Adel Denewer

Laparoscopic Assisted Cystectomy and Lymphadenectomy for Bladder Cancer: Initial Experience

Abstract. This study discusses our initial experience in the field of laparoscopic management of bladder carcinoma. Ten patients with invasive bladder tumors of variable histology and ranging from stage T2 to T3b were submitted to this procedure. Intraoperative assessment, lateral dissection, posterior dissection, anterior dissection, and urethral transection were achieved laparoscopically. The specimen retrieval and continent pouch construction was performed through a limited abdominal incision. This new regimen allows precise radical lymphadenectomy, early postoperative mobility, fewer wound complications, and shorter hospital stay. The early postoperative results of this procedure are encouraging. Modification and continuous refinement of the technique is still ongoing.

Can Nipple-sparing Mastectomy and Immediate Breast Reconstruction with Modified Extended Latissimus Dorsi Muscular Flap Improve the Cosmetic and Functional Outcome among Patients with Breast Carcinoma?

BackgroundNipple–areola complex (NAC) preservation is a new revolution in breast cancer surgery and breast reconstruction, if reliability and safety are considered. The latissimus dorsi muscular flap is a versatile flap that is gaining renewed popularity for immediate breast reconstruction with development of modifications. We are introducing nipple-sparing mastectomy (NSM) for Egyptian patients with breast carcinoma and reporting our results with a new modification of the extended latissimus dorsi muscular flap.MethodsBetween July 2005 and August 2006; forty-one patients with stage I to III breast carcinoma had NSM and immediate breast reconstruction. We performed a new modification to the extended latissimus dorsi muscular flap that allowed us to obtain enough autologous tissue to reconstruct the breast without implant or back incision. The postoperative aesthetic results with specific view of the preserved NAC were evaluated.ResultsWe applied both an objective and subjective aesthetic result to our monitoring. Aesthetic grading results of breast reconstruction were as follows: excellent in 31, good in 6, fair in 2, poor in 2. Both reconstructed breast and donor site complications were minor. Patients are followed for a median follow-up of 7.9 months (range: 4–11 months). In this short period of follow-up, no local recurrence or distant failure has been observed.ConclusionsNipple-sparing mastectomy with immediate breast reconstruction using modified extended latissimus dorsi muscular flap allows single-stage, totally autologous reconstruction with a satisfactory aesthetic result, low morbidity, and good quality of life.

Skin-Sparing Mastectomy with Immediate Breast Reconstruction by a New Modification of Extended Latissimus Dorsi Myocutaneous Flap

BackgroundThe introduction of skin-sparing mastectomy has revolutionized both breast cancer surgery and breast reconstruction. Latissimus dorsi myocutaneous flap is a versatile flap that is gaining renewed popularity with the development of flap modifications and the continued recognition of its reliability and safety. We report our results with a new modification of the extended latissimus dorsi flap after skin-sparing mastectomy for breast cancer.MethodsFrom January 2002 to January 2006, 140 patients of breast carcinoma had unilateral skin-sparing mastectomy and immediate breast reconstruction. A total of 132 cases of invasive duct carcinoma and eight cases of invasive lobular carcinoma are included. Age ranged from 27 to 53 (median, 40.5) years. Tumor stage was stage I in 22 cases, stage II in 100 cases, and stage III in 18 cases. We performed a new modification to the standard extended latissimus dorsi flap, which allowed us to obtain enough autologous tissue to reconstruct the relatively large breast of the Egyptian women without implant. The postoperative aesthetic results and donor side morbidity, including contour deformity and scaring, were examined.ResultsWe applied both an objective and subjective aesthetic result monitoring. Aesthetic grading results of breast reconstruction were excellent in 85, good in 42, fair in ten and poor in three cases. Both flap and donor site complications were minor. Patients were followed for a median of 32.4 (range, 12-48) months. During this period of follow-up, no episode of local or distant failure was observed.ConclusionsSkin-sparing mastectomy with immediate breast reconstruction using our new modification of extended latissimus dorsi flap allows single-stage, totally autologous reconstruction with satisfactory aesthetic results and low morbidity.

