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Armando E Giuliano - One of the best experts on this subject based on the ideXlab platform.
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surgical complications associated with sentinel lymph node dissection slnd plus axillary lymph node dissection compared with slnd alone in the american college of surgeons oncology group trial z0011
Journal of Clinical Oncology, 2007Co-Authors: Anthony Lucci, Linda M Mccall, Peter D Beitsch, Patrick W Whitworth, Douglas S Reintgen, P Blumencranz, Marilyn A Leitch, Sukumal Saha, Kelly K. Hunt, Armando E GiulianoAbstract:Purpose The American College of Surgeons Oncology Group trial Z0011 was a prospective, randomized, multicenter trial comparing overall survival between patients with positive sentinel lymph nodes (SLNs) who did and did not undergo axillary lymph node dissection (ALND). The current study compares complications associated with SLN dissection (SLND) plus ALND, versus SLND alone. Patients and Methods From May 1999 to December 2004, 891 patients were randomly assigned to SLND + ALND (n = 445) or SLND alone (n = 446). Information on wound infection, axillary Seroma, paresthesia, brachial plexus injury (BPI), and lymphedema was available for 821 patients. Results Adverse surgical effects were reported in 70% (278 of 399) of patients after SLND + ALND and 25% (103 of 411) after SLND alone (P ≤ .001). Patients in the SLND + ALND group had more wound infections (P ≤ .0016), Seromas (P ≤ .0001), and paresthesias (P ≤ .0001) than those in the SLND-alone group. At 1 year, lymphedema was reported subjectively by 13% (3...
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surgical complications associated with sentinel lymph node dissection slnd plus axillary lymph node dissection compared with slnd alone in the american college of surgeons oncology group trial z0011
Journal of Clinical Oncology, 2007Co-Authors: Anthony Lucci, Linda M Mccall, Peter D Beitsch, Patrick W Whitworth, Douglas S Reintgen, P Blumencranz, Marilyn A Leitch, Sukumal Saha, Kelly K. Hunt, Armando E GiulianoAbstract:PURPOSE: The American College of Surgeons Oncology Group trial Z0011 was a prospective, randomized, multicenter trial comparing overall survival between patients with positive sentinel lymph nodes (SLNs) who did and did not undergo axillary lymph node dissection (ALND). The current study compares complications associated with SLN dissection (SLND) plus ALND, versus SLND alone. PATIENTS AND METHODS: From May 1999 to December 2004, 891 patients were randomly assigned to SLND + ALND (n = 445) or SLND alone (n = 446). Information on wound infection, axillary Seroma, paresthesia, brachial plexus injury (BPI), and lymphedema was available for 821 patients. RESULTS: Adverse surgical effects were reported in 70% (278 of 399) of patients after SLND + ALND and 25% (103 of 411) after SLND alone (P
Z E Winters - One of the best experts on this subject based on the ideXlab platform.
