Surgical Treatment Of Breast Cancer Research Articles

The role of local and systemic control methods in the treatment of oligometastatic breast cancer, taking into account biological subtypes (literature review)

Combined methods of treatment of oligometastatic breast cancer (OMBC) based on systemic drug treatment and local treatment methods - stereotactic radiation therapy (SRT) or surgical treatment - are not included in current clinical guidelines. The European Society of Medical Oncology (ESMO) recommends the use of local control methods for patients with breast cancer without taking into account the biological subtype of the tumor. This review presents a modern understanding of the oligometastatic biological subtype based on data from clinical studies on this topic, which could contribute to decision-making in real clinical practice.The aim of the review is analysis of the effectiveness of combined treatment methods: systemic drug therapy and local treatment methods (SRT) or surgical treatment of breast cancer of various molecular genetic subtypes.To assess the clinical effectiveness of various approaches to the treatment of breast cancer, depending on the biological subtype, a search was conducted for scientific publications in the Medline bibliographic database. Prospective and retrospective studies demonstrate an increase in the effectiveness of treatment through a combination of systemic therapy and local control methods (surgical treatment or SRT) OMBC depending on the biological subtypes. In hormonepositive breast cancer with bone damage, SRT is most preferable, whereas in visceral oligometastases, surgical treatment is recommended. For immunocompetent tumors of triple-negative and HER2-positive biological subtypes of breast cancer, surgical treatment of OMBC is not recommended, except in cases where the positive status of HER2 is combined with a high level of expression of hormonal receptors or metastatic bone damage.The results of current prospective studies focusing on certain biological subtypes of breast cancer will help further determine the role of this strategy in the treatment of this cohort of patients. Understanding the characteristics of the tumor process in breast cancer will allow you to personalize the treatment of patients with this disease.

Changes in breast cancer incidence and surgical treatment in Baden–Württemberg (Germany) during the COVID-19 pandemic

The COVID-19 pandemic affected the diagnostics and treatment of breast cancer. Numerous studies reported an early decline in breast cancer (BC) incidence during the COVID-19 pandemic. Less evidence is available on changes in medical care. Reports from individual patients have provided anecdotal evidence for a shift from breast-conserving surgery to mastectomy to reduce the number of visits to radiation units during the pandemic. This study aimed to explore changes in BC incidence and surgical treatment in the south of Germany. Using data from the Baden-Württemberg Cancer Registry, the age-standardized incidence of BC (ICD-10 C50 and D05) (women) in 2018–2021 was investigated overall and by age and stage using standardized incidence ratios. Among pre-operative stage I/IIA BC patients, differences in the time to surgery and type of surgery were investigated using negative binomial and logistic regression models. The incidence of invasive BC decreased significantly from 170.9 per 100,000 women in 2018/2019 to 159.7 in 2020 and increased to 169.2 in 2021. This decrease resulted from a lower incidence around April 2020 and was also observed for non-invasive BC. In 2021, incidence of invasive BC was still decreased by 8% in women aged 80 + years. Surgical treatment was analyzed in 22,708 BC patients with a pre-operative stage ≤ IIA. The median time to surgery was 33 days in 2018/2019, 32 days in 2020 and 36 days in 2021. The proportion of mastectomies increased from 16.1% in 2018/2019 to 17.1% in 2020 and 17.3% in 2021 (adjusted odds ratio and 95% confidence interval (2021 vs. 2018/2019): 1.13 (1.03–1.24)). The adjusted increase was strongest for patients aged 50–59 years (1.34 (1.09–1.64)) and those with high-grade tumors (1.27 (1.07–1.51)). While the early return to pre-pandemic age-standardized BC incidence rates is promising, missed cases have not been caught up until 2021. Furthermore, the decreased incidence in elderly women in 2021 warrants further attention. In early-stage BC, a slightly greater rate of mastectomies was observed, although such a change was not recommended. This result underlines the importance of good communication of adapted treatment guidelines in such exceptional circumstances.

Role of Immunotherapy in Conjunction With the Surgical Treatment of Breast Cancer: Preoperative and Postoperative Applications.

