Introduction Recent data suggest that margins ≥2 mm after breast-conserving surgery may improve local control in invasive breast cancer (BC). By allowing large resection volumes, oncoplastic breast-conserving surgery (OBCII; Clough level II/Tübingen 5-6) may achieve better local control than conventional breast conserving surgery (BCS; Tübingen 1-2) or oncoplastic breast conservation with low resection volumes (OBCI; Clough level I/Tübingen 3-4). Methods Data from consecutive high-risk BC patients treated in 15 centers from the Oncoplastic Breast Consortium (OPBC) network, between January 2010 and December 2013, were retrospectively reviewed. Results A total of 3,177 women were included, 30% of whom were treated with OBC (OBCI n = 663; OBCII n = 297). The BCS/OBCI group had significantly smaller tumors and smaller resection margins compared with OBCII (pT1: 50% vs. 37%, p = 0.002; proportion with margin <1 mm: 17% vs. 6%, p < 0.001). There were significantly more re-excisions due to R1 (“ink on tumor”) in the BCS/OBCI compared with the OBCII group (11% vs. 7%, p = 0.049). Univariate and multivariable regression analysis adjusted for tumor biology, tumor size, radiotherapy, and systemic treatment demonstrated no differences in local, regional, or distant recurrence-free or overall survival between the two groups. Conclusions Large resection volumes in oncoplastic surgery increases the distance from cancer cells to the margin of the specimen and reduces reexcision rates significantly. With OBCII larger tumors are resected with similar local, regional and distant recurrence-free as well as overall survival rates as BCS/OBCI.

AbstractAims. To devise a scoring system for clinical variables related to positive findings at relaparotomy in secondary peritonitis. Methods. We have retrospectively studied 195 cases of patients after relaparotomy. According to the operation’s findings, the patients were divided into two groups: ‘relaparatomy unnecessary’ group A, ‘relaparotomy necessary’ group B. 6 factors (age, sex, leukocyte count, C reactive protein, time of symptoms to index operation, Mannheim Peritonitis Index) were evaluated in respect to their significance in decision making for relaparotomy. The predictive value for positive operation`s findings of these factors was evaluated by logistic multivariate regression analysis. According to this model a risk scoring system was created to support the decision whether to perform a relaparotomy. Results. Relaparotomy was unnecessary (Group A) for 154 (79,0%) patients, for 41 (21,0%) it was necessary (Group B). Comparing the groups A and B, we found a significant difference in patients’ mean age (54 v. 63 years, p=0,002), mean CRP level (133,2 v. 182,8 mg/L, p=0,025), mean time of symptoms to index operation (38,1 v. 67,1 hours, p=0,006) and mean MPI value (22,4 v. 29,4, p<0,0001). According to the above-mentioned predictors, a scoring system was devised: −0,17-(0,003×patient’s age years)+(0.153×time of symptoms to index operation hours)-(0,297×MPI)+(0,192×CRP mg/l). The score was 24,798±25,593 in group A and 36,572±32,543 in group B(p=0,028). Conclusions: Scoring system was devised to assist in creating treatment strategy after secondary peritonitis. If the score is ≥37, a planned relaparotomy should be performed. If the score is ≤24, other diagnostic and therapeutic tactics should be applied.

Background. The aim of this article is to present a rare clinical case of vasa praevia as well as to assess the relevance of the problem by reviewing the latest literature sources.Materials and methods. In this report we present a case of a 33-yearold woman diagnosed with vasa praevia at 33 weeks of pregnancy, after hospitalisation with preterm rupture of membranes following the delivery of a live healthy baby through a lower segment Caesarean section during 33rd week of gestation at Vilnius University Hospital Santariškių Clinics. We investigated all the documentation of the patient before and after delivery.Results and conclusions. Vasa praevia is a rather rare pathology which is likely to occur during pregnancy, may result in heavy bleeding and be particularly threatening to the fetus life. A timely diagnosis for these women is essential. The gold standard for vasa praevia diagnosis is the fetal ultrasound scan. Vasa praevia pathology is found during the routine second trimester ultrasound check-up. The selection of proper tactics applied during pregnancy care is essential. At the gestational age of 28-32, it is advisable to mature fetal lungs as well as the fetus condition should be investigated by a perinatologist. The mode of delivery is the C-section which tends to reduce the frequency of possible complications.

No abstract