The adaptation process of a teaching and research hospital to changing trends in modern breast surgery

Ünsal, Mustafa; Dural, Ahmet Cem; Çelik, Muhammet Ferhat; Akarsu, Cevher; Başoğlu, İrfan; Dilege, M. Ece; Kapan, Selin; Alış, Halil

doi:10.5152/ucd.2014.2670

Cited by 3 publications

(3 citation statements)

References 20 publications

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“…Despite reports showing that the concerns of patients who underwent SLNB are unfounded due to the low risk of developing lymphedema, preventive measures should be taken because, although low, the risk exists. Several factors are attributed to the development of lymphedema after the SLNB and ALND procedures, such as the rupture of lymphatic vessels of the arm; 19 , 20 , 37 the fact that the sentinel lymph node draining to the breast and upper limb is the same and that its removal disrupts lymphatic drainage; 38 obesity; 20 , 21 poor surgical techniques; 39 low educational level; advanced stage of disease; infections; number of lymph nodes involved; associated comorbidities; trauma; time after surgery; 36 anatomical peculiarities of the lymphatic system, which vary among patients; 35 and combination with adjuvant radiotherapy. 40 , 41…”

Section: Discussionmentioning

confidence: 99%

Arm lymphoscintigraphy after axillary lymph node dissection or sentinel lymph node biopsy in breast cancer

Sarri¹,

Dias²,

Laurienzo³

et al. 2017

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PurposeCompare the lymphatic flow in the arm after breast cancer surgery and axillary lymph node dissection (ALND) versus sentinel lymph node biopsy (SLNB) using lymphos-cintigraphy (LS).Patients and methodsA cross-sectional study with 39 women >18 years who underwent surgical treatment for unilateral breast cancer and manipulation of the axillary lymph node chain through either ALND or SLNB, with subsequent comparison of the lymphatic flow of the arm by LS. The variables analyzed were the area reached by the lymphatic flow in the upper limb and the sites and number of lymph nodes identified in the ALND or SLNB groups visualized in the three phases of LS acquisition (immediate dynamic and static images, delayed scan images). For all analyses, the level of significance was set at 5%.ResultsThere was a significant difference between the ALND and SLNB groups, with predominant visualization of lymphatic flow and/or lymph nodes in the arm and axilla (P=0.01) and extra-axillary lymph nodes (P<0.01) in the ALND group. There was no significant difference in the total number of lymph nodes identified between the two groups. However, there was a significant difference in the distribution of lymph nodes in these groups. The cubital lymph node was more often visualized in the immediate dynamic images in the ALND group (P=0.004), while the axillary lymph nodes were more often identified in the delayed scan images of the SLNB group (P<0.01). The deltopectoral lymph node was only identified in the ALND group, but with no significant difference.ConclusionThe lymphatic flow from the axilla was redirected to alternative extra-axillary routes in the ALND group.

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Section: Discussionmentioning

confidence: 99%

Arm lymphoscintigraphy after axillary lymph node dissection or sentinel lymph node biopsy in breast cancer

Sarri¹,

Dias²,

Laurienzo³

et al. 2017

OTT

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“…The way an incision is closed and managed post-operatively affects cosmetic outcome (5). Historically, in breast cancer surgery, simultaneously ensuring treatment effect, shrinking excision scope and attending to the cosmetic effect has been important (6). To improve the aesthetic results for female patients undergoing breast cancer surgery, surgical techniques have been developed to render scars less noticeable (7,8).…”

Section: Introductionmentioning

confidence: 99%

Retrospective observational cohort study on cosmetic outcome of using Ti‑Ni memory alloy wire for intradermal suture following mastectomy in patients with breast cancer