Breast cancer is one of the most common cancers in the world. Since the appearance of molecular medicine, the perspective of breast cancer treatment has changed, making it more successful in comparison with the treatment during previous years. Numerous ongoing trials are exploring the capacity of immunotherapy, mainly in immune checkpoint inhibitors (ICIs), in conjunction with conventional therapies or with antibody-drug conjugates (ADCs). The current narrative review discusses the advantages and limitations of immunotherapy in breast cancer treatment in conjunction with the surgical options available. Going through the modern capacity of surgery treatment and how the use of immunotherapy in conjunction with it has emerged as a transformative approach to breast cancer and listing the main complications and adverse effects caused by ICIs. We searched Google Scholar, PubMed, MEDLINE, and EMBASS. Fourteen different articles showed that the use of cytokines and cancer vaccines revealed new possibilities to treat breast cancer with antibodies against PD-1/PD-L1 (pembrolizumab), PI3K/Akt/mTOR (alpelisib and everolimus), CAR T-cell (chimeric antigen receptor), PARP (poly ADP-ribose polymerase), and CTLA4 (cytotoxic T-lymphocyte-associated protein 4), and with representative relevance of changing in tumor microenvironment. Immunotherapy made it possible to reduce recurrences, after radiotherapy and surgery. Estrogen receptor (ER) and human epidermal growth factor receptor 2 (HER2) targets show also a high effectivity. In recent years, the release of new strategies has become promising, for changing the microenvironment and de-escalation of therapy based on tumor biology, novel biomarkers, and tumor spread.

Why do women with early breast cancer in Northern Sri Lanka undergo mastectomy? Decision-making and ways forward

BackgroundDespite robust evidence confirming equivalent survival rates and better cosmetic outcomes with breast-conserving surgery (BCS) and radiotherapy compared to mastectomy, the rates of mastectomy among women with early breast cancer have not declined significantly in Sri Lanka. This study explores views on the surgical treatment of breast cancer among Northern Sri Lankan women who were eligible for BCS but underwent mastectomy.MethodsAn exploratory descriptive qualitative study was carried out among 15 women who underwent mastectomy for early breast cancer. Patients who were referred to the Tellippalai Trail Cancer Hospital for adjuvant therapy after mastectomy and matched the study criteria were recruited. Data were collected through in-depth semi-structured interviews, which were transcribed in Tamil, translated into English, coded using QDA Miner Lite software, and analysed thematically.ResultsNine out of 15 participants were either not aware of breast-conserving surgery (BCS) as a treatment option or their eligibility for BCS at the time of mastectomy. According to participant narratives, the treating team had recommended mastectomy to most participants. While many opted for mastectomy believing that it was associated with lower rates of recurrence and spread compared to BCS, these beliefs were frequently reinforced by the treating team. The pros and cons of the two approaches had not been discussed before surgery with most participants. In the absence of information, family and friends weighed in on the decision to opt for mastectomy, ultimately resulting in feelings of loss and regret in most instances.ConclusionMost participants were not aware that they were eligible for BCS. These information gaps need to be urgently addressed for women to make informed decisions about their health.

Seroma incidence and risk factors in women undergoing mastectomies as surgical breast cancer treatment.

Seroma is the most common early complication following surgical breast cancer treatment. Its development is associated with pain, scar complications, adjuvant therapy delays, the need for outpatient visits, and increased care costs. Assess seroma incidence and risk factors in women undergoing mastectomies. This study comprises a prospective cohort encompassing women aged 18 or over undergoing mastectomies as a breast cancer treatment. Patients underwent physiotherapy on the 1st, 7th, and 30th postoperative days for kinetic-functional, skin, and wound healing assessments and were attended to by nurses for surgical wound care, draining liquid on the 7th, 14th, and 21st postoperative days. Seroma was defined as the presence of local fluctuations requiring puncture, regardless of the punctured volume. A total of 249 women were evaluated, with a mean age of 57.5 (SD = 11.8). A total of 77.1% were classified as overweight or obese, 60.2% were hypertensive, 21.3% were diabetic, 66.7% underwent neoadjuvant chemotherapy and 62.7% underwent axillary lymphadenectomies. Seroma incidence was 71.1%, requiring, on average, two aspiration punctures until condition resolution. Overweight or obese women and those who underwent axillary lymphadenectomies exhibited 1.92- and 2.06-fold higher risk for seroma development (OR = 1.92; 95% CI 1.02-3.61; p = 0.042; and OR = 2.06; 95% CI 1.17-3.63; p = 0.012), respectively. Seroma incidence was very high. Being overweight or obese and undergoing axillary lymphadenectomy comprise independent seroma development risk factors. This study is part of a randomized clinical trial evaluating the effectiveness of applying compressive taping to prevent post-mastectomy seroma, which was approved by the Brazilian National Cancer Institute, Research Ethics Committee (2,774,824), and it is registered in the ClinicalTrials.gov (NCT04471142, on July 15, 2020).