Social Support and Hope Among Egyptian Women with Breast Cancer after Mastectomy

Introduction Breast cancer is the most common cancer among Egyptian women. We report the unique assessment of hope and social support outcomes of women with breast cancer after mastectomy in Egyptian community. Patients and methods Between July 2009 and June 2010, three hundred and one women with newly diagnosed breast cancer joined this study. Socio-demographic data including patients age, level of education, occupation, social status, and residence were collected by means of structured interviews based on special questionnaires. These questionnaires were designed to measure hope and social support. Results Age ranged from 21 to 88 years (median = 45.8 years and SD ± 13.3). A low degree of hope was reported in 103 patients (34.2%), a moderate degree in 109 patients (36.2%), and a high degree in 89 patients (29.6%). A low degree of social support was reported in 119 patients (39.5%), a moderate degree in 101 patients (33.6%), and a high degree in 81 patients (26.9%). Conclusions Social support is related to many psychological factors, which can be quantitatively analyzed and it can predict hope. However, there were no significant differences between the socio-demographic variables (age, educational levels, residence and martial status) and social support, hope, and their sub-components among Egyptian women with breast cancer.

Outcome of Pectoralis Major Myomammary Flap for Post-mastectomy Breast Reconstruction: Extended Experience

BackgroundIn the past decade there has been an enormously expanding interest among rural Egyptian patients, relatives, and treating oncologists in post-mastectomy reconstruction as an integral part of patient care. We introduced our technique of pectoralis major myomammary cutaneous flap for single-stage reconstruction of large breasts, nipple, and areola.MethodsThe new technique is based on performing modified radical mastectomy in the classic manner, and then using a pectoralis major myocutaneous pedicled flap from the other side in breast reconstruction. The flap is based on the pectoral branch of the thoracoacromial artery, and a sector from the medial part of the healthy breast with its overlying skin and a part of the nipple–areola complex is included with the flap. This technique was used in our center in one 118 patients, with very promising results.ResultsMajor flap necrosis was not observed in patients treated with this technique, and there were no local recurrences observed during the follow-up period. Excellent cosmetic results were achieved in 49 of the 118 (41.5%) cases.ConclusionWe recommend this new technique as a single-stage, simple solution for reconstruction of large breasts after mastectomy

Can we put a simplified algorithm for reconstruction of large scalp defects following tumor resection

BackgroundReconstruction of large scalp defects after tumor resection is a challenging problem. We aimed at putting an algorithm for reconstruction of those defects.MethodsForty-two patients with scalp malignancies were enrolled in this study. Tumors were resected to a 1 cm negative margin and defects were reconstructed according to their size and to patient general condition.ResultsNo peri-operative mortality was encountered. Usage of free flaps was superior in cosmoses and function with an acceptable rate of complications.Conclusionfor scalp defects wider than100 cm2, the best tool of reconstruction is free flaps. Pedicled distant flaps are reserved if free flaps are not feasible or failed. Split thickness skin grafts are cosmetically inferior and not suitable for recurrent and irradiated tumours and better reserved for patients who cannot tolerate major operations.

Myomammary flap of pectoralis major muscle for breast reconstruction: new technique.

Abstract. Simple mastectomy and modified radical mastectomy is still the preferred surgical technique for management of breast cancer, as it is always in the second stage (II). Breast reconstruction in Egypt is always accompanied by reduction mammoplasty of the other breast. The new method utilizes a myomammary flap from the other side. This flap depends on the other breast being of moderate or large size. The flap being transferred depends on the pedicle of the pectoralis major tunneled under the skin. The new technique utilizes the nipple on the healthy side to reconstruct the nipple of the new breast at the same time. A reduction mammoplasty was achieved in healthy contralateral huge breasts. A total of 23 female patients were submitted for breast reconstruction using a pectoralis major myomammary flap from the other relatively large breast. The flap depended on a blood supply from the pectoral branch of the thoracoacromial artery. Good cosmetic results were achieved in 60% of cases, fair results in 25%, and unsatisfactory results in 15%. In conclusion, this new technique of breast reconstruction is suitable especially for patients with large, healthy breasts and for relatively poor patients.