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randomized clinical trial on the effect of fibrin sealant on latissimus dorsi donor site Seroma formation after breast reconstruction
British Journal of Surgery, 2012Co-Authors: R Llewellynbennett, Z Rayter, Rosemary Greenwood, John R Benson, Rachel English, J Turner, Z E WintersAbstract:Background: Latissimus dorsi (LD) flap procedures comprise 50 per cent of breast reconstructions in the UK. They are frequently complicated by Seroma formation. Fibrin sealants may reduce Seroma volumes at the donor site. The aim was to investigate the effect of fibrin sealant (Tisseel®) on total Seroma volumes from the breast, axilla and back (donor site) after LD breast reconstruction. Secondary outcomes were specific back Seroma volumes together with incidence and severity of wound complications. Methods: Consecutive women undergoing implant-assisted or extended autologous LD flap reconstruction were randomized to either standard care or application of fibrin sealant to the donor-site chest wall. All participants were blinded for the study duration but assessors were only partially blinded. Non-parametric methods were used for analysis. Results: A total of 107 women were included (sealant 54, control 53). Overall back Seroma volumes were high, with no significant differences between control and sealant groups over 3 months. Fibrin sealant failed to reduce in situ back drainage volumes in the 10 days after surgery, and did not affect the rate or volume of Seromas following drain removal. Conclusion: This randomized study, which was powered for size effect, failed to show any benefit from fibrin sealant in minimizing back Seromas after LD procedures. Copyright © 2012 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
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randomized clinical trial of the effect of quilting latissimus dorsi flap donor site on Seroma formation
British Journal of Surgery, 2006Co-Authors: I Daltrey, H Thomson, M Hussien, K Krishna, Z Rayter, Z E WintersAbstract:Background: Latissimus dorsi (LD) flap breast reconstruction is associated with a high incidence of donor site Seromas, despite the use of surgical drains. The aim of this study was to evaluate the use of donor site quilting sutures, as well as drains, on the incidence, volume and frequency of Seroma aspiration. Methods: The trial randomized 108 women undergoing LD breast reconstruction to quilting procedures (54) or control group (52) for intention-to-treat analysis; two were excluded. Outcome measures were the incidence and volume of postoperative Seroma. Secondary outcome measures included postoperative back pain, analgesic consumption, shoulder movement and duration of hospital stay. Results: Quilting significantly reduced the overall incidence of Seroma from 46 of 48 (96 per cent) to 43 of 52 (83 per cent) (P = 0·036), including the 38 women who had extended LD flap (with or without implants). There were further significant reductions in Seroma volume (P = 0·004), frequency of aspiration (P = 0·001) and overall Seroma volumes, including surgical drainage and symptomatic Seromas (P = 0·013). Subset analyses for LD–implant (60 women) and extended LD (with or without implant) showed similar significance. Quilting did not affect back pain or compromise shoulder mobility. Conclusion: Quilting significantly reduced overall Seroma volumes after LD breast reconstruction including extended LD, and is recommended in combination with surgical drains. Copyright © 2006 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
Riccardo Bonomi - One of the best experts on this subject based on the ideXlab platform.
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fibrin glue instillation under skin flaps to prevent Seroma related morbidity following breast and axillary surgery
Cochrane Database of Systematic Reviews, 2013Co-Authors: Muhammad S Sajid, Kristian H Hutson, Ignazio F Rapisarda, Riccardo BonomiAbstract:BACKGROUND Fibrin glue (FG) combines fibrinogen and thrombin, under the presence of factor XIII and calcium chloride, and produces a 'fibrin clot' as would occur through the natural clotting cascade. FG is thought to close over any small vessels including lymphatics that are too small for conventional surgical closure, thereby reducing Seroma formation, Seroma incidence and related comorbidities. OBJECTIVES To assess the evidence on the effectiveness of FG in people undergoing breast and axillary surgery and to establish whether FG is an efficient modality to prevent postoperative Seroma and Seroma-related outcomes. SEARCH METHODS We searched the Cochrane Breast Cancer Group's (CBCG) Specialised Register (9 December 2011), the Cochrane Central Register of Controlled Trials (CENTRAL, Issue 1 2012), MEDLINE (9 December 2011), EMBASE (9 December 2011), LILACS (22 October 2012), SCI-E (22 October 2012), the World Health Organization's International Clinical Trial Registry (9 December 2011) and ClinicalTrials.gov (22 October 2012). SELECTION CRITERIA Randomised controlled trials (RCTs) comparing the effectiveness of FG in terms of reducing the postoperative Seroma incidence and related comorbidities in people undergoing breast and axillary surgery. DATA COLLECTION AND ANALYSIS At least two review authors independently scrutinised search results, selected eligible studies and extracted the data. The pooled analysis of the extracted data was achieved by the statistical analysis on Review Manager software. The quality of studies was assessed using The Cochrane Collaboration's 'Risk of bias' tool. MAIN RESULTS The search of four standard electronic databases yielded 119 potentially relevant studies but only 18 RCTs involving 1252 people were found suitable for statistical analysis. There was significant heterogeneity among trials and the majority of trials were of poor quality. The use of FG under skin flaps following breast and axillary surgery failed to reduce the incidence of postoperative Seroma (risk ratio (RR) 1.02; 95% Confidence Interval (CI) 0.90 to 1.16, P value = 0.73), mean volume of Seroma (standardised mean difference (SMD) -0.25; 95% CI -0.92 to 0.42, P value = 0.46), wound infection (RR 1.05; 95% CI 0.63 to 1.77, P value = 0.84), postoperative complications (RR 1.13; 95% CI 0.63 to 2.04, P value = 0.68) and length of hospital stay (SMD -0.2; 95% CI -0.78 to 0.39, P value = 0.51). FG reduced the total volume of drained Seroma (SMD -0.75, 95% CI -1.24 to -0.26, P value = 0.003) and duration of persistent Seromas requiring frequent aspirations (SMD -0.59; CI 95% -0.95 to -0.23, P value = 0.001). AUTHORS' CONCLUSIONS FG did not influence the incidence of postoperative Seroma, the mean volume of Seroma, wound infections, complications and the length of hospital stays in people undergoing breast cancer surgery. Due to significant methodological and clinical diversity among the included studies this conclusion may be considered weak and biased. Therefore, a major multicentre and high-quality RCT is required to validate these findings.