Collateralization of the upper extremity lymphatic system after axillary lymph node dissection.

Lymphatic drainage from the arm may be altered after axillary lymph node dissection (ALND). Understanding these alterations is important as they may change standard surgical and radiation treatment in recurrent breast cancer or upper extremity skin cancers, including melanoma. Utilizing a single-institution planar and single photon emission computed tomography/computed tomography lymphoscintigraphy database, we identified patients with a diagnosis of upper extremity cutaneous melanoma from 2008 to 2023 who previously underwent ALND for cancer treatment and did not develop upper extremity cancer-related lymphedema. ALND patients were matched to control patients presenting with cutaneous melanomas at the same anatomic sites. Sentinel lymph nodes (SLNs) were compared between both groups. Of 3628 upper extremity melanoma cutaneous patients, 934 met inclusion criteria, including 22 ALND and 912 control patients. Level I axillary SLN drainage was observed in 98% of controls and 27% of ALND patients (p < 0.001). Level II axillary SLN drainage was observed in 3% of controls and 27% of ALND patients (p < 0.001). Level III axillary SLN drainage was observed in 1% of controls and 32% of ALND patients (p < 0.001). Epitrochlear SLN drainage was observed in 9% of controls and 32% of ALND patients, respectively (p < 0.046). Brachial SLN drainage was observed in 4% of controls and 23% of ALND patients (p < 0.001). Distinct changes in functional lymphatic drainage were seen between the arms of patients who previously underwent ALND versus control patients. Levels II and III axillary, epitrochlear, and brachial nodes are possible sites of metastatic disease that should be considered in patients with a prior ALND.

Types of Breast Cancer Surgery and Breast Reconstruction.

Background: Breast cancer continues to be a significant diagnostic and therapeutic problem. Mastectomy is still a frequently used treatment method, but its form is changing with progress in medicine. Methods: We have described important types of surgical treatments for breast cancer, such as modified radical mastectomy, breast-conserving surgery, contralateral prophylactic mastectomy, and robotic mastectomy. Breast reconstruction is also a very important element of treatment because it directly affects the mental state of patients after the procedure. We have also described types of breast reconstruction, such as implants, acellular dermal matrices, autologous reconstruction, robotic breast reconstruction, and fat grafting. Results: The aim of our study was to compare available types of surgical treatment for breast cancer and breast reconstruction to help tailor personalized treatment to patients.

Features of Epidemiology and Surgical Treatment of Triple Negative Breast Cancer in Azerbaijan

Purpose. To study the characteristics of the prevalence of triple-negative breast cancer (TNBC) in the Republic of Azerbaijan, to determine the effectiveness of surgical methods in treatment of the disease. Materials and methods. The study included 769 patients aged 21 to 87 years with a diagnosis of triple negative breast cancer who underwent examination and treatment at the National Center of Oncology (NCO) of the Ministry of Health of the Republic of Azerbaijan during 2015–2019. The molecular subtypes of tumors in patients were determined based on immunohistochemical examination of tumor tissue obtained by tru-cut biopsy. Results. Epidemiological studies in the Republic of Azerbaijan determined that the extensiveness of TNBC was 9.4%, the intensity was 3.70/0000, and the injury rate was 22.30/0000. The lethality rate in the Republic was 12.0%, and the total mortality rate was 1.50/0000. Statistical analysis showed that 63 (12.0%) patients who underwent organ– preserving surgery had recurrences, and 51 (9.7%) had a lethal outcome. Depending on the type of surgery, there was no statistically sign if incant difference between the recurrence rate and lethality in operated patients (p=0.169). Thus, 38 (16.5%) patients with TNBC who underwent mastectomy had a relapse, and 28 (12.1%) had a lethal outcome. Conclusion. In the Republic of Azerbaijan, the extensiveness of TNBC is 9.4%, and the lethality rate is 12.0%. In patients with TNBC, the type of surgery (organ-preserving surgery and mastectomy) does not affect he percentage of long-term recurrency of the disease and mortality. Цель. Изучение особенностей распространения трижды негативного рака молочной железы (ТНРМЖ) в Азербайджанской Республике, определение эффективности хирургических методов лечения заболевания. Материалы и методы. В исследование были включены 769 пациентов в возрасте от 21 года до 87 лет с диагнозом ТНРМЖ, проходивших обследование и лечение в Национальном центре онкологии (НЦО) Министерства здравоохранения Азербайджанской Республики в течение 2015–2019 гг. Молекулярные подтипы опухолей у пациентов определяли на основании иммуногистохимического исследования опухолевой ткани, полученной методом tru-cut биопсии. Результаты. По данным эпидемиологических исследований, в Азербайджанской Республике показатель экстенсивности заболевания ТНРМЖ составил 9,4%, показатель интенсивности – 3,70/0000, а показатель травматичности – 22,30/0000. Показатель летальности по республике составил 12,0%, а общий коэффициент смертности – 1,50/0000. Статистический анализ показал, что у 63 (12,0%) пациентов, перенесших органосохраняющие операции, зафиксирован рецидив, а у 51 (9,7%) – летальный исход. В зависимости от вида операции статистически значимой разницы между частотой рецидивов и летальностью у оперированных пациентов не выявлено (р=0,169). Так, у 38 (16,5%) пациентов с ТНРМЖ, перенесших мастэктомию, наблюдался рецидив, а у 28 (12,1%) – летальный исход. Заключение. В Азербайджанской Республике экстенсивность ТНРМЖ составляет 9,4%, а летальность – 12,0%. У пациентов с ТНРМЖ тип операции (органосохраняющая операция и мастэктомия) не влияет на процент отдаленного рецидива заболевания и летальности.

