scholarly journals Reducing bias and increasing surgical knowledge: multicentre prospective breast cancer studies

2021 ◽  
Vol 108 (3) ◽  
pp. 231-232
Author(s):  
M Sund
Keyword(s):  
Breast Cancer ◽  
Breast Surgery ◽  
Risk Of Bias ◽  
Multicentre Studies ◽  
Multicentre Trials ◽  
Cancer Studies

Abstract In the March issue of BJS several hot topics within the breast surgery field are highlighted in beautifully planned and executed prospective multicentre trials. BJS encourages the surgical communities in most fields to move towards prospective collaborative and multicentre studies, thereby increasing both power and generalizability as well as reducing the risk of bias.

The role of cardio-protective agents in breast cancer patients to prevent anthracycline induced cardiotoxicity: a systematic review and network meta-analysis

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
P Jeyaprakash ◽  
S Sangha ◽  
K Robeldo ◽  
K Ellenberger ◽  
S Sivapathan ◽  
...  
Keyword(s):  
Breast Cancer ◽  
High Risk ◽  
Ace Inhibitors ◽  
Ace Inhibitor ◽  
Beta Blockers ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Breast Cancer Patients ◽  
Protective Agents ◽  
Cardio Protection

Abstract Background Anthracycline (ANT)-based chemotherapy for breast malignancies have significantly improved cancer outcomes. However, the cardiotoxicity induced by ANTs in the breast cancer population has increased major adverse cardiac events. While randomised controlled trials (RCTs) have explored different primary preventative agents to confer cardio-protection pre chemotherapy, comparisons between agents has been limited. It is unclear which drug is the most efficacious in preserving Left Ventricular Ejection Fraction (LVEF) amongst this population. Purpose To perform a network meta-analysis of RCTs comparing the impact on LVEF of various prophylactic cardio-protective agents, when prescribed to breast cancer patients prior to ANT-based chemotherapy. Methods Two independent authors performed a literature search as per the PRISMA guidelines using four databases (CENTRAL, Cochrane Reviews, MEDLINE, SCOPUS), to find RCTS evaluating cardio protective agents. The trial population was limited to patients with breast cancer without prior ANT exposure. Trials were only included if the cardio-protective agents were commenced prior to ANT dosing. The assessed outcome was a mean change in LVEF pre and post ANT dosing, compared to placebo prevention. Extracted data included age, ANT dose, and LVEF pre and post chemotherapy. The Cochrane Risk of Bias tool was used to appraise included RCTs. Results From 2807 search results, we identified twelve RCTs which evaluated 1126 patients. Seven studies assessed beta-blockers alone and two assessed combination ACE inhibitors and beta blockers. Individual studies assessing ACE inhibitors, spironolactone or rosuvastatin alone were also included. All patients were female with an average age of 50.5 and average ANT dose of 412 mg/m2. Our network meta-analysis showed beta-blockers showed significant protection with higher LVEF than placebo by 2.38% [0.52, 4.25]. ACE inhibitors showed a similar magnitude of LVEF preservation 2.59% [−0.20, 5.38] but not statistically significant due to wider CI because of lower sample size (n=250). Spironolactone showed a statistically significant preservation in LVEF by 12.80% [3.44, 22.16], however this was based on a single study (n=83), with marked measurement bias and deviations from intended intervention. All included trials had an intermediate or high risk of bias, with marked heterogeneity in ANT dosing and LVEF monitoring. Conclusion Beta-blockers minimise LVEF decline when administered prior to anthracycline chemotherapy, compared against alternate agents. Data may be underpowered to demonstrate the benefit of ACE inhibitor and combination beta blocker/ACE inhibitor prescription. The quality of RCT data to date is limited by a high risk of bias and significant heterogeneity between RCA reporting. This analysis is likely to inform clinical practice, and allow clinicians to prescribe primary cardio-protection in patients at high risk of cardiotoxicity. Funding Acknowledgement Type of funding source: None

scholarly journals Breast Cancer Surgery During the COVID-19 Pandemic: An Observational Clinical Study of the Breast Surgery Clinic at Ospedale Policlinico San Martino – Genoa, Italy