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prevention of postoperative Seroma related morbidity by quilting of latissimus dorsi flap donor site a systematic review
Clinical Breast Cancer, 2011Co-Authors: Muhammad S Sajid, Dibendu Betal, N Akhter, I F Rapisarda, Riccardo BonomiAbstract:Abstract Objective To systematically analyze the effectiveness of quilting of latissimus dorsi (LD) flap donor site in the prevention of Seroma and related morbidities. Methods All published studies comparing the effectiveness of quilting versus no-quilting of LD flap donor site in the prevention of Seroma and related morbidities in patients undergoing breast reconstruction were analysed systemically. Results Five comparative studies on quilting versus no-quilting encompassing 440 patients were suitable for statistical analysis. There was no heterogeneity among trials. Therefore, in the fixed-effects model, quilting was effective in terms of reducing the incidence of donor-site Seroma formation, reducing the average volume of the Seroma, and reducing the total volume of drained Seroma. In addition, quilting did not increase the risk of postoperative complications. Combined quilting and fibrin glue was also effective in reducing the average volume of the Seroma and total drained volume of the Seroma. Combination of quilting and glue did not influence the incidence of Seroma formation at LD flap donor site and overall operative complications. Conclusion Quilting of the LD flap donor site is helpful in reducing the incidence of Seroma formation, reducing Seroma volume, and reducing total drained Seroma volume. Combined quilting and fibrin glue further enhances its effectiveness. Quilting with or without fibrin glue may be considered an option in patients undergoing LD flap breast reconstruction to control Seroma-related morbidity. However, a major multicenter randomized controlled trial is required to achieve stronger and reliable evidence before recommending it as a routine procedure.
Anthony Lucci - One of the best experts on this subject based on the ideXlab platform.
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surgical complications associated with sentinel lymph node dissection slnd plus axillary lymph node dissection compared with slnd alone in the american college of surgeons oncology group trial z0011
Journal of Clinical Oncology, 2007Co-Authors: Anthony Lucci, Linda M Mccall, Peter D Beitsch, Patrick W Whitworth, Douglas S Reintgen, P Blumencranz, Marilyn A Leitch, Sukumal Saha, Kelly K. Hunt, Armando E GiulianoAbstract:Purpose The American College of Surgeons Oncology Group trial Z0011 was a prospective, randomized, multicenter trial comparing overall survival between patients with positive sentinel lymph nodes (SLNs) who did and did not undergo axillary lymph node dissection (ALND). The current study compares complications associated with SLN dissection (SLND) plus ALND, versus SLND alone. Patients and Methods From May 1999 to December 2004, 891 patients were randomly assigned to SLND + ALND (n = 445) or SLND alone (n = 446). Information on wound infection, axillary Seroma, paresthesia, brachial plexus injury (BPI), and lymphedema was available for 821 patients. Results Adverse surgical effects were reported in 70% (278 of 399) of patients after SLND + ALND and 25% (103 of 411) after SLND alone (P ≤ .001). Patients in the SLND + ALND group had more wound infections (P ≤ .0016), Seromas (P ≤ .0001), and paresthesias (P ≤ .0001) than those in the SLND-alone group. At 1 year, lymphedema was reported subjectively by 13% (3...