Future challenges in the surgical treatment of breast cancer – Oncoplastic, prophylactic procedures and reconstructive surgery

AbstractMedical knowledge is doubling faster and faster. Surgeons are highly specialized and must be trained not only in surgery, but also in imaging and oncology to meet the modern requirements of a breast center. This article describes what has changed in the surgical treatment of breast cancer over the past 20 years since the introduction of certified breast centers in Germany, and what could change in the future. Pre- and post-operative conferences have become a central component of the interdisciplinary exchange of information. Every breast-conserving operation must be precisely planned, marked and carried out in a controlled manner. Basic anatomical knowledge is not sufficient enough to perform a prophylactic mastectomy. Implant-based reconstructions change their shape and strength over time and usually lead to follow-up operations. Tissue engineering offers interesting approaches to replace the disadvantages of conventional implants in order to achieve the durability and quality similar to autologous tissue reconstructions.

Analysis and relationship between the volume of upper limb lymphoedema and pressure pain threshold, neural range of motion, pain intensity, kinesiophobia, pain hypervigilance and catastrophizing in breast cancer survivors.

Lymphedema of the upper limbs and persistent pain are frequent sequelae after surgical treatment of breast cancer. The aim of this paper was to analyze the upper limb volume, pressure pain threshold, neural range of motion, pain intensity, kinesiophobia, pain hypervigilance and catastrophizing in patients with and without lymphoedema after breast cancer surgery. Secondly, we aimed to investigated the association between upper limb volume and these variables. Descriptive observational study. Faculty of Health Sciences of the University of Granada. Fifty-eight post-surgical breast cancer survivors, 29 with upper limb lymphoedema and 29 without lymphoedema. We measured upper limb volume (perimetric method). Also, pressure pain thresholds were assessed with a digital algometer, neural range of motion (neurodynamic test for radial, ulnar and median nerves), pain intensity (visual analogue scale), kinesiophobia, pain hypervigilance and catastrophizing (validated tests). To detect differences between the groups for the measurement variables we performed a t-test for independent samples analysis. A simple linear regression analysis adjusting for age and body mass index was performed to check the association among upper limb volume and pain variables in the group with lymphoedema. The analysis showed that lymphoedema group had lower pressure pain threshold bilaterally in the masseter (origin P≤0.036; insertion P≤0.046), temporalis (insertion P≤0.021), suboccipitalis (P≤0.036); second (P≤0.014), third (P≤0.001) and tenth rib (P≤0.001); affected side of the temporalis (origin P=0.025); temporomandibular joint (P=0.024); neural range of motion in the median nerve (P=0.047), ulnar (P=0.042) on the affected side and radial (P=0.039) on the unaffected side; and greater kinesiophobia (P=0.042). Linear regression analysis only showed a significant association between upper limb volume and neural range of motion in the radial nerve (P=0.020) in the lymphedema group. No significant associations were obtained for the rest of variables. These findings suggest that the presence of lymphoedema may contribute to an increased level of generalized mechanosensitivity and fear to movement in this population. Upper limb lymphedema can lead to heightened mechanosensitivity and movement-related fear in breast cancer survivors. Therefore, fast track rehabilitation approach should be focus in screening and rehabilitation methods for detection and control this sequalae.

