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Carla S Fisher - One of the best experts on this subject based on the ideXlab platform.
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early postoperative outcomes in breast conservation surgery versus Simple Mastectomy with implant reconstruction a nsqip analysis of 11 645 patients
Annals of Surgical Oncology, 2016Co-Authors: Bryan Pyfer, Abhishek Chatterjee, Brian J Czerniecki, Julia Tchou, Lilian Chen, John F Nigriny, Carla S FisherAbstract:Little has been studied that compares early postoperative outcomes between breast conservation surgery (BCS) and Simple Mastectomy with implant reconstruction (SM). Our goal was to utilize a large-volume database to compare such outcomes in women with early stage breast cancer. The National Surgery Quality Improvement Program (NSQIP) database was searched for patients who underwent partial or complete Mastectomy between 2009 and 2012. Exclusion criteria eliminated potential confounding factors. We compared preoperative comorbidities and postoperative complication rates between each treatment group by Chi square and two-sample t tests; we also determined the odds ratios for the likelihood of adverse events in a number of categories. A total of 11,645 patients met the study criteria: 9571 underwent BCS and 2074 underwent SM with implant reconstruction. The baseline characteristics of the two groups showed significant differences for age (61.7 years in BCS, 53.5 years in SM), body mass index (29.6 kg/m2 in BCS, 27.0 kg/m2 in SM), and rates of hypertension (47.0 % in BCS, 25.6 % in SM), coronary artery disease (1.3 % in BCS, 0.6 % in SM), chronic obstructive pulmonary disease (2.4 % in BCS, 1.0 % in SM), and diabetes (11.7 % in BCS, 5.9 % in SM). Statistical analysis between each treatment modality revealed that the SM with implant group had significantly higher total complication (5.5 vs. 2.1 % in BCS), wound (2.8 vs. 1.4 % in BCS), infection (1.9 vs. 0.4 % in BCS), and bleeding (0.2 vs. 0.05 % in BCS) rates than the BCS group. BCS has fewer overall early postoperative wound, infectious, and bleeding complications despite a significantly higher rate of preexisting risk factors.
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early postoperative outcomes in lumpectomy versus Simple Mastectomy
Journal of Surgical Research, 2015Co-Authors: Abhishek Chatterjee, Bryan Pyfer, Brian J Czerniecki, Kari M Rosenkranz, Julia Tchou, Carla S FisherAbstract:Abstract Background Relatively scarce outcomes research exists that compares early postoperative complications between breast conservation surgery (BCS) and Simple Mastectomy (SM). Such information would improve a surgeon's ability to provide informed consent when considering treatment options, especially for women with early stage breast cancer who have the option to receive either BCS or SM. Materials and methods The National Surgical Quality Improvement Program database from years 2009–2012 was analyzed. For each treatment group, we used Current Procedural Terminology codes specific to the treatment modality with sentinel lymph node biopsy as an inclusion criteria. We excluded patients who received axillary lymphadenectomies, bilateral disease or symmetry procedures, and additional breast reconstructive surgery. We compared each group with chi square and two-sample t-tests to look for preoperative comorbidity differences, then used unadjusted odds ratios to compare postoperative complication rates. Results Inclusion and exclusion criteria provided 6682 patients in the BCS group and 3339 patients in the SM group. Baseline comorbid condition characteristics showed no clinical differences between groups except for diabetes (8.5% in SM versus 6.5% in BCS). Statistical analysis between each treatment modality revealed that the SM group had significantly higher wound complications, bleeding, infections, and overall complications than the BCS group. Conclusions Although both BCS and SM options have low early postoperative complication rates when treating early stage breast cancer, BCS has fewer complications with regard to bleeding, wound complications and infections.
Roger W. Blamey - One of the best experts on this subject based on the ideXlab platform.
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the prediction of local or regional recurrence after Simple Mastectomy for operable breast cancer
British Journal of Surgery, 2005Co-Authors: M R Williams, C W Elston, C P Hinton, J H Todd, D A L Morgan, Roger W. BlameyAbstract:Both the histological grade of the primary tumour and lymph node status have been found to contribute significantly towards the development of a local or regional recurrence after Simple Mastectomy for operable breast cancer. No other factor, from a series of seven studied, has been found to be of independent significance. A small group of patients with grade III tumours, lymph node positive at Mastectomy, has been identified in whom more than 40 per cent of all symptomatic local or regional recurrences occurred. The chance a patient in this group has of developing a local or regional recurrence requiring treatment within 4 years approaches 50 per cent.
