

Dosimetry of intensity-modulated radiation therapy and volumetric-modulated arc therapy techniques after modified radical mastectomy for breast cancer and hypofractionated intensity-modulated radiotherapy.

The aim of this study was to compare the advantages and disadvantages of intensity-modulated radiation therapy (IMRT) and volumetric-modulated arc therapy (VMAT) in patients with left-sided breast cancer who underwent hypofractionated IMRT after a modified radical mastectomy. Twenty patients who required adjuvant radiotherapy after modified radical mastectomy were randomly selected, and a specified dose of 43.5 Gy/15 F was used to plan for IMRT or VMAT. Dose-volume histograms (DVHs) were utilized to evaluate the dose distribution of the planning target volumes (PTVs) and organs at risk (OARs). VMAT demonstrated a greater and more uniform dose distribution of PTVs and lower number of monitor units. No significant differences were found in V5 of the affected lung and heart between the two techniques (P > 0.05). The V10, V20, V30, and Dmean of the affected lung and V10, V20, V30, V40, Dmean, and Dmax of the whole heart were better in the VMAT than in the IMRT (P < 0.05). The Dmean and Dmax of the left anterior descending (LAD) branch of the coronary artery of the heart were better in the VMAT (P < 0.05), and the use of the VMAT effectively reduced the cardiopulmonary dose. A significant advantage of V30 and Dmean was also found in VMAT (P < 0.05). These findings indicate that VMAT has higher clinical significance than IMRT, because it improved the dose distribution in the target area, reduced the cardiopulmonary dose, protected the OARs (e.g. thyroid), and shortened the treatment duration.

Effect of single intravenous injection of esketamine on quality of recovery during early period after modified radical mastectomy for breast cancer: A retrospective study.

To assess the impact of a single esketamine intravenous (IV) injection on the quality of recovery during early period after modified radical mastectomy for breast cancer. This retrospective study included 80 patients who underwent modified radical mastectomy under general anesthesia in Huzhou Maternity & Child Health Care Hospital from March to October 2022. All patients were between 35 to 55 years, weighting between 45 and 70 kg and Grade-I or II according to the American Society of Anesthesiologists (ASA). Patients were grouped based on the type of pain management used. Patients (n=40) who were given 0.25 mg/kg esketamine single IV injection prior to completion of the surgery were assigned to Group-E, and patients (n=40) who were not treated with esketamine, comprised the control Group-C. Patients' data, such as education years, operation time, blood loss, the 9-item Quality of Recovery (QoR-9) scores before the anesthesia induction (T0), one (T1) and two hours after the extubation (T2), the 40-item Quality of Recovery (QoR-40) scores one (D1) and two days after the surgery (D2), and the rate of adverse reactions were assessed in both groups. Compared with T0, the QoR-9 scores at T1 and T2 were markedly lower in all patients. Compared to Group-C, the QoR-9 scores at T1 and T2 in Group-E were considerably increased (P<0.05). Similarly, the QoR-40 scores on D1 and D2 in Group-E were significantly higher compared to Group-C (P<O.05). Single intravenous injection of esketamine can improve the quality of the recovery of breast cancer patients during the early period after the modified radical mastectomy.

Breast Conserving Surgery is Better for Sexual Satisfaction Compared to a Modified Radical Mastectomy for Breast Cancer.

This study aimed to determine the difference between the level of sexual satisfaction in breast cancer patients with Modified Radical Mastectomy (MRM) and Breast Conserving Surgery (BCS). This study used a cross-sectional study using a validated Female Sexual Function Index questionnaire. This study was conducted from 2020 until 2021. Data were collected and analyzed using the chi-square test for bivariate variables and logistic regression for multivariate variables. Patients with BCS were more satisfied with their sexual activity than patients undergoing modified radical mastectomy (p = 0.0001, OR 6.25, CI = 2.78 - 14.01). Other factors having effect on sexual satisfactions were: age that showed a statistically effect on sexual satisfaction (patients <55 years were more satisfied than patients ≥55 years ( p = 0.004, OR = 3.23, CI 1.44 - 7.22), the period after operation (<5 years vs >5 years) showed a statistically significant difference in sexual satisfaction ( p = 0.087, OR=0.53, CI = 0.25-1.10), Having chemotherapy treatment showed statistically significant risk for sexual satisfaction (p = 0.003, OR=7.39, CI= 1.62-33.83). Factors having no statistically significant effect on sexual satisfactions were: Radiotherapy treatment (p = 0.133, OR=1.75 and CI = 0.84 -3.64), length of marriage as defined with <10 years and > 10 years (p = 0.616, OR=1.39 and CI = 0.38-5.09), marital status (p = 0.082, OR =0.39, CI=0,13 - 1.16), educational status (p = 0.778, OR = 1.18, CI = 0.37 - 3.75), and work at home vs outside home (p = 0.117, OR=1.8, and CI = 0.86 - 3.78). BCS as surgical therapy option is the most dominant factor related to sexual satisfaction followed by age group, and chemotherapy group.

