Undergoing Breast Surgery Research Articles

Neoadjuvant penpulimab combined with taxanes and carboplatin in triple-negative breast cancer: A single-arm, open-label, multi-center phase II clinical study (neoTAPPL).

588 Background: The integration of immunotherapy with neoadjuvant chemotherapy has been shown to enhance pathologic complete response (pCR) and survival outcomes in patients with triple-negative breast cancer (TNBC). Nonetheless, additional research is required to ascertain the optimal neoadjuvant regimen. Here we present a prospective phase II NeoTAPPL trial in which evaluated the efficacy and safety of penpulimab (anti-PD-1 antibody) in combination with taxanes and carboplatin for TNBC patients. Methods: In this open-label, multi-center phase II study, patients with untreated, histologically confirmed TNBC in stage II-III were enrolled. Patients received 6 cycles of neoadjuvant therapy with penpulimab (200 mg, d1, q3w) plus taxanes (docetaxel 75 mg/m 2 or nab-paclitaxel 260 mg/m 2 , d1, q3w) and carboplatin (AUC=6, d1, q3w). Patients who either completed or discontinued the neoadjuvant treatment would undergo breast surgery. Adjuvant chemotherapy and immunotherapy were at the discretion of the treating physician, and radiation therapy was per standard of care. The primary endpoint was the rate of pCR based on the definition of ypT0/Tis ypN0. Secondary endpoints included residual cancer burden (RCB), event free survival (EFS), overall survival (OS), adverse events (AE), and immune response biomarkers. Results: 50 patients were enrolled, among which 37 patients received neoadjuvant treatment and underwent breast surgery. The median age was 51 years (range, 32-72). 33 (89.2%) patients had stage II breast cancer at diagnosis. 21 of the 37 patients achieved pCR (56.7%; 95% CI, 40.9%-71.3%), and 29 patients achieved RCB 0-1 (78.4%; 95% CI, 62.8%-88.6%). The ORR and DCR were 86.5% (95% CI, 72.0%-94.1%) and 91.9% (95% CI, 78.7%-97.2%), respectively. Subgroup analysis showed that 60.6% (20/33) patients with stage II had achieved pCR, 25% (1/4) patients with stage III reached this outcome. The pCR rate was 56.5% (13/23) in patients with negative lymph nodes, and 57.1% (8/14) in those with positive lymph nodes. Treatment-emergent adverse events (TEAEs) of any grade occurred in all 37 pts, in which 20 (54.1%) were grade ≥3. The most common grade ≥3 TEAEs were neutropenia (43.2%), leukopenia (24.3%), anemia (21.6%), and thrombocytopenia (18.9%). 15 patients (40.5%) experienced immune related adverse events (irAEs), all of which were hypothyroidism. Conclusions: In this trial, we demonstrated that an anthracycline-free neoadjuvant regimen consisting of penpulimab, carboplatin and taxanes in TNBC showed promising antitumor efficacy and manageable safety profile. The study is still ongoing. Clinical trial information: ChiCTR2300071925 .

The preliminary efficacy and safety results of neoadjuvant phase II study of anlotinib plus tislelizumab combined with chemotherapy in triple-negative breast cancer.