Correction: Future challenges in the surgical treatment of breast cancer – Oncoplastic, prophylactic procedures and reconstructive surgery

Correction: Future challenges in the surgical treatment of breast cancer – Oncoplastic, prophylactic procedures and reconstructive surgery

Tremendous and infrequently adenoid cystic carcinoma of the breast without any metastasis for more than 20 years: A case report.

Breast adenoid cystic carcinoma is an extremely rare tumor that is incompletely understood, accounting for less than <0.1% of all breast cancers, with an average diameter of 3 cm, and it is extremely rare to see a large, non-metastatic breast adenoid cystic carcinoma with a diameter of about 30 cm. Since this disease is extremely rare, there are few reports in the literature and limited data on clinical diagnosis and treatment. We present a case of a 71-year-old woman with a large, non-metastatic adenoid cystic carcinoma of the left breast and share our opinion on the diagnosis and treatment of this case. A 71-year-old woman with a 20-year-old left breast mass with local bleeding and rupture for 1 hour presented to our hospital for further diagnosis and treatment. A computed tomography scan showed a large soft tissue mass shadow in the left breast and malignancy was considered. Subsequently, tissue aspiration pathology was performed and the results confirmed adenoid cystic carcinoma of the breast. Intraoperative pathology results of radical mastectomy for left breast cancer diagnosed adenoid cystic carcinoma of the breast and immunohistochemistry results of triple-negative breast cancer. Treatment of adenoid cystic carcinoma of the breast included neoadjuvant chemotherapy for breast cancer, radical mastectomy of the left breast, and postoperative chemotherapy. Initially, neoadjuvant chemotherapy for breast cancer was performed, and the TAC regimen was used to successfully reduce the size of the tumor and gain access to surgical treatment for breast cancer. The patient has recovered well after the surgery, with no wound infection or ulceration, and is now waiting for the patient's physical function to recover for postoperative chemotherapy, with no obvious discomfort. Adenoid cystic carcinoma tumors are usually around 3 cm; such a huge 30 cm adenoid cystic carcinoma of the breast is extremely rare, and it is extremely rare to find a breast malignancy that has not developed regional lymph node and distant metastases for more than 20 years. Clinicians must remain vigilant for early breast malignancies at a high age of incidence and conduct further research for diagnosis to avoid delays.

The influence of magnetic fields and fluctuating currents in the complex of medical rehabilitation on the state of peripheral blood flow in the early postoperative period of breast cancer

Abstract. Taking into account the high prevalence of complications after radical surgical treatment of breast cancer, medical rehabilitation courses were developed and conducted in the early postoperative period (2–4 days after surgery) with the inclusion of physical factors: fluctuating currents, extended local magnetic therapy, general magnetic therapy, as well as physical therapy, training with biofeedback on the support reaction (balance therapy) and individual sessions with a medical psychologist. Purpose. In a comparative aspect, study the indicators of peripheral microcirculation to assess the effectiveness of various methods of magnetic therapy and fluctuarization in patients operated on for breast cancer in the early postoperative period. Material and methods. The study included 107 women operated on for breast cancer 2–4 days after surgery. Using simple randomization, the patients were divided into 3 groups, comparable in age, clinical and functional indicators; at all stages of the study, the patients underwent clinical, functional and laboratory examinations, and questionnaires. In the 1st group (n=35), in the early postoperative period, in the complex of medical rehabilitation, 10 fluctuarization procedures were carried out using an expanded technique; in the 2nd group (n=35), patients received 10 procedures of expanded magnetic therapy; in the 3rd group (n =37) patients received 10 procedures of general magnetic therapy. In addition to physiotherapy, all patients received a complex of physical therapy, balance therapy and classes with a medical psychologist. Results. In the early stages, fluctuating currents seemed more effective, which, due to chaotic changes in the frequency and amplitude of current pulses, help restore conduction along peripheral nerves and activate muscle fiber contractility, improving hemodynamics. It should be noted the effect of extended and general magnetic therapy on improving the contractility of the muscles of the upper limb and the conductivity of peripheral nerve fibers, as well as on the restoration of capillary blood flow. Early signs of the regeneration process are a restructuring of microvascular regulation, namely an increase in the contribution of nutritional blood flow, the activity of myogenic and neurogenic oscillations in hemodynamics, and an increase in blood flow activity.