In Vivo ◽  
2020 ◽  
Vol 34 (3 suppl) ◽  
pp. 1667-1673 ◽  
Author(s):  
PIERO FREGATTI ◽  
MARCO GIPPONI ◽  
MARIA GIACCHINO ◽  
MARCO SPARAVIGNA ◽  
FEDERICA MURELLI ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Clinical Study ◽  
Breast Surgery ◽  
Cancer Surgery ◽  
Breast Cancer Surgery

Flexible parametric modelling of the hazard function in breast cancer studies

2010 ◽  
Author(s):  
Ilaria Ardoino ◽  
Federico Ambrogi ◽  
Chris Bajdik ◽  
Paulo J. Lisboa ◽  
Elia M. Biganzoli ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Hazard Function ◽  
Parametric Modelling ◽  
Cancer Studies

Dermatography: 10 Years of Applications as an Adjuvant Treatment after Nipple and Areola Reconstruction

2000 ◽  
Vol 17 (1) ◽  
pp. 23-26 ◽  
Author(s):  
Eddy M. Van Der Velden ◽  
Brigitte H. I. M. Drost ◽  
Otto E. Ijsselmuiden ◽  
Abraham M. Baruchin
Keyword(s):  
Breast Cancer ◽  
Radiation Therapy ◽  
Breast Surgery ◽  
Total Resection ◽  
Refined Method ◽  
Aesthetic Results ◽  
The Aesthetic ◽  
Small Parts ◽  
Bilateral Reconstruction ◽  
Over Time

Introduction: Nipple and areola reconstruction have recently become in demand because more women are having breast surgery because of breast cancer diagnoses. Many methods for reconstructing the nipple and areola of the breast have been described and several treatment methods have been developed to improve the aesthetic results. The purpose of this paper is to describe one method, dermatography, a refined method of medical tattooing and the results obtained from this method. Materials and Methods: Over 10 years, 112 patients were treated with dermatography for nipple and areola reconstructions. Of these, 89 patients had received a unilateral reconstruction and 23 received a bilateral reconstruction. The first dermatographic treatment was given 8–12 months after the last intervention by the plastic surgeon. The average session lasted 45 minutes. Results were assessed by means of a short questionnaire. Results over time were evaluated by comparing pictures from previous sessions. Dermatography uses a modified tattooing called a dermainjector machine. Keloidectomy is the technique used to reduce keloid in postoperative scars. The needles of the dermainjector are positioned at an angle of 70–90 degrees to the scar surface. Small parts of the keloid are removed. At the same time pigmentation is performed. Results: Patients evaluated their results as satisfactory. Pigmentation over 5 years was judged to be stable with minor loss of pigment in only 6% of the patients, all of whom received radiation therapy for their cancer. Dermatography was well tolerated by the patients. None of the patients required local anesthesia. Discussion: Patients receiving total resection of their breasts are getting younger and perceiving the results as a severe deformation of their bodies. Results of reconstruction are judged very critically. We found that our patients considered the general visual aspect of the nipple and areola shape more important, and most of the patients did not consider reconstruction of the actual nipple mound to be necessary.

