This study investigated whether the type of surgical procedure used to treat breast cancer (mastectomy versus breastconserving lumpectomy) had any effect on the quality of life and social status of women. The prospective analysis included 382 women newly diagnosed with nonmetastatic breast cancer who had undergone a surgical intervention for breast carcinoma at our institution: 198 patients had undergone mastectomy with axillary lymphadenectomy and 184 patients had undergone breast-conserving lumpectomy with local axillary lymphadenectomy. The post-mastectomy women reported significantly more financial problems, a lowered social status and more physical symptoms compared with the breast-conserving post-lumpectomy patients. The patients that underwent lumpectomy were more satisfied with their body image and their sexual life. Since the adverse financial effects of wage loss can significantly decrease a patient's quality of life, this study indicates that postmastectomy patients in particular need to be protected more effectively against a decline in their social status.

We evaluated postoperative concentrations of inflammatory indicators, including procalcitonin, after gynaecological operations for benign and malignant tumours in patients with a normal postoperative course and assessed the utility of procalcitonin in differentiating between non-bacterial inflammation and bacteraemic complications in the postoperative period. This prospective study included 99 patients: 47 after a standard gynaecological operation (Piver I) and no postoperative infectious complications (group 1), 35 after a major procedure (Piver II or III) and no postoperative infectious complications (group 2), and five with postoperative sepsis after Piver II or III procedures (group 3). We also studied serum procalcitonin concentrations in a group of 12 patients (group 4) with terminal forms of gynaecological cancer who were hospitalized for palliative treatment but did not undergo surgery. Postoperative C-reactive protein (CRP) concentration corresponded with extent of tissue trauma in groups 1 and 2 and was significantly lower in group 1 than group 2. Inflammatory indicators were highest in groups 1 and 2 on postoperative day 2. In group 3, in which sepsis developed, values were highest on postoperative day 4. In particular, procalcitonin was > 2 ng/ml in all patients with postoperative sepsis by postoperative day 2 but was always 2 ng/ml, with no signs of infection or raised CRP. It is concluded that, for early detection of postoperative infectious complications after gynaecological surgery, procalcitonin levels > 2 ng/ml are more specific than CRP.

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