e12600 Background: The KEYNOTE-522 trial demonstrated that adding pembrolizumab to chemotherapy improves the pathologic complete response (pCR) rate and survival in triple-negative breast cancer (TNBC). Several studies have also shown that antiangiogenic agents can enhance the response to immune-checkpoint inhibitors. This study aims to assess the efficacy and safety of anlotinib (a multitarget anti-angiogenic TKI), tislelizumab (anti-PD-1 antibody), combined with nab-paclitaxel and anthracycline as a neoadjuvant regimen for patients with TNBC. Methods: In this prospective, single-arm, open-label, phase II trial, patients with untreated, histologically confirmed TNBC in stage II-III were enrolled. Patients received 5 cycles of anlotinib (8 mg qd, d1-14; 21 days per cycle) with 6 cycles of tislelizumab (200 mg, once every 3 weeks) plus nab-paclitaxel (260 mg/m 2 , once every 3 weeks) and anthracycline (epirubicin 75 mg/m 2 or doxorubicin 60 mg/m 2 ), followed by surgery. Adjuvant chemotherapy and immunotherapy were at the discretion of the treating physician, and radiation therapy was per standard of care. The primary endpoint is the pCR (ypT0/Tis ypN0) rate, and the secondary endpoints include invasive disease-free survival (iDFS), event-free survival (EFS), overall survival (OS), adverse events (AE), and immune response biomarkers. Results: From Nov 2023 to Dec 2024, 19 patients were received neoadjuvant treatment and underwent breast surgery. The median age was 45 years (range, 30-68). At diagnosis, 16 (84.2%) patients were clinical stage II, 9/19 (47.4%) were clinically node positive. 13 of the 19 patients achieved pCR (68.4%; 95% CI, 46%-84.6%). The ORR and DCR were 47.4% (95% CI, 27.3%-68.3%) and 100% (95%CI, 85.7%-100%), respectively. Subgroup analysis showed the pCR rate of patients who were diagnosed initially to be lymph node positive was 77.7% (7/9), higher than that of patients who were lymph node negative (60%; 6/10). By the clinical stage, the pCR rate was 62.5% (10/16) in patients with stage II, and 100% (3/3) in those with stage III. Treatment-emergent adverse events (TEAEs) of any grade occurred in all 19 pts, with 15 (78.9%) experiencing grade ≥3 TEAEs. The most common grade ≥3 TEAEs were leukopenia (78.9%), neutropenia (73.7%), increased GGT (10.5%), and anemia (5.3%). Conclusions: The preliminary results demonstrated that anlotinib plus tislelizumab and chemotherapy as neoadjuvant therapy for TNBC showed promising antitumor efficacy and manageable safety profile. The study is still ongoing. Clinical trial information: NCT04914390 .

Utilization of weight management treatment and subsequent cardiovascular events among patients with breast cancer.

Overweight and obese breast cancer (BC) survivors face higher risks of recurrence and all-cause mortality, including from cardiovascular disease (CVD). Weight management therapy (WMT) may reduce cardiovascular events (CVE). We assessed trends in WMT in BC survivors and evaluated rates of CVE. We conducted a retrospective cohort study using the MarketScan Database, including overweight and obese patients (18-95years) with invasive BC (2009 -2021), who underwent breast surgery. Exclusions were prior bariatric surgery or secondary cancers. Patients were categorized by weight status and by WMT, including nutrition counseling, medications, and bariatric surgery. We utilized descriptive statistics, univariate analysis for factors associated with WMT receipt and rates of CVE, and a multivariable logistic regression model to determine WMT-associated factors. We identified 35,206 patients: 18.8% overweight, 53.7% obese class I/II/unspecified, and 27.4% obese class III. WMT was utilized by 5.3%, 6.4%, and 9.6%, respectively (p < 0.001). Among 2,484 patients who received WMT, 72.7% had nutrition counseling, 26.7% received weight loss medication, and 4.9% underwent bariatric surgery. From 2009 to 2021, WMT use increased from 3.7% to 11.3% (p < 0.001), and use of weight loss medication increased from 0.3% to 5.1% (p < 0.001). Factors associated with receipt of WMT included younger age, greater degree of obesity, more recent year of surgery, lumpectomy, higher comorbidity score, and prior WMT. CVE incidence was lower in WMT recipients (0.8% vs.1.3%, p = 0.02). In patients with BC, WMT has increased over time, and most markedly weight loss medication use. WMT is associated with lower incidence of CVE.