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local recurrence after Simple Mastectomy
British Journal of Surgery, 2005Co-Authors: S Orourke, M H Galea, D L Morgan, D Euhus, Sarah E Pinder, I O Ellis, C W Elston, Roger W. BlameyAbstract:A retrospective study was carried out to determine the clinical significance of local recurrence after Simple Mastectomy and node biopsy for primary operable breast cancer, without postoperative irradiation or systemic adjuvant therapy. Local recurrence was defined as a histologically proven lesion in or deep to the Mastectomy skin flaps. A total of 966 patients with a median follow-up of 7 years were reviewed. Of these, 223 (23 per cent) developed local recurrence but half the tumours were small single lesions; 70 women had multiple discrete lesions and 21 diffuse carcinomatous dermal infiltration. Local recurrence showed significant associations with tumour grade, nodal status and the presence of lymphovascular invasion in the primary tumour. A predictive index containing these three variables was constructed. Adjuvant irradiation of the flaps is recommended for patients with high scores; such women would otherwise have a 39 per cent chance of developing local recurrence by 5 years. Different types of local recurrence have different chances of responding to local therapy: 13 per cent of single local recurrences, 32 per cent of multiple spot recurrences and 70 per cent of the diffuse type failed to respond to local therapy. Local recurrence predicts reduced patient survival.
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comparison of psychological aspects and patient satisfaction following breast conserving surgery Simple Mastectomy and breast reconstruction
European Journal of Cancer, 2000Co-Authors: S K Alghazal, Lesley Fallowfield, Roger W. BlameyAbstract:The aim of this study was to assess and compare the psychological outcome and satisfaction of patients whom underwent wide local excision, Mastectomy alone and Mastectomy with breast reconstruction. A total of 577 patients had different types of operations for primary breast cancer (254 (44%) had wide local excision, 202 (35%) had Simple Mastectomy and 121 (21%) had breast reconstruction). Psychosocial morbidity and satisfaction were studied retrospectively using self-evaluation questionnaires. The three different surgical groups were cross-matched into four different age group. Significant statistical differences existed between the three procedures regarding satisfaction and psychosocial morbidity (anxiety, depression, body image, sexuality and self-esteem) in favour of wide local excision followed by breast reconstruction. Greatest morbidity was seen in the Mastectomy group. Patient satisfaction of cosmetic outcome and psychosocial aspects was greater with wide local excision than with breast reconstruction or Mastectomy. However, since wide local excision is indicated in only a group of patients, breast reconstruction should be an option available to patients requiring Mastectomy.
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paget s disease of the nipple
British Journal of Surgery, 1991Co-Authors: A R Dixon, C W Elston, M H Galea, Ian O Ellis, Roger W. BlameyAbstract:A total of 48 women with Paget's disease of the nipple (nipple eczema containing Paget cells but without a palpable lump) presented to one surgeon over a 13-year period. Temporary healing of the nipple eczema occurred in six patients. In all, 21 of 34 patients with in situ (DCIS) or invasive ductal carcinoma had mammographic abnormalities. Treatment was by Simple Mastectomy (37 cases), cone excision of the nipple-areola complex (ten cases) and tamoxifen (one case). DCIS was found in 45 operative specimens (96 per cent); eight had associated invasion. The DCIS was predominantly large cell solid/comedo in type and was multifocal in seven cases (19 per cent). At a median (range) follow-up of 56 (18–96) months, four of the ten patients treated by cone excision have developed a local recurrence, two of these patients have also developed metastases. Two of the 37 patients who underwent Mastectomy developed loco-regional recurrences; both had invasive foci at their first operation and remain disease free at 8 years. We no longer feel that cone excision is appropriate treatment.
A A Shivas - One of the best experts on this subject based on the ideXlab platform.