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.

Abstract P2-01-08: The Efficacy of Anlotinib Combined with TEC in Neo-adjuvant Treatment for Triple-Negative Breast Cancer and The Value of Multi-point Core Needle Biopsy in Prediction of Pathologic Complete Remission: A Retrospective analysis

Abstract background While neo-adjuvant anthracycline and taxane-based chemotherapy remains the standard of care for locally advanced TNBC, the optimal chemotherapy regimen is debatable. Anlotinib, a novel multi-target tyrosine kinase inhibitor that effectively inhibits VEGFR, FGFR, c-KIT, c-MET, and RET, monotherapy has been proven effective in HER-2 negative metastatic breast cancer. This study aims to evaluate the efficacy and safety of anlotinib combined with TEC in neo-adjuvant treatment for locally advanced TNBC, and to evaluate the value of predicting pathological response by multi-point core needle biopsy during neo-adjuvant therapy. method This study retrospectively analyzed 18 patients (Pts) with locally advanced triple-negative breast cancer who received anlotinib combined with TEC neo-adjuvant therapy and surgical treatment from August 2020 to January 2022 in the Breast Diagnosis and Treatment Center of Anhui Cancer Hospital. Pts with clinical stage IIb/III TNBC were to be treated with 6 cycles of anlotinib (12mg, d1-14, q3w) plus 6 cycles of docetaxel (75 mg/m2, d1, q3w), Epirubicin (90 mg/m2, d1, q3w) and cyclophosphamide (600 mg/m2, d1, q3w) followed by surgery. Before the fifth cycle of treatment, ultrasound-guided multi-point Core needle biopsy was performed to evaluate the efficacy of neo-adjuvant therapy and predict the pathological complete response, as well as to guide the selection of surgical methods. The primary endpoint was pathological complete response (pCR, ypT0/is). Result Eighteen pts, the median age was 48 years (range, 23-60), were included in the statistical analysis. All patients completed 6 cycles of anlotinib combined with TEC neo-adjuvant therapy followed by radical mastectomy for breast cancer. Regarding pathological response, there were 4 (22.2%), 2 (11.1%), and 12 (66.7%) patients realizing Miller-Payne grade G3, G4, and G5, respectively. Besides, 12 (66.7%) patients achieved pCR. Additionally, the accuracy of multi-point core needle biopsy in predicting pCR was 94.4% in the interval between neo-adjuvant therapy. The grade 3 or 4 AEs were neutropenia and thrombocytopenia in 3 cases each, anemia, arrhythmia, and ALT increased in cases 1 case each. One patient dropped out of the group due to tumor rupture and bleeding. conclusion Anlotinib combined with TEC as neo-adjuvant therapy showed manageable toxicity and promising antitumor activity for locally advanced TNBC. It is safe, reliable, feasible and accurate to evaluate the efficacy of neo-adjuvant therapy and to predict pathological complete response by multi-point core needle biopsy. It means that the clinical evaluation of neo-adjuvant therapy can transition from imaging evaluation to pathological evaluation, which is helpful for the choice of surgical methods. Citation Format: Kuojun Ren, Shikai Hong, Zhengzhi Zhu, Shengying Wang, Jianjun Liu, Hong Gao, Shuhan Wang. The Efficacy of Anlotinib Combined with TEC in Neo-adjuvant Treatment for Triple-Negative Breast Cancer and The Value of Multi-point Core Needle Biopsy in Prediction of Pathologic Complete Remission: A Retrospective analysis [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 P2-01-08.

Comparison of outcomes of LigaSure system and conventional electrocautery in patients undergoing modified radical mastectomy for breast cancer.