SEXUAL WELL-BEING AND ITS ASSOCIATION WITH BREAST SURGERY INDICATIONS: AN EXPLORATORY STUDY

Abstract Objectives Breast surgery can have a negative impact on a woman’s body image. The impact of breast cancer (BC) surgery on sexuality and body image is well described. This study investigates if surgery has impact on sexual wellbeing and/or if BC specific treatments weigh on the decline in sexual functioning. We compared sexual functioning and wellbeing in patients who underwent breast surgery for invasive BC versus patients who underwent surgery for non-invasive indications. Methods Between Oct-2021 and Jan-2024, we recruited women &amp;gt;18 years who underwent breast surgery (self-report) via: the breast clinic of University Hospitals Leuven; social media platforms of Think Pink vzw; and patients support groups. After eConsent, participants completed an online survey, which included validated questionnaires. Results Cfr table 1. Both groups had a comparable outcome for DAS and WHO-5 indicating a good partner relation and wellbeing. Combining the cutoff score of FSFI and FSDS-R we found more sexual dysfunction in the BC-group (41/74 (55.4%)) compared to the non BC-group (2/12 (16.7%)). When considering the use of endocrine therapy (ET), we noticed that a sexual disfunction was present in 52.4% of BC survivors who never took ET, 55.9% of those still taking ET and in 60.0% of those who stopped ET. We found more sexual distress after breast surgery in the invasive BC group compared to the non-BC group. While participants with invasive BC who never took ET (n = 21) had a mean FSDR-R-score of 18,14, those still taking ET (n = 43) had a mean FSDS-R-score of 24,65 and those who stopped ET had a mean FSDS-R score of 34,89. Conclusions This study shows that a higher percentage of women who underwent surgery for invasive-BC reported a sexual dysfunction. Moreover, women using ET reported lower sexual function and higher sexual distress compared to women who never used ET. Women who stopped ET reported the lowest scores on sexual function and the highest scores on sexual distress. These results highlight the importance of addressing sexual side effects during BC treatment and follow-up. Conflicts of Interest None.

Comparison between nurse anesthetists and anesthesiology residents of blood pressure management during general anesthesia: a retrospective analysis using an electronic anesthesia record database

BackgroundSeveral Japanese educational institutions have begun to train nurse anesthetists. They manage the patient consistently from pre-operation to post-operation in collaboration with the anesthesiologist. This has helped improve the quality of anesthetic management in an anesthesiologist shortage environment in Japan. However, no studies have examined the quality of anesthetic management by nurses worldwide. Therefore, this study investigated the quality of anesthesia among novice anesthesiology residents and nurse anesthetists, focusing on blood pressure control.MethodsThis study included adult patients undergoing breast surgery. Nurse anesthetists or anesthesiology residents oversaw general anesthesia. Intraoperative electronic medical records were used to compare the general anesthesia management of nurses and residents. The primary outcome was the sum of the duration during which the mean blood pressure was < 65 mmHg. This was quantified as a percentage of the total anesthesia time (time under mean 65 mmHg: TUm65). Independent variables included patient demographic characteristics, clinical information, the percentage decrease from baseline in the lowest mean blood pressure during anesthesia, and the hourly infusion volume.ResultsNo significant difference was observed in the TUm65 (nurse anesthetists vs. anesthesiology residents: median [IQR] 11.3% [3.3–20.7] vs. 18.1% [5.3–24.0], p = 0.078). No significant differences were noted between nurses and residents concerning the other outcomes.ConclusionNo significant differences were observed in the intraoperative blood pressure control between the nurse anesthetists and anesthesia residents.

Survival outcomes in hormone receptor-negative breast cancer among BRCA carriers versus noncarriers in western Sweden.