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surgical complications associated with sentinel lymph node dissection slnd plus axillary lymph node dissection compared with slnd alone in the american college of surgeons oncology group trial z0011
Journal of Clinical Oncology, 2007Co-Authors: Anthony Lucci, Linda M Mccall, Peter D Beitsch, Patrick W Whitworth, Douglas S Reintgen, P Blumencranz, Marilyn A Leitch, Sukumal Saha, Kelly K. Hunt, Armando E GiulianoAbstract:PURPOSE: The American College of Surgeons Oncology Group trial Z0011 was a prospective, randomized, multicenter trial comparing overall survival between patients with positive sentinel lymph nodes (SLNs) who did and did not undergo axillary lymph node dissection (ALND). The current study compares complications associated with SLN dissection (SLND) plus ALND, versus SLND alone. PATIENTS AND METHODS: From May 1999 to December 2004, 891 patients were randomly assigned to SLND + ALND (n = 445) or SLND alone (n = 446). Information on wound infection, axillary Seroma, paresthesia, brachial plexus injury (BPI), and lymphedema was available for 821 patients. RESULTS: Adverse surgical effects were reported in 70% (278 of 399) of patients after SLND + ALND and 25% (103 of 411) after SLND alone (P
David E Wazer - One of the best experts on this subject based on the ideXlab platform.
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persistent Seroma after intraoperative placement of mammosite for accelerated partial breast irradiation incidence pathologic anatomy and contributing factors
International Journal of Radiation Oncology Biology Physics, 2006Co-Authors: Suzanne B Evans, Seth A Kaufman, Lori Lyn Price, Gene A Cardarelli, Thomas A Dipetrillo, David E WazerAbstract:Purpose: To investigate the incidence of, and possible factors associated with, Seroma formation after intraoperative placement of the MammoSite catheter for accelerated partial breast irradiation. Methods and Materials: This study evaluated 38 patients who had undergone intraoperative MammoSite catheter placement at lumpectomy or reexcision followed by accelerated partial breast irradiation with 34 Gy in 10 fractions. Data were collected regarding dosimetric parameters, including the volume of tissue enclosed by the 100%, 150%, and 200% isodose shells, dose homogeneity index, and maximal dose at the surface of the applicator. Clinical and treatment-related factors were analyzed, including patient age, patient weight, history of diabetes and smoking, use of reexcision, interval between surgery and radiotherapy, total duration of catheter placement, total excised specimen volume, and presence or absence of postprocedural infection. Seroma was verified by clinical examination, mammography, and/or ultrasonography. Persistent Seroma was defined as Seroma that was clinically detectable >6 months after radiotherapy completion. Results: After a median follow-up of 17 months, the overall rate of any detectable Seroma was 76.3%. Persistent Seroma (>6 months) occurred in 26 (68.4%) of 38 patients, of whom 46% experienced at least modest discomfort at some point during follow-up. Of these symptomatic patients, 3 required biopsy or complete cavity excision, revealing squamous metaplasia, foreign body giant cell reaction, fibroblasts, and active collagen deposition. Of the analyzed dosimetric, clinical, and treatment-related variables, only body weight correlated positively with the risk of Seroma formation (p 0.04). Postprocedural infection correlated significantly (p 0.05) with a reduced risk of Seroma formation. Seroma was associated with a suboptimal cosmetic outcome, because excellent scores were achieved in 61.5% of women with Seroma compared with 83% without Seroma. Conclusion: Intraoperative placement of the MammoSite catheter for accelerated partial breast irradiation is associated with a high rate of clinically detectable Seroma that adversely affects the cosmetic outcome. The Seroma risk was positively associated with body weight and negatively associated with postprocedural infection. © 2006 Elsevier Inc. Accelerated partial breast irradiation, MammoSite, Seroma, Radiotherapy, Breast cancer.