Objective: To compare LigaSure system and conventional electrocautery in patients undergoing modified radical mastectomy for breast cancer in terms of mean wound drainage. Study Design: Randomized Controlled Trial. Setting: Department of Surgery, of Allama Iqbal Medical College, Jinnah Hospital Lahore. Period: April 2019 to Mar 2020. Material &amp; Methods: Total of 162 patients were selected. Patients divided in two group A &amp; B for Ligasure and electrocautery group respectively. Two drains placed, one in each flap and axilla after surgery. The drains were removed when the output was less than 30ml/ 24 hours. All patients were discharged after the drain removal. Results: The mean age in Ligasure group was 56.16 ± 7.87 years and in Electrocautery group was 55.00 ± 8.38 years. The mean wound drainage output in Ligasure group was 652.67 ± 93.05 ml and in Electrocautery group was 973.91 ± 87.84 ml. The mean drainage output was statistically lower in Ligasure group as compared to Electrocautery group, p-value &lt; 0.001. Conclusion: Through the findings of current study it is concluded that LigaSure system leads less mean wound drainage than conventional electrocautery in patients undergoing modified radical mastectomy for breast cancer. So, in future therapeutic efficacy of LigaSure system can be opted to minimized the risk related wound drainage in patients undergoing modified radical mastectomy for breast cancer in terms of mean wound drainage.

Chinese Society of Breast Surgery (CSBrS) Practice Guideline 2022.

The Chinese Society of Breast Surgery (CSBrS) Practice Guideline 2021 was published nearly one year ago. The new guideline was revised based on comprehensive feedback of the previous publication. The aim is to provide a better reference suitable for Chinese breast surgeons. Referred to GRADE (Grading of Recommendations Assessment, Development and Evaluation) system, evidences accepted by the Guideline were classified into four categories: I, II, III and IV, which reflected the reliability of the evidences quantitatively. The guideline also comprehensively considered the accessibility of the guideline in clinical practice in China and gave recommendations with different strengths. The guideline emphasized the basic idea that a curative surgical approach falls under the category of radical tumor surgery. Six chapters, including "Diagnosis and treatment of patients with invasive breast cancer", "Sentinel lymph node biopsy in patients with early-stage breast cancer", "Breast-conserving surgery in patients with early-stage breast cancer", "Modified radical mastectomy of breast cancer", "Central venous access for the systemic treatment of breast cancer", and "Breast cancer in pregnancy and postpartum breast cancer" were revised. Compared with the 2021 edition, the new guideline has been revised in six chapters based on the latest research evidence and clinical needs.

SUBDERMAL PLEXUS AS A GUIDE FOR SKIN FLAP THICKNESS IN MODIFIED RADICAL MASTECTOMY IN BREAST CANCER

Introduction: Breast cancer is the most common invasive cancer to affect women in the world and is the second highest cause of cancer death in women after lung cancer. Different surgical options are available for treating breast cancer but Modified Radical Mastectomy is still the most common surgery performed worldwide for breast cancer and has the lowest incidence of loco-regional recurrence. Aim: The aim of this study to find out the role of sub-dermal plexus as a guide to achieve optimum skin flap thickness during modified radical mastectomy for breast cancer. Materialsandmethods: This prospective study was conducted in the Department of Surgery and Pathology, Zoram Medical College Hospital, Falkawn, Mizoram. A total of 40 patients with Breast carcinoma for which Modified Radical Mastectomy were included in this study. Results: All the patients were observed for skin flap necrosis. The overall incidence of Flap necrosis was 0% as observed on POD1, POD2, POD4 and POD6. Although after POD14, there were a total of 5 patients who had surgical site infection with wound gaping for whom debridement, dressings and secondary suturing were done. Conclusion: we concluded that there is minimal chance of skin flap necrosis and minimal chance of leaving behind breast tissue using subdermal plexus of vein as a guide for optimum skin flap thickness in modified radical mastectomy in patients with breast cancer.

Comparison of the Analgesic Efficacy of Ultrasound-Guided Superficial Serratus Anterior Plane Block With Deep Serratus Anterior Plane Block in Patients Undergoing Modified Radical Mastectomy: A Randomized Clinical Trial.

Background Acute postoperative pain after breast cancer surgery adversely affects recovery and is an independent predictor of chronic postsurgical pain in these patients. Serratus plane blocks have been found to provide analgesia to the anterior hemithorax. However, trials comparing superficial serratus plane block and deep serratus block in breast cancer surgery patients are sparse. Methodology A total of 74 female patients with American Society of Anesthesiologists physical status I and II scheduled for elective modified radical mastectomy for breast cancer were randomized into two groups. Group A patients received a superficial serratus plane block with 30 mL of 0.25% bupivacaine, and group B patients received a deep serratus plane block with 30 mL of 0.25% bupivacaine. Postoperatively, the Numerical Rating Scale (NRS) score was measured during the immediate postoperative period, after 30 minutes and at one, four, eight, 16, and 24 hours, as well as on the second and third day. After discharge, the NRS scores were recorded in the second and third weeks and then monthly once for three months. All patients received patient-controlled analgesia with intravenous (IV) morphine. The duration of analgesia, pain scores, and 24-hour morphine consumption were also noted. Results In group A, the mean duration of analgesia (hours) was 5.51 ± 1.42, whereas in group B the mean duration of analgesia (hours) was 6.69 ± 1.18 (p < 0.01). NRS scores for pain during rest at 12 and 16 hours and NRS scores for pain during cough at eight, 12, and 16 hours, as well as at the third month were significantly lower in group B. However, morphine consumption was comparable between the groups. Conclusions Deep serratus plane block was associated with better NRS scores for pain on rest and coughing and prolonged duration of analgesia after a modified radical mastectomy. We conclude that the deep serratus plane block provides superior and extended analgesia than the superficial serratus plane block after a modified radical mastectomy.