BRCA-related hormone receptor (HR)-negative breast cancers (BC) are reported to have aggressive tumor biology but also exhibit chemosensitivity. However, the impact of BRCA1/2 pathogenetic variants (PV) on BC outcomes remains unclear. This study compares survival outcomes for HR-negative BC between BRCA carriers and noncarriers. From 489 female BRCA-carriers prospectively registered in western Sweden (1996-2017), those with primary HR-negative BC who underwent breast surgery until 2019 were included in the BRCA cohort. For each BRCA-carrier, three BRCA-noncarriers with HR-negative BC were matched based on age, time of diagnosis, and follow-up duration. Overall survival (OS) was analyzed using Kaplan‑Meier estimates and Cox proportional hazard ratios after adjustment for stage, chemotherapy, and surgical technique. A sensitivity analysis was performed to investigate the effect of HER2 status on HR-negative BC diagnosed after 2007. Among the 106 BRCA carriers, 101 (95%) had a BRCA1 and 5 (5%) a BRCA2 PV. Most of the BRCA-carriers (89/106, 84%) were diagnosed with BC prior to genetic screening. Surgical techniques were similar between BRCA-carriers (n = 106) and noncarriers (n = 318). Chemotherapy was more common among BRCA-carriers (87% vs. 72%, p < 0.001). No significant difference in OS was found between BRCA-carriers and noncarriers among patients with HR-negative BC (adjusted HR: 0.81 [95% confidence interval [CI]: 0.43-1.53], p = 0.51) or considering HER2 status (adjusted HR 0.95 [95% CI: 0.43-2.07], p = 0.89). This study suggests that BRCA1/2 pathogenic variants do not independently impact survival outcomes in HR-negative BC. However, a moderate association between BRCA status and OS cannot be ruled out.

T1 Mapping-Derived Parameters in Breast Lesions: Diagnostic Accuracy and Correlation with Pathologic Features.

T1 Mapping-Derived Parameters in Breast Lesions: Diagnostic Accuracy and Correlation with Pathologic Features.

Changing Opioid Prescribing Algorithms in Plastic Surgery.

Changing opiate prescribing practices in surgical fields without guidelines or standardizations can be a daunting task. An encouraging amount of literature has shown the benefits of reducing opioid use, but many plastic surgeons hesitate to initiate this directive. We present a practice modification designed to reduce the number of opiates prescribed and highlight the steps needed to implement a new prescribing algorithm. In October of 2023, we implemented a new opiate algorithm for patients undergoing breast surgery. In the preintervention group, patients received 30 pills of postoperative opiates and recorded their consumption. Following the intervention, patients were given a maximum of 10 pills. To guide this new prescribing practice, we relied on pill consumption analysis from our preintervention group. In each cohort, data were collected on postoperative analgesic use per procedure. Forty-one survey responses were included in our preintervention cohort and 10 in our postintervention cohort. A median of 5.5 pills was consumed by patients who received implant or tissue expanders, 4.75 pills for pedicled flaps, 12 pills for fat grafting, 5 pills for breast reduction, and 12.5 pills for gender affirming mastectomies. Before and after the intervention, median opiate consumption was similar at 6 pills and 5.5 pills, respectively. Patients in both cohorts would consume pills for a median of 4 days. In the preintervention group, patients had a median of 24 unused pills. This was significantly reduced to 0.5 unused pills in the postintervention cohort (P < 0.000). Refill requirements and analgesic use by the 2 groups was not significantly different (P = 0.063 and P = 0.545). We have outlined a pathway for updating opioid prescribing algorithms in plastic surgery. Our opiate intervention significantly diminished opiate excess, reducing the risk for abuse. With growing research demonstrating the benefits of regulating prescriptions, and the best ways to implement change, surgeons can feel confident to just say yes to this meaningful reform.

Prognostic Factors and Their Impact on Survival in Patients with De Novo Metastatic Breast Cancer

This study aimed to investigate the prognostic factors affecting overall survival (OS) in patients with de novo metastatic breast cancer (dnMBC). Additionally, the importance of local treatments on survival was evaluated. The data of 106 patients with dnMBC were analyzed. Primary breast surgery was performed in 15 patients (14%), while first-line systemic therapy constituted the initial treatment modality for 91 patients (86%). Local treatments were administered to 48 patients (45%), of which 63% underwent breast surgery alone and 37% underwent both breast surgery and radiotherapy. In univariate analysis, patient performance status, extent of metastasis, response of primary breast tumors and metastatic lesions to first-line systemic therapy, administration of local treatments, and the use of breast radiotherapy and surgery were identified as prognostic factors (p&lt; 0.050). In multivariate analysis, being in the triple-negative subgroup (HR: 5.06, 95% CI: 2.46–10.43, p&lt; 0.001), having polymetastatic disease (HR: 1.19, 95% CI: 1.15–3.17, p= 0.013), partial response of metastatic lesions to first-line systemic therapy (HR: 2.25, 95% CI: 1.84–4.29, p= 0.014), and non-response to first-line systemic therapy (HR: 2.67, 95% CI: 1.56–4.59, p&lt; 0.001) were identified as independent poor prognostic factors. The median OS was 34 months, with 2-year OS at 58% and 5-year OS at 19%. The most significant prognostic factors for dnMBC in this study were molecular subtyping, extent of metastasis, and response of metastatic lesions to first-line systemic therapy. Although local treatments targeting the breast influenced prognosis, their impact was not as strong as the aforementioned variables. Keywords: De novo metastatic breast cancer, Radiotherapy, Prognostic factors, Overall survival