Targeted breast surgery: Non-direct approach.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e12602-e12602
Author(s):  
Peter Kern ◽  
Alina Kessel ◽  
Oliver Hoffmann ◽  
Ann-Kathrin Bittner ◽  
Rainer Kimmig
Keyword(s):  
Breast Cancer ◽  
Mammary Gland ◽  
Neoadjuvant Chemotherapy ◽  
Breast Surgery ◽  
Intraoperative Ultrasound ◽  
Direct Approach ◽  
Aesthetic Result ◽  
Stage Distribution ◽  
Tumor Stages ◽  
Patient Reported

e12602 Background: Breast conserving surgery is the standard in T1-T3 primary breast cancer. The cosmetic result is very much depending upon the surgeon ́s experience, the tumor-size/breast ratio and the technique applied. We have proposed a nomogram earlier (1) which has been cited earlier by the American Society of Breast Surgeons Consensus Conference as a concept for avoidance of re-excisions and achievement of a favorable aesthetic result. Our nomogram proposed 5 simple oncoplastic techniques to handle the vast majority of breast cancer cases, with high rates of free margins. However, these techniques all used direct access to the mammary gland through the skin above the tumor, leaving permanent scars in the visible skin of the breast. To avoid this, we now have chosen a more natural access to the mammary gland along natural transitions and Langerhans´s skin lines in this prospective open-label study. Methods: We conducted a prospective open-arm study including all primary invasive and non-invasive breast cancer cases of tumor stages AJCC 0-III A (Version 8.0). Non-palbable tumors and those undergoing neoadjuvant chemotherapy had to be marked by a wire and clipped before. Intraoperative ultrasound was applied before skin incision and after removal of the tumor including ultrasound of the specimen to confirm clear margins). Resection was performed as a segmentectomy and SLN biopsy and axillary clearance was done according to national guidelines. Access to the tumor was chosen in a non-direct approach according to the proximity of the tumor to one of the following natural transitions: 1. areola 2. axillary line 3. inframammary fold. Results: 84 patients with breast conserving targeted breast surgery with a "non-direct to the tumor approach" have been enrolled so far. 76 patients had primary surgery with stage distribution as follows: Tis (1), T1a (3), T1b (8), T1c (30), T2 (30), T3 (4) and T4b(1). 8 patients had neoadjuvant chemotherapy with stage distribution as follows: ypT0 (3), ypT1a (2), ypT1c (1) and ypT2 (2). Histopathology was predominantly invasive-ductal breast cancer (70), followed by invasive-lobular (6), ductulo-lobular (5), invasive- ductal and pure DCIS (1), invasive-ductal and mucinous (1) and mucinous only (1). After first surgery according to our nomogram 77 patients had a tumor resection with free margins and 7 with involved margins, thus 91,6 % tumors were resected with free margins at first surgery. The remaining 8,4 % of cases were margin-free after second surgery. Conclusions: Scars were not visible on the surface of the breast outside of natural transitions and rate of free margins was high with targeted breast surgery at a rate of 91,6 % without any cosmetic impairment due to the remote natural access to the mammary gland. Patient-reported outcome in detail has been evaluated by validated questionnaires and demonstrated a high satisfaction with scar pattern, volume and symmetry.

scholarly journals Right Breast Mastectomy and Reconstruction with Tissue Expander under Thoracic Paravertebral Blocks in a 12-Week Parturient

2015 ◽  
Vol 2015 ◽  
pp. 1-3 ◽  
Author(s):  
Christopher Allen-John Webb ◽  
Paul David Weyker ◽  
Shara Cohn ◽  
Amanda Wheeler ◽  
Jennifer Lee
Keyword(s):  
Breast Cancer ◽  
Postoperative Pain ◽  
General Anesthesia ◽  
Pain Control ◽  
Breast Surgery ◽  
Anesthetic Management ◽  
Healthy Woman ◽  
Tissue Expander ◽  
Postoperative Pain Control ◽  
Tissue Expanders

Paravertebral blocks are becoming increasingly utilized for breast surgery with studies showing improved postoperative pain control, decreased need for opioids, and less nausea and vomiting. We describe the anesthetic management of an otherwise healthy woman who was 12 weeks pregnant presenting for treatment of her breast cancer. For patients undergoing breast mastectomy and reconstruction with tissue expanders, paravertebral blocks offer an anesthetic alternative when general anesthesia is not desired.

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