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Simple Mastectomy and pectoral node biopsy
British Journal of Surgery, 2005Co-Authors: A P M Forrest, M M Roberts, E L M Cant, A A ShivasAbstract:Evidence is presented to support the view that biopsy of the pectoral and axillary tail nodes obtained at Simple (total) Mastectomy gives a reliable estimate of axillary node status. The technique is described.
Zoltan Matrai - One of the best experts on this subject based on the ideXlab platform.
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abstract ot 23 01 examining and comparing the temporal changes and results of cosmetic quality of life and patient satisfaction achieved with immediate and delayed immediate implant based breast reconstruction procedures and contralateral symmetrisation techniques after skin sparing mastectomies with unilateral Simple Mastectomy and with bilateral skin sparing mastectomies and immediate implant based breast reconstructive surgeries clinicaltrials gov identifier nct04356235
Cancer Research, 2021Co-Authors: Mihaly Ujhelyi, Akos Savolt, Orsolya Huszar, Orsolya Ping, Norbert Meszaros, Nora Jani, Matyas Ujlaki, Istvan Kenessey, Zsofia Jozsef, Zoltan MatraiAbstract:IntroductionThe immediate (I-BR) or delayed-immediate (DI-BR) implant-based breast reconstruction (BR) of the affected breast following nipple, areola, skin-sparing Mastectomy (NSM, ASM, SSM) techniques requires almost in all cases symmetrization of the contralateral breast. The long term results of implant-based BR (subpectoral or prepectoral) and symmetrization following advanced postMastectomy BR techniques significantly decrease over time and later result in a limited patient satisfaction rate. Beyond the satisfactory early results BRs, there are only limited long term data on cosmetics and patient satisfaction. In fact with time patient dissatisfaction necessitates repeated surgeries, with an extra load for both to the patient and the health system. The aim of the study is to gain high quality data about the deteriorating cosmetic outcomes of bilateral BRs on the long term. Trial design In this response-adaptive prospective randomized study patients are sub-grouped into 6 study groups after BR surgery with silicone implant (following uni- or bilateral NSM, ASM, SSM) with symmetrization in case of unilateral Mastectomy (mastopexy and/or silicone implant and/or mesh sling technique to suspend the breast with or without reduction) or Simple Mastectomy without symmetrization. The planned number of patients is a minimum of 528 cases. The measurements of the breast, the ptosis, photo documentation using valid BCCT.core software, BREAST-Q questionnaire and Likert scale are performed preoperatively, 4 weeks after delayed BR with symmetrization, 3 months after, every 6 months for 5 years. Primary endpoint Using correlation analysis to measure objective changes over time in the quality of life (QoL) and patient satisfaction associated with the symmetry achieved by different surgical techniques up to five years of follow-up. To compare the QoL and the satisfaction rate in the control group with a Simple Mastectomy, bilateral SSM, ASM, NSM and BR. Secondary endpoint To determine the prognostic factors, patient subgroups, and surgical techniques associated with patients, surgery, and oncological therapies in an optimal way. Furthermore, the study should give relevant data about the oncoplastic concept of prophylactic SSM, ASM, or NSM on the contralateral side and BR, without the presence of hereditary breast and ovarian cancer syndrome, using the same surgical technique than on the affected side. The long term PRO results of postMastectomy BR should be necessarily part of the initial patient information in the future. Inclusion criteria- Under the age of 65 with uni- or bilateral primary breast cancer, needing advanced Mastectomy independently of the axillary surgery, having I-BR os DI-BR on the ipsilateral side and symmetrization on the contralateral side - Control group: patients under 65 years with unilateral Simplex Mastectomy without BR. Exclusion criteria-Pregnancy-associated breast cancer-Prior breast surgery and/or radiotherapy -Severe non-surgical complication-Long-term steroid usage Present accrual and target accrual The trial was activated on 22 April 2020. As of 5 July, 23 patients have been randomized. Accrual is currently running according to protocol and is planned until 2025. Interim analysis performed after 2 years’ median follow-up period. The final analysis is performed 5 years after closing the patient inclusion period. Citation Format: Mihaly Ujhelyi, Akos Savolt, Orsolya Huszar, Orsolya Ping, Norbert Meszaros, Nora Jani, Matyas Ujlaki, Istvan Kenessey, Zsofia Jozsef, Zoltan Matrai. Examining and comparing the temporal changes and results of cosmetic, quality of life and patient satisfaction achieved with immediate and delayed-immediate implant-based breast reconstruction procedures and contralateral symmetrisation techniques after skin-sparing mastectomies with unilateral Simple Mastectomy and with bilateral skin-sparing mastectomies and immediate implant-based breast reconstructive surgeries. (ClinicalTrials.gov Identifier: NCT04356235) [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr OT-23-01.