Tranexamic Acid for Postoperative Outcomes in Breast Plastic Surgery: A Systematic Review and Meta-analysis.

Tranexamic acid (TXA), a synthetic antifibrinolytic agent, offers considerable promise as a potential therapy to improve postoperative outcomes for patients undergoing breast surgery. However, its specific role in plastic breast surgery remains understudied. Hence, we aimed to evaluate its efficacy in cosmetic plastic breast surgery. An extensive literature search of electronic databases such as PubMed, Embase, and Cochrane CENTRAL was conducted from inception to October 2023. Quality assessment of the included studies was done using the Newcastle-Ottawa scale (NOS). The results of our analyses were presented as odds ratios (ORs) with 95% confidence intervals (CIs) and pooled using a random effects model. A p-value < 0.05 was considered significant in all cases. A total of 8 studies, encompassing 2311 participants were included in our analysis. The pooled analysis demonstrates that TXA is associated with a significant improvement in hematoma formation (OR 0.37, 95% CI: 0.24-0.58; p<0.0001). There was no significant improvement in seroma formation (OR 0.65, 95% CI: 0.33-1.27; p=0.21), infection rate (OR 1.84, 95% CI: 0.49-6.94; p=0.37) or partial loss of the nipple-areolar complex (OR 0.47, 95% CI: 0.12-1.82; p=0.28). Tranexamic acid demonstrated considerable efficacy in improving postoperative outcomes for patients undergoing cosmetic and reconstructive breast surgeries. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions toAuthors www.springer.com/00266 .

Banana Supplementation for Breast Cancer Surgery Patients: A Two-Center Experience

Introduction: Patients frequently encounter both physical and mental challenges after undergoing surgery for breast cancer, leading to a negative impact on their general well-being. Our objective was to investigate the beneficial effects of dietary supplementation with bananas on patients after breast cancer surgery. Methods: Among breast cancer patients who had undergone breast surgery, the banana group (n = 77) consumed an additional banana daily alongside their regular diet, while the non-banana group (n = 77) did not. Negative emotions, sleep quality, sexual health, complication rates, length of hospital stay, and quality of life were assessed. Results: Compared to the non-banana group, patients in the banana group exhibited lower levels of depression and anxiety, better sleep quality, more satisfactory sexual quality of life, and a higher overall quality of life postoperatively. Nonetheless, the complication rates and length of hospital stay did not show any notable variances between the 2 groups. Conclusion: This study highlights the novel finding that simple dietary supplementation with bananas significantly enhances mental well-being and overall quality of life in breast cancer patients following surgery, despite no notable impact on physical recovery metrics.

Same Day Breast Surgery Under Thoracic Epidural

Breast cancer is the most common cancer in women in the United States. In patients undergoing breast surgery who have significant pulmonary or cardiac comorbidities, an alternative anesthetic technique to general anesthesia may be desirable. This case report demonstrates the successful administration of a thoracic epidural as the primary anesthetic in a patient undergoing same-day bilateral partial mastectomies.