Shear-wave elastography as a supplementary tool for axillary staging in patients undergoing breast cancer diagnosis

BackgroundPreoperative evaluation of axillary lymph node status is crucial for the selection of both systemic and surgical treatment in early breast cancer. This study assessed the particular role of additional shear wave elastography (SWE) in axillary staging in patients undergoing initial breast cancer diagnostics.MethodsOne hundred patients undergoing axillary lymph node biopsy due to a sonographically suspicious axillary lymph node were prospectively evaluated with SWE using virtual touch tissue imaging quantification (VTIQ). Mean values of tissue stiffness for axillary tissue and lymph node tissue were measured prior to core-cut biopsy of the lymph node. All lymph nodes were clip-marked during the biopsy. Cut-off values to differentiate between malignant and benign lymph nodes were defined using Youden’s index.ResultsLymph nodes with evidence of malignant tumor cells in the final pathological examination showed a significantly higher velocity as measured by SWE, with a mean velocity of 3.48 ± 1.58 m/s compared to 2.33 ± 0.62 m/s of benign lymph nodes (p < 0.0001). The statistically optimal cutoff to differentiate between malignant and benign lymph nodes was 2.66 m/s with a sensitivity of 69.8% and a specificity of 87.5%.ConclusionsLymph node metastases assessed with SWE showed significantly higher elasticity values compared to benign lymph nodes. Thus, SWE provides an additional useful and quantifiable parameter for the sonographic assessment of suspicious axillary lymph nodes in the context of pre-therapeutic axillary staging in order to differentiate between benign and metastatic processes and support the guidance of definitive biopsy work-up.Critical relevance statementShear-wave elastography provides an additional useful and quantifiable parameter for the assessment of suspicious axillary lymph nodes in the context of pre-therapeutic axillary staging in order to differentiate between benign and metastatic processes and support guiding the definitive biopsy work-up.Key PointsSWE is a quantifiable ultrasound parameter in breast cancer diagnosis.SWE shows a significantly higher velocity in malignant lymph nodes.SWE is useful in improving the sensitivity and specificity of axillary staging.Graphical

Opioid-Free Anesthesia and Analgesic Quality During the Postoperative Period of Oncological Breast Surgery

&amp;lt;i&amp;gt;Background: &amp;lt;/i&amp;gt;Pain is one of the most common symptoms in cancer patients. We can understand it as a multifactorial phenomenon. Breast cancer surgical treatment generates real damage to the structures and activates nociception which can generate persistent pain. Current anesthetic management is based on the use of opioids, which generate a large number of complications that can severely affect this group of patients, increasing morbidity and mortality. Opioid-free techniques have been shown to reduce complications and generate optimal anesthetic-analgesic management as well as decrease postoperative misuse. The purpose of this research is to compare both approaches and evaluate their impact on this population group. &amp;lt;i&amp;gt;Methods: &amp;lt;/i&amp;gt;Simple, prospective, randomized, controlled blind clinical trial in 30 patients undergoing oncological mammary quadrantectomy a. The patients were divided into two groups study, the first (group A) received balanced general anesthesia with opioids as an analgesic strategy, the other group (group B) received general anesthesia balanced opioid-free supplemented with a PECs II regional block and/or Serratus (BRILMA) according to the patient&amp;apos;s sonoanatomy, and ketamine-lidocaine as adjuvant drugs. Analgesia was assessed using the numerical pain scale at 2, 4, and 6 o&amp;apos;clock. The severity and impact of pain on the daily performance of patients were measured using the Brief Pain Inventory (BPI) short form in combination with clinical examination, the presence of postoperative complications, the length of stay in hours and the need for rescue with opioids. &amp;lt;i&amp;gt;Results: &amp;lt;/i&amp;gt;35% of the patients in group A required analgesic rescue with Tramadol to improve pain postoperative, while in group B only 10% needed it. 33% of the patients in group A completed their postoperative period with nausea and vomiting, while in the opioid-free group the percentage was only 1%. Referring to the length of hospital stay from surgery to discharge, group A was hospitalized for a period of 25 hours (SD=21.2), while group B was there for 15.2 hours (SD=8.7). &amp;lt;i&amp;gt;Conclusions:&amp;lt;/i&amp;gt;. Use of opioid-free anesthesia along with adjuvant strategies (drugs and nerve blocks) represent a safe and effective anesthetic strategy related with a lower incidence of complications from the use of opioids in the postoperative period, a lower consumption of analgesic rescues, a decrease in the length of hospitalization and a greater degree of comfort for the patient. This protocol represents an alternative when it comes to providing good intra and postoperative conditions for such a susceptible group of patients.