Qin

Sun

et al. 2017

Oncol Lett

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Abstract. The method of suturing for incisions is crucial for the comprehensive treatment of clinical patients with breast cancer. Suturing is considered a major part of post-surgical recovery and may serve as a marker for evaluation of surgical outcome. The present study aimed to establish an effective means of suturing for patients who received modified radical surgery that helps to improve the cosmetic outcome of the incision. Enrolled patients were divided into an active and a control group. Ti-Ni memory alloy wire for intradermal suture in the active group and silk for interruption suture in the control group were applied to assess the different prognosis-associated factors. The Vancouver Scar Scale (VSS) was used to evaluate the wound size and the recovery time of the scars. The association between diabetes and the number of days of wound healing was also analyzed. The results indicated that the mean VSS score of the active group was decreased compared with that of the control group (P<0.001). The VSS scores of four main features (vascularity, pigmentation, pliability and height) between the two groups also statistically differed (P<0.001). Furthermore, the mean number of days of wound healing was significantly decreased for the active group compared with that for the control group (P=0.0026) in the patients with diabetes. In addition, the usage of Ti-Ni memory alloy wire was able to decrease the mean number of wound healing days between patients with diabetes and their non-diabetic counterparts (P=0.7009). The present study indicated that intradermal suture offers improved cosmetic outcome for patients undergoing mastectomy with or without axillary surgery. This technique may be useful for preventing scar overgrowth and for facilitating the recovery process in patients with diabetes. IntroductionIn 1882, Halsted pioneered the radical resection of the breast. Breast surgery methods have changed since and clinicians commonly perform breast-conserving surgery. However, the optimal approach for radical resection remains controversial (1). Along with social progress and improvements in the quality of life, patients with cancer, particularly patients with breast cancer have increasing requirements for the function and cosmetic outcome following surgery (2,3). A previous study identified that 61% of patients reported that the opinions of their partners of the scars were important to them (4). The way an incision is closed and managed post-operatively affects cosmetic outcome (5). Historically, in breast cancer surgery, simultaneously ensuring treatment effect, shrinking excision scope and attending to the cosmetic effect has been important (6). To improve the aesthetic results for female patients undergoing breast cancer surgery, surgical techniques have been developed to render scars less noticeable (7,8).In China, the majority of patients with breast cancer are treated with modified radical surgery using discontinuous silk suture, which leaves a very noticeable scar (9). A study on cosmetic surgery identified ...

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“…The evaluation of historical development of breast cancer surgery reveals that the role of radical surgical methods that have been applied in the past were replaced by less invasive methods (3). Axillary lymph node involvement is the most significant clinical prognostic factor in the treatment of breast cancer (4).…”

Section: Introductionmentioning

confidence: 99%

Evaluation of the Probability of Non-sentinel Lymph Node Metastasis in Breast Cancer Patients with Sentinel Lymph Node Metastasis using Two Different Methods

et al. 2015

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Objective: The aim of this retrospective clinical study was to evaluate the accuracy and feasibility of two different clinical scales, namely the Memorial Sloan-Kettering Cancer Center (MSKCC) nomogram and Tenon's axillary scoring system, which were developed for predicting the non-sentinel lymph node (NSLN) status in our breast cancer patients. Material and Methods:The medical records of patients who were diagnosed with breast cancer between January 2010 and November 2013 were reviewed. Those who underwent sentinel lymph node biopsy (SLNB) for axillary staging were recruited for the study, and patients who were found to have positive SLNB and thus were subsequently subjected to axillary lymph node dissection (ALND) were also included. Patients who had neoadjuvant therapy, who had clinically positive axilla, and who had stage 4 disease were excluded. Patients were divided into two groups. Group 1 included those who had negative NSLNs, whereas Group 2 included those who had positive NSLNs. The following data were collected: age, tumor size, histopathological characteristics of the tumor, presence of lymphovascular invasion, presence of multifocality, number of negative and positive NSLNs, size of metastases, histopathological method used to define metastases, and receptor status of the tumor. The score of each patient was calculated according to the MSKCC nomogram and Tenon's axillary scoring system. Statistical analysis was conducted to investigate the correlation between the scores and the involvement of NSLNs. Results:The medical records of patients who were diagnosed with breast cancer and found to have SLNB for axillary staging was reviewed. Finally, 50 patients who had positive SLNB and thus were subsequently subjected to ALND were included in the study. There were 17 and 33 patients in Groups 1 and 2, respectively. Both the MSKCC nomogram and Tenon's axillary scoring system were demonstrated to be significantly accurate in the prediction of the involvement of NSLNs (p<0.05 for each). Among all the parameters, the only one that was found to be correlated with the risk of NSLN involvement was the presence of lymphovascular invasion. Conclusion:The MSKCC nomogram and Tenon's axillary scoring system both seem to be reliable tools for the assessment of NSLN status in SLNBpositive breast cancer in our breast cancer population. Nevertheless, the omission of ALNB in SLNB-positive breast cancer cannot be yet recommended because of the lack of long-term results of current nomograms and scoring systems.

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The adaptation process of a teaching and research hospital to changing trends in modern breast surgery

Cited by 3 publications

References 20 publications

Arm lymphoscintigraphy after axillary lymph node dissection or sentinel lymph node biopsy in breast cancer

Arm lymphoscintigraphy after axillary lymph node dissection or sentinel lymph node biopsy in breast cancer

Retrospective observational cohort study on cosmetic outcome of using Ti‑Ni memory alloy wire for intradermal suture following mastectomy in patients with breast cancer

Evaluation of the Probability of Non-sentinel Lymph Node Metastasis in Breast Cancer Patients with Sentinel Lymph Node Metastasis using Two Different Methods

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