Frailty Trajectories Following Adjuvant Chemotherapy and Mortality in Older Women With Breast Cancer

Frailty assessed at a single time point is associated with mortality in older women with breast cancer. Little is known about how changes in frailty following cancer treatment initiation affect mortality. To evaluate the association between claims-based frailty trajectories following adjuvant chemotherapy initiation and 5-year mortality in older women with stage I to III breast cancer. This longitudinal cohort study used the Surveillance, Epidemiology, and End Results cancer registries linked to Medicare claims data (claims from 2003-2019). Women aged 65 years or older with stage I to III breast cancer diagnosed from 2004 to 2017 were included. Eligible women underwent breast surgery followed by adjuvant chemotherapy as initial treatment. A landmark design was used to identify frailty trajectories during the year following chemotherapy initiation. Continuous enrollment in Medicare fee-for-service from 180 days before cancer diagnosis through 360 days following chemotherapy initiation (landmark) was required. Women who died or disenrolled before the landmark were excluded. Analyses were conducted between September 2022 and March 2024. Claims-based frailty trajectories during the 360 days following chemotherapy initiation were identified using the Faurot frailty index, a validated claims-based proxy for frailty based on demographics and diagnosis, procedure, and durable medical equipment claims. The Faurot frailty index was calculated every 30 days from chemotherapy initiation through the landmark (360 days after chemotherapy initiation). Claims-based frailty trajectory clusters were identified using longitudinal K-means clustering. Associations between the claims-based frailty trajectory clusters and 5-year mortality from the landmark were estimated using Kaplan-Meier analysis. In total, 20 292 women with breast cancer (median [IQR] age, 70 [67-74] years) were identified. The K-means analysis resulted in 6 trajectory clusters: 3 robust (16 120 women [79.4%]) or resilient (3259 [16.1%]) trajectories and 3 nonresilient trajectories (913 women [4.5%]). Five-year mortality was higher in women belonging to the 3 nonresilient trajectories compared with those belonging to the 3 resilient trajectories (52.1% vs 20.3%; difference, 31.8%; 95% CI, 29.0%-36.2%). In this cohort study of women with stage I to III breast cancer, frailty changes following chemotherapy initiation were associated with long-term survival. Future research should assess the association of frailty interventions following cancer treatment initiation with survival and patient-centered outcomes in this population.

Comparison of Pectoral Nerve Block (II) And Erector Spinae Block for Postoperative Analgesia Following Breast Surgeries

Introduction: Effective postoperative pain management is essential in breast cancer surgeries to enhance recovery and reduce opioid-related side effects. Regional anesthesia techniques, such as the Pectoral Nerve Block (PECS-II) and Erector Spinae Plane (ESP) Block, have been used as opioid-sparing strategies. However, comparative data on their efficacy remain limited. This study aimed to evaluate and compare the analgesic effectiveness of PECS-II and ESP blocks in postoperative pain control, opioid consumption, and time to first analgesic requirement in patients undergoing breast surgery. Methodology: This randomized controlled study included 60 patients undergoing elective breast cancer surgery, divided into two groups: PECS-II (n=30) and ESP (n=30). Patients were randomly assigned using a computer-generated randomization method. Both blocks were performed under ultrasound guidance 30 minutes before general anesthesia. Postoperative pain was assessed using the Numeric Rating Scale (NRS) at multiple time intervals (immediately, 1, 2, 6, 12, and 24 hours). Primary outcomes included nalbuphine consumption, time to first analgesic requirement, and pain scores. Data were analyzed using SPSS, with p&lt;0.05 considered statistically significant. Results: The PECS-II group had lower nalbuphine consumption (1.72 ± 3.24 mg vs. 3.79 ± 4.22 mg, p = 0.037) and a longer time to first analgesic (9.01 ± 1.68 vs. 4.64 ± 0.98 hours, p = 0.001). Pain scores at all-time intervals were significantly lower in the PECS-II group (p = 0.001), indicating superior and prolonged analgesia with reduced opioid use. Conclusion: The PECS-II block provided superior postoperative analgesia with lower pain scores, reduced opioid consumption, and prolonged analgesic duration compared to the ESP block. These findings support its preference for effective pain management in breast surgeries.