Abhishek Chatterjee - One of the best experts on this subject based on the ideXlab platform.
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early postoperative outcomes in breast conservation surgery versus Simple Mastectomy with implant reconstruction a nsqip analysis of 11 645 patients
Annals of Surgical Oncology, 2016Co-Authors: Bryan Pyfer, Abhishek Chatterjee, Brian J Czerniecki, Julia Tchou, Lilian Chen, John F Nigriny, Carla S FisherAbstract:Little has been studied that compares early postoperative outcomes between breast conservation surgery (BCS) and Simple Mastectomy with implant reconstruction (SM). Our goal was to utilize a large-volume database to compare such outcomes in women with early stage breast cancer. The National Surgery Quality Improvement Program (NSQIP) database was searched for patients who underwent partial or complete Mastectomy between 2009 and 2012. Exclusion criteria eliminated potential confounding factors. We compared preoperative comorbidities and postoperative complication rates between each treatment group by Chi square and two-sample t tests; we also determined the odds ratios for the likelihood of adverse events in a number of categories. A total of 11,645 patients met the study criteria: 9571 underwent BCS and 2074 underwent SM with implant reconstruction. The baseline characteristics of the two groups showed significant differences for age (61.7 years in BCS, 53.5 years in SM), body mass index (29.6 kg/m2 in BCS, 27.0 kg/m2 in SM), and rates of hypertension (47.0 % in BCS, 25.6 % in SM), coronary artery disease (1.3 % in BCS, 0.6 % in SM), chronic obstructive pulmonary disease (2.4 % in BCS, 1.0 % in SM), and diabetes (11.7 % in BCS, 5.9 % in SM). Statistical analysis between each treatment modality revealed that the SM with implant group had significantly higher total complication (5.5 vs. 2.1 % in BCS), wound (2.8 vs. 1.4 % in BCS), infection (1.9 vs. 0.4 % in BCS), and bleeding (0.2 vs. 0.05 % in BCS) rates than the BCS group. BCS has fewer overall early postoperative wound, infectious, and bleeding complications despite a significantly higher rate of preexisting risk factors.
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early postoperative outcomes in lumpectomy versus Simple Mastectomy
Journal of Surgical Research, 2015Co-Authors: Abhishek Chatterjee, Bryan Pyfer, Brian J Czerniecki, Kari M Rosenkranz, Julia Tchou, Carla S FisherAbstract:Abstract Background Relatively scarce outcomes research exists that compares early postoperative complications between breast conservation surgery (BCS) and Simple Mastectomy (SM). Such information would improve a surgeon's ability to provide informed consent when considering treatment options, especially for women with early stage breast cancer who have the option to receive either BCS or SM. Materials and methods The National Surgical Quality Improvement Program database from years 2009–2012 was analyzed. For each treatment group, we used Current Procedural Terminology codes specific to the treatment modality with sentinel lymph node biopsy as an inclusion criteria. We excluded patients who received axillary lymphadenectomies, bilateral disease or symmetry procedures, and additional breast reconstructive surgery. We compared each group with chi square and two-sample t-tests to look for preoperative comorbidity differences, then used unadjusted odds ratios to compare postoperative complication rates. Results Inclusion and exclusion criteria provided 6682 patients in the BCS group and 3339 patients in the SM group. Baseline comorbid condition characteristics showed no clinical differences between groups except for diabetes (8.5% in SM versus 6.5% in BCS). Statistical analysis between each treatment modality revealed that the SM group had significantly higher wound complications, bleeding, infections, and overall complications than the BCS group. Conclusions Although both BCS and SM options have low early postoperative complication rates when treating early stage breast cancer, BCS has fewer complications with regard to bleeding, wound complications and infections.