Comparison of the Outcome of Gentamycin Lavage Versus Normal Saline Lavage for Axillary Dissection in Modified Radical Mastectomy

Aim: To compare the gentamycin lavage with normal saline lavage after axillary dissection in modified radical mastectomy in terms of mean postoperative wound drainage was the objective of this study. Material: This Randomized controlled trial was conducted at Department of Surgery, Jinnah Hospital Lahore form July, 2018 to June, 2019. Total 100 female patients with 30 to 60 years of age, who underwent modified radical mastectomy for breast cancer. The patients were divided into two groups; group A (operative wound washed with 500ml normal saline) and B (wound washed with 500ml of gentamycin solution (240mg) in addition to the 500ml of normal saline). Results: Mean age and BMI of patients were 49.60±5.83 vs. 49.50±6.723 years (p=0.937) and 27.02±2.90 vs. 27.12±3.33 kg/m2 (p=0.873), in group A and B, respectively. Mean wound drainage were 356.46 ± 59.11 vs. 317.42 ± 51.92 ml (p=0.001), in group A and B, respectively. Conclusions: Gentamycin lavage reduces the postoperative axillary wound drainage after modified radical mastectomy as compared to normal saline lavage. Keywords: Gentamycin Lavage; Axillary Dissection; Modified Radical Mastectomy

The formation of lateral conical defects after radical mastectomy in patients with breast cancer

Aim to find the main causes of the lateral conical defects formation in obese patients after radical mastectomy for breast cancer.&#x0D; Material and methods. We analysed prospectively 82 breast cancer patients with various degrees of obesity. The patients were randomized into two groups. In the main group (43 patients), the original RME method (RU patent No. 2748639, dated May 28, 2021) was used; in the control group (39 patients), the standard RME method was applied.&#x0D; Results. The use of a standard elliptical incision for RME in obese patients leads to the formation of lateral conical defects, the frequency of which reaches 74%. There is a high correlation between the frequency of formation of lateral conical defects in radical mastectomy with expansion of the breast base (Spearman index 0.85 (p0.05), chest circumference (Spearman index 0.92(p0.05), fat pedicle thickness (Spearman index 0.94 (p 0.05) and degree of mammoptosis (Spearman index 0.98 (p 0.05).

Assessment of Textbook Oncologic Outcomes Following Modified Radical Mastectomy for Breast Cancer.

Textbook oncologic outcome (TOO) is a composite outcome measure attained when all desired short-term quality metrics are met following an oncologic operation. The objective of this study was to determine the incidence of TOO and its impact on the overall survival (OS) among patients with invasive ductal carcinoma (IDC) following modified radical mastectomy (MRM). The 2004-2017 National Cancer Database was queried for patients with non-metastatic IDC who underwent MRM. TOO was defined as having attained five metrics: resection with negative microscopic margins, American Joint Committee on Cancer compliant lymph node evaluation (n≥10), no prolonged length of stay (50th percentile by year), no 30-d readmission, and no 30-d mortality. OS was defined as the time in months between the date of diagnosis and the date of death or last contact. A total of 75,063 patients were identified, of which 40.8% achieved TOO. The TOO patients had a lower median age and were more likely to be White, privately insured, and without comorbidities. In terms of facility characteristics, patients with TOO were more likely to be seen in comprehensive community cancer programs with a high case-volume per year. The TOO group had a statistically significant higher median OS compared to the non-TOO group (165.6 versus 142.2mo; P<0.001). On multivariate analysis TOO was independently associated with a reduced risk of death (HR=0.82; P<0.001). TOO is achieved in approximately 41% of patients undergoing MRM for IDC. Achieving TOO is associated with improved median OS and reduced risk of death. TOO therefore merits further attention in efforts to improve surgical outcomes.

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.