Artificial intelligence can extract important features for diagnosing axillary lymph node metastasis in early breast cancer using contrast-enhanced ultrasonography

Contrast-enhanced ultrasound (CEUS) plays a pivotal role in the diagnosis of primary breast cancer and in axillary lymph node (ALN) metastasis. However, the imaging features that are clinically crucial for lymph node metastasis have not been fully elucidated. Hence, we developed a bimodal model to predict ALN metastasis in patients with early breast cancer by integrating CEUS images with the annotated imaging features. The model adopted a light-gradient boosting machine to produce feature importance, enabling the extraction of clinically crucial imaging features. In this retrospective study, the diagnostic performance of the model was investigated using 788 CEUS images of ALNs obtained from 788 patients who underwent breast surgery between 2013 and 2021, with the ground truth defined by the pathological diagnosis. The results indicated that the test cohort had an area under the receiver operating characteristic curve (AUC) value of 0.93 (95% confidence interval: 0.88, 0.98). The model had an accuracy of 0.93, which was higher than the radiologist’s diagnosis (accuracy of 0.85). The most important imaging features were heterogeneous enhancement, diffuse cortical thickening, and eccentric cortical thickening. Our model has an excellent diagnostic performance, and the extracted imaging features could be crucial for confirming ALN metastasis in clinical settings.

Impact of Rosenthal effect-based nursing intervention on self-care ability and hope level in patients undergoing breast surgery

ObjectiveTo investigate the impact of Rosenthal effect-based nursing intervention on self-care ability and hope level in patients undergoing breast surgery.MethodsA total of 200 patients with breast disease admitted to the First Affiliated Hospital of Wenzhou Medical University for treatment from January 2022 to January 2023 were randomly divided into the observation group (n = 100) and the control group (n = 100). The control group was given routine nursing care, while the observation group was additionally given Rosenthal effect-based nursing intervention. Afterward, the psychological status, self-care ability, hope level, and quality of life were compared between the 2 groups pre-and post-intervention.ResultsAfter the intervention, the observation group saw lower Self-Rating Anxiety Scale and Self-Rating Depression Scale scores than the control group. Meanwhile, the post-intervention scores of health knowledge, management skills, responsibility, management concept, positive action, close relationship with others, attitude towards the present and future, social function, psychological function, physical function, and material lifewere higher in the observation group compared with those in the control group, with statistically significant differences (p < 0.05).ConclusionRosenthal effect-based nursing intervention is beneficial for improving the psychological status, self-care ability, hope level, and quality of life of patients undergoing breast surgery. The findings suggest that this intervention should be considered for integration into standard care protocols for breast surgery patients to optimize their post-surgical outcomes and well-being. Future research should focus on evaluating the long-term effectiveness and feasibility of implementing this intervention in diverse clinical settings.

Paravertebral block is not superior to the interpectoral and pectoserratus plane block for patients undergoing breast surgery: An updated meta-analysis of randomised controlled trials with meta-regression and trial sequential analysis.

Breast surgery is frequently associated with significant acute postoperative pain, necessitating effective pain management strategies. Both thoracic paravertebral block (PVB) and interpectoral plane and pectoserratus plane (IP+PS) blocks have been used to relieve pain after breast surgery. In this systematic review and meta-analysis with trial sequential analysis, we aimed to identify the optimal analgesic technique for achieving effective pain relief in breast surgery. The primary outcome of this study was postoperative opioid consumption expressed as morphine milligram equivalent (MME) at 24 h. Secondary outcomes included resting and movement pain scores at 0, 6, 12 and 24 h, postoperative nausea and vomiting (PONV), and rescue analgesic requirements within the first 24 h. A meta-analysis of randomised controlled trials (RCTs) with meta-regression and trial sequential analysis (TSA). We systematically searched Pubmed, Scopus, the Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, Google Scholar, Medline (from inception to until 1 October 2024). RCTs that include patients undergoing breast surgery with PVB or IP+PS block, with no language restriction. Eighteen RCTs with 924 patients were included. No significant difference in MME consumption at 24 h was observed between the two techniques; mean difference (MD) -1.94 (95% confidence interval (CI) -4.27 to 0.38, P = 0.101). Subgroup analyses revealed a minor advantage for IP+PS in patients without axillary involvement; MD -2.42 (95% CI -3.56 to -1.29, P < 0.001), though below the threshold of clinical significance. Secondary outcomes, including pain scores, PONV incidence and rescue analgesic requirements were comparable. Trial sequential analysis (TSA) confirmed sufficient sample size, suggesting further studies may not alter conclusions. PVB and IP+PS blocks offer comparable analgesic efficacy and opioid-sparing effects after breast surgery, with no meaningful differences in 24-h MME consumption, pain scores, or PONV incidence.