Influence of Fragmented Human DNA on the Relationship between MicroRNA (miR-21, -221, -222, and -429) of the Lymph and the Structure of the Thymus after Surgical Treatment and Chemotherapy for Breast Cancer.

In female Wistar rats, we studied the relationship between the levels of miR-21, miR-221, miR-222, and miR-429 in the lymph and morphometric parameters of the thymus after surgical treatment of breast cancer, chemotherapy, and administration of fragmented human DNA. The levels of pro-oncogenic miR-221 and miR-222 in the lymph decreased after surgical treatment and chemotherapy in comparison with the pathological controls. Positive correlations of miR-221 and miR-429 with small lymphocytes in the cortical substance and miR-21 and miR-429 with small lymphocytes of the medullary substance of the thymus were revealed. After administration of fragmented human DNA, an increase in the level of miR-429 in the lymph was detected in comparison with resection+chemotherapy. In the subcapsular zone of the cortical substance, proliferative activity and the number of cells with pyknotic nuclei decreased. The number of macrophages increased in all structural zones of the thymus. The following interrelations were revealed: in the subcapsular zone of the cortical substance, correlations of immunoblasts with miR-222, macrophages and mitotically dividing cells with miR-429; in the central part of the cortical substance and medullary substance, as well as the cortical-medullary zone, correlation of miR-221 with mitotically dividing cells; in the central part of the medullary substance, correlation of miR-429 with epithelial cells.

Breast cancer recurrence rate after mastectomy in young females.

e12591 Background: Breast cancer is the most commonly diagnosed female cancer worldwide and the most common cause of cancer mortality in women. Surgical treatment of early breast cancer includes lumpectomy or mastectomy with or without reconstruction. Despite the surgeon’s best effort to perform a radical resection of the breast tissue during mastectomy to achieve locoregional control, residual fibroglandular tissue was found in 20% of breasts on postoperative breast MRI, which carries a risk of recurrence. Younger women with breast cancer have inferior survival rates despite receiving more aggressive therapy. Tumors in young women are more likely to be poorly differentiated, hormone receptor-negative, have a high proliferation index, and more lymphovascular invasion, which is partially explained by patients’ genetic profile. Another factor that could contribute to poor outcomes is the advanced stage at the time of diagnosis, including larger tumor size and higher rates of axillary lymph node positivity. This knowledge has motivated us to conduct this study that is dedicated to looking at the recurrence rate in young females following mastectomy. Methods: This is a retrospective study that collected data from young female patients who were diagnosed with breast cancer between January 2010 and August 2018, had an age at diagnosis of 18-45 years old, and underwent unilateral or bilateral mastectomy with or without reconstruction. The study also looked at the patient’s risk factors and genetic profile. Results: A total of 115 patients were diagnosed with early-stage breast cancer between January 2010 and August 2018 and underwent mastectomy. 81.74% were Caucasian females, and 8.7% were African American females. The mean age of diagnosis was 36.9 years. The mean BMI was 30.5 kg/m2. 59.13% of patients had a family history of breast cancer. The most common genetic mutations were BRCA1 at 7.83% and BRCA2 at 8.7%. 71% of patients underwent a bilateral mastectomy. 76% of patients had reconstruction. 77% of tumors were ER-positive, 68% PR-positive, and 26% HER2-positive. 49.4% of tumors were Nottingham grade 3. 52% of patients had no nodal involvement, while 35% had N1 disease. 34.6% had lymphovascular invasion. We found that 18/115 patients had recurrence of breast cancer following mastectomy. 5/17 patients had locoregional recurrence, while 12/17 patients had a distant recurrence; 1 patient’s recurrence data was unavailable. The median time to recurrence was 1147.5 days (335 to 3107). The 5-year recurrence free survival rate is 86% ± 3%. Conclusions: Our study found that 15.65% of young females had recurrence after mastectomy. To our knowledge, this is the first dedicated study to look at the recurrence rate after mastectomy in this young, high-risk patient population. Our study aims to encourage larger studies in young females with breast cancer to help tailor the treatment plan in this population.