Pharyngoesophageal reconstruction after resection of hypopharyngeal carcinoma: a new algorithm after analysis of 142 cases

BackgroundThe aim of this study is to define an algorithm for the choice of reconstructive method for defects after laryngo-pharyngo-esophagectomy for hypopharyngeal carcinoma.MethodsOne hundred and forty two cases of hypopharyngeal carcinoma were included and operated on by either partial pharyngectomy, total pharyngectomy or esophagectomy. The reconstructive method was tailored according to the resected segment.ResultsPectoralis flap was used in 48 cases, free jejunal flap in 28 cases, augmented colon bypass in 4 cases, gastric pull up in 32 cases and gastric tube in 30 cases. Mean hospital stay was 12 days. Mortality rate was 10.6% and morbidity rate was 31.7%. Total flap failure occurred in 3 cases of free flap and one case of pectoralis flap. There were 23 cases of early fistula. Late stricture occurred in 19 cases, being highest with myocutaneous flap (early fistula 12/50 and late stricture 13/50).ConclusionFree jejunal flap was the flap of choice for reconstruction when the safety margin is still above the clavicle. In cases with added esophagectomy, we recommend gastric tube as a method of choice for reconstruction.

Therapeutic reduction mammoplasty in large- breasted women with cancer using superior and superomedial pedicles

BACKGROUND Surgical management of breast cancer in large-breasted women presents a real challenge. This study aims to evaluate the outcome of therapeutic reduction mammoplasty in large-breasted women with breast cancer using superior and superomedial pedicles, situated at any breast quadrant except for the central and upper medial quadrants. METHODS Fifty women with breast cancer and large breasts underwent simultaneous bilateral reduction mammoplasty. The weight of the tissue removed ranged from 550 g to 1050 g and the tumor-free safety margins by frozen section were in the range of 4 cm to 12 cm. RESULTS The age of the patients ranged from 36 to 58 (median 43) years and tumor size ranged from 1 cm to 4 cm. The cosmetic outcomes were excellent in 32 patients (64%), good in 15 (30%) patients, and fair in three patients (6%). The follow-up period was 8-36 (mean 20) months, with no local recurrence or systemic metastasis. CONCLUSION Therapeutic reduction mammoplasty using superior and superomedial pedicles was shown to be oncologically safer than traditional conservative surgery. This oncoplastic procedure yields a satisfactory esthetic outcome with lower morbidity in large-breasted women with breast cancer.

Quality of life among Egyptian women with breast cancer after sparing mastectomy and immediate autologous breast reconstruction: a comparative study

Breast reconstruction is considered as an integrated part of the modern breast surgery. The aim of this study is to evaluate whether immediate autologous breast reconstruction influences QOL and patient satisfaction outcomes among Egyptian women with breast cancer in comparison to the traditional mastectomy. This is a prospective study in which 200 Egyptian women with non metastatic breast cancer were included; group I (100 patients) underwent sparing mastectomy with immediate autologous breast reconstruction and group II (100 patients) underwent traditional mastectomy. The patient satisfaction with breast reconstruction was evaluated by special questionnaire and the reasons given by traditional mastectomy patients for not having breast reconstruction were recorded. Both breast impact of treatment scale (BITS) and body satisfaction scale (BSS) were evaluated in both groups. Patient satisfaction with breast reconstruction had a high mean score of 14.44 out of total degrees of 20 and most of them voted yes for having the same reconstruction again if they were offered it and would recommend reconstruction to other patients. No difference was found between the two groups as regard the BITS score. However, the BSS score showed a higher score among the reconstruction group. Egyptian ladies with breast cancer show better QOL and body image satisfaction outcomes following immediate breast reconstruction.