Effectiveness of Intraoperative Ketorolac in Outpatient Breast Surgery: A Double-blinded Prospective Randomized Controlled Trial.

The use of nonnarcotic analgesics, such as ketorolac, has been shown to reduce postoperative pain and opioid consumption. This double-blinded randomized trial is designed to assess the efficacy of intraoperative ketorolac in reducing postoperative narcotic use in outpatient breast reconstruction and reduction procedures. This study is a prospective double-blinded randomized controlled trial. Adult patients, 18-64 years of age, undergoing breast surgery were randomized to receive 15 mg of ketorolac, 30 mg of ketorolac, or a placebo dose of saline. Patients' opioid requirements in the postoperative anesthesia care unit and postoperative opioid utilization and pain scores were collected through a daily survey. Postoperative hematomas were assessed before discharge and at subsequent follow-up visits for a period of 14 days. Of the 63 patients included in the study, 31 patients underwent delayed reconstruction following mastectomy and 35 patients underwent breast reduction surgery. Patients who received 30 mg of ketorolac had the fastest pain resolution (P < 0.05). The rate of opioid discontinuance was the fastest overall in patients who received 15 mg of ketorolac (rate = -0.072) when compared with the 30-mg ketorolac group (rate = -0.071) and the placebo group (rate = -0.065). Total opioid usage in the postoperative anesthesia care unit was not statistically different across the 3 groups. Only 1 patient developed a hematoma in the 15-mg ketorolac group. This study demonstrates that a single dose of intraoperative ketorolac was associated with reduced opioid usage and postoperative pain. However, due to the study size, the difference in hematoma rate was not statistically significant.

SURGICAL SITE INFECTION IN PATIENTS UNDERGOING BREAST SURGERY

Background: Breast pathologies frequently warrant surgical intervention. Surgical site infection is a common post-operative complication that is associated with significant morbidity and mortality. The current research determines incidence of surgical site infection in patients undergoing breast surgery. This will help implement preventive measures in this regard. Objective: To determine the incidence of surgical site infection in patients undergoing breast surgery. Materials and methods: It was a cross-sectional descriptive study conducted from 1st July 2023 to 31st march 2024 (9 months) in surgery unit of Khyber Teaching Hospital, Peshawar. Female patients above 15 years of age undergoing breast surgery were included while non-consenting patients were excluded. Patient’s blood specimen was sent to Pathology department for determination of blood counts and chemistry. Wound swab was obtained from the cases with infected wounds and were sent to microbiology section for culture to identify causative organism. Mean and standard deviation were used to compute quantitative variables. Frequency and percentages were used for qualitative variables. Results: Mean age of 80 study subjects is 58±29.5 (Range:39-69) years. The commonest breast procedures performed were Modified Radical Mastectomy with axillary dissection and lumpectomy which were performed in 33(41.3%) and 18(22.5%) cases respectively. The mean Hemoglobin level was 10.7 ± 1.37 (6-13). Rate of surgical site infection was 0(0%). Conclusions: The incidence of surgical site infection in patients undergoing breast surgery is negligible, which is attributed to the strict infection control measures in our operation theatre.

Spatial and temporal changes of breast-conserving surgery rates and its influential factors among Chinese patients with breast cancer from 2013 to 2019: a registry-based study

ObjectiveOur study aims to evaluate the spatial and temporal changes of breast-conserving surgery (BCS) rates and influential factors of BCS in Guangdong Province, China.Design, setting and participantsThis registry-based cohort study...