Influence of Photodynamic Therapy with Subsequent Surgical Treatment of Experimental Breast Cancer on Quantitative Changes in miRNAs in a Mesenteric Lymph Node.

In female Wistar rats with breast cancer, quantitative changes of pro-oncogenic miRNAs (miR-21, -27a, and -221) and tumor-suppressive miR-429 in the mesenteric lymph node were assessed after photodynamic therapy for breast cancer and after photodynamic therapy followed surgical treatment. The level of pro-oncogenic miR-221 in the mesenteric lymph node decreased, and the level of pro-oncogenic miR-21 increased after photodynamic therapy for breast cancer followed by surgical treatment in comparison with the corresponding parameters after photodynamic therapy alone. The content of tumor-suppressive miR-429 remained reduced, as in the group of animals receiving photodynamic therapy alone.

Endoscopic Bilateral Nipple-sparing Mastectomy via a Single Axillary Incision with Immediate Pre-pectoral Implant-based Breast Reconstruction.

Oncoplastic breast surgery, with its focus on improving cosmetic outcomes while maintaining oncological safety, has fundamentally transformed the landscape of breast cancer surgical treatment, giving rise to an array of techniques for breast reconstruction. Nipple-sparing mastectomy (NSM) with immediate implant-based breast reconstruction (IBBR) has emerged as a cornerstone in managing early breast cancer. Aligned with the principles of minimally invasive surgery, recent years have witnessed the widespread integration of endoscopic approaches in breast surgery, encompassing procedures like endoscopic breast-conserving surgery (E-BCS) and endoscopic nipple-sparing mastectomy (E-NSM), among others. Capitalizing on the advantages of inconspicuous and shorter incisions, improved visibility, and the avoidance of radiation therapy, the popularity of E-NSM with IBBR is on the rise. However, conventional E-NSM with IBBR often requires two or more incisions, which can result in suboptimal cosmetic outcomes and even prosthesis loss.This paper presents a comprehensive account of the intricate surgical procedures involved in endoscopic bilateral nipple-sparing mastectomy with immediate pre-pectoral implant-based breast reconstruction. The insights shared are drawn from the collective experience of our institution. Notable benefits associated with the described surgical approach encompass enhanced cosmetic outcomes, improved postoperative quality of life, and enhanced physiological functions attributable to the application of pre-pectoral implant-based breast reconstruction through a single incision.

Contributors to post-operative venous thromboembolism risk after breast cancer surgery: A systematic review and meta-analysis

IntroductionVenous thromboembolism (VTE) events are a preventable complication for patients undergoing surgery for breast cancer. However, there is a lack of consistency in the existing literature regarding the potential risk factors affecting these individuals. MethodsThis study aimed to investigate the potential risk factors associated with an increased risk of VTE following surgery for breast cancer. Data on patient characteristics such as age, body mass index (BMI), existing comorbidities, smoking history, surgical interventions, duration of hospitalization, and post-operative complications were recorded and analyzed. ResultsThirty-one studies investigating the incidence of VTE following surgical interventions for breast cancer were included. This study included 22,155 female patients with a mean age of 50.8 ± 2.9 years. The weighted mean length of surgery and hospital stay were 382.1 ± 170.0 min and 4.5 ± 2.7 days, respectively. The patients were followed-up for a weighted mean duration of 13.8 ± 21.2 months. The total incidence of VTE events was 2.2% (n = 489). Meta-analysis showed that patients with post-operative VTE had a significantly higher mean age and BMI, as well as longer mean length of surgery (P < 0.05). Comparing the techniques of autologous breast reconstruction showed that the risk of post-operative VTE is significantly higher with deep inferior epigastric perforator (DIEP) flaps, compared with the transverse rectus abdominus myocutaneous and latissimus dorsi myocutaneous flaps (P < 0.05). Compared with delayed reconstruction, immediate reconstruction was associated with a significantly higher incidence of VTE (P < 0.05). Smoking history, length of hospital stay, and Caprini score did not correlate with increased incidence of post-operative VTE. ConclusionThe incidence rate of VTE events in patients receiving surgical treatment for breast cancer is 2.2%. Risk factors for developing post-operative VTE in this patient population were found to be older age, increased BMI, extended length of surgical procedures, and DIEP flap reconstruction.