Julian Puppe

A Head-to-head Comparison between SurgiMend and Epiflex in 127 Breast Reconstructions.

Background: The use of acellular dermal matrices (ADM) has become a widely used option in breast reconstruction. A great deal of literature is available, totaling over 2400 ADM reconstructions. Nonetheless, head-to-head comparisons between SurgiMend and Epiflex are not yet reported. In fact, this is the first clinical data report on the use of Epiflex. This work will, therefore, compare postoperative complication rates and costs for these ADMs. Methods: This analysis is a retrospective review of a single surgeon’s 6-year experience with both SurgiMend—an acellular bovine dermal collagen matrix for soft-tissue reconstruction and Epiflex—a decellularized human skin tissue from 2008 to 2013. Results: One hundred patients had a total of 127 implant-based reconstructions using SurgiMend (64 cases; 50.4%) or Epiflex (63 cases; 49.6%). Gross complication rates were 11.1% for SurgiMend and 40.6% for Epiflex including hematoma, postoperative skin irritation, infection, necrosis, and revision surgery. The most common complication was postoperative red breast syndrome. Severe complications requiring revision surgery were significantly increased in patients treated with Epiflex (12.5%) compared with SurgiMend (4.8%). Conclusions: This retrospective analysis favors the use of SurgiMend over Epiflex because of significantly lower gross complication rates. Severe complication rates are comparable with those reported in literature for both products. Although results promote the use of SurgiMend, the single surgeon retrospective nature of this work limits its clinical impact.

Inframammary Fold Reconstruction: A Biomechanical Analysis.

Background: Inframammary fold reconstruction has scarcely been evaluated in literature. No biomechanical analyses have been performed comparing different reconstructive methods. This evaluation compares the gold-standard suture reconstruction with an intrarib anchor system (Micro BioComposite SutureTak, Arthrex). Methods: Three analysis groups were compared including 8 Sawbone blocks, 22 embalmed cadaver, and 27 regular cadaver specimens (N = 57). Transient mechanical analysis was performed at 5 N/s using an Instron 5565 test frame. Results: Ultimate load favored the anchor system (compared with the gold-standard suture) by a factor of 9.8 (P < 0.0001) for the regular cadaver group and a factor of 1.7 (P < 0.038) for the embalmed cadaver group. A similar statistically significant benefit was shown for stiffness and load at 2-mm displacement. Conclusions: This analysis showed an anchor system to be the biomechanically superior fixation method in terms of ultimate load, fixation stiffness, and displacement at failure when compared with the gold-standard suture method in inframammary fold reconstruction. Because of superior stability in every aspect, an anchor system may be considered for inframammary fold reconstruction.

Evaluation of QTc Interval Prolongation in Breast Cancer Patients after Treatment with Epirubicin, Cyclophosphamide, and Docetaxel and the Influence of Interobserver Variation.

Background: Chemotherapy with anthracyclines is associated with life-threatening electrocardiographic alterations including corrected QT (QTc) interval prolongation. Patients and Methods: In this study we assessed the effect of epirubicin, cyclophosphamide, and docetaxel (EC-Doc) on the QTc interval in 10 patients with early breast cancer. Cardiac toxicity was assessed with symptoms, transthoracic echocardiography, electrocardiography (ECG), and serum cardiac markers at baseline and after 4 cycles of EC and 4 cycles of docetaxel. To evaluate the influence of interobserver variation, the QTc interval was analyzed by a cardiologist, a gynecologist, and with automated ECG interpretation software. Results: There was a significant QTc prolongation after EC treatment independent of the investigator. In addition, a significant increase in N-terminal prohormone of brain natriuretic peptide (NT-proBNP) levels was noted after EC treatment. QTc prolongation and NT-proBNP levels normalized after docetaxel treatment. Other biochemical markers were within normal ranges. No clinically relevant effect on left ventricular ejection fraction was observed. Conclusion: This prospective study demonstrated that EC treatment increases the QTc interval and NT-proBNP levels in women with early breast cancer. This effect was reversible and independent of docetaxel administration. Moreover, the treating physician can safely perform QTc interval evaluation as part of clinical routine independent of his/her specialty. Due to the small number of patients, further conclusions are limited at this point.

Neoadjuvant Therapy of Cervical Carcinoma with the Angiogenesis Inhibitor Bevacizumab: a Single-Centre Analysis

Introduction Cervical cancer is the fourth most frequent cancer in women worldwide. Addition of the VEGF antibody bevacizumab in combination with platinum-containing chemotherapy achieved an improvement in overall survival in advanced cervical cancer. To date there are no data on neoadjuvant use of bevacizumab. We therefore studied the benefit of neoadjuvant combined therapy with bevacizumab in a group of cervical cancer patients. Patients and Methods This retrospective cohort study analysed 14 patients with cervical cancer FIGO stages 1b1 to IV who received neoadjuvant platinum-containing chemotherapy in combination with bevacizumab. The comparative cohort consisted of 16 patients who were treated with neoadjuvant platinum-containing chemotherapy alone. The response rates were determined by means of preoperative clinical examination, diagnostic imaging (RECIST), changes in tumour markers (SCC) and by histopathology. Results A clinical response was found in 93.8% (n = 15) of patients after bevacizumab-free therapy and in 100% (n = 14) of the patients who were treated with bevacizumab in addition. Combined therapy with bevacizumab led to a higher rate of clinical complete remission (42.9 vs. 12.5%; p = 0.072) and significantly improved the reduction in tumour size (Δ longest diameter: 3.7 vs. 2.5 cm; p = 0.025). Downgrading was observed in 100% of all patients treated with bevacizumab compared with 75% in the control arm. The rate of pathological complete remission (pCR) was not altered significantly (28.6% [n = 4] vs. 37.5% [n = 6]; p = 0.460). Discussion Overall, combined therapy with bevacizumab led to a better clinical response. Operability was therefore improved more often. Because of the small patient cohort, larger prospective studies are necessary to validate the effect of neoadjuvant combined therapy with bevacizumab.

Laparoscopic Pectopexy: A Biomechanical Analysis

Introduction Pectopexy, a laparoscopic method for prolapse surgery, showed promising results in recent literature. Further improving this approach by reducing surgical time may decrease complication rates and patient morbidity. Since laparoscopic suturing is a time consuming task, we propose a single suture /mesh ileo-pectineal ligament fixation as opposed to the commonly used continues approach. Methods Evaluation was performed on human non-embalmed, fresh cadaver pelves. A total of 33 trials was performed. Eight female pelves with an average age of 75, were used. This resulted in 16 available ligaments. Recorded parameters were ultimate load, displacement at failure and stiffness. Results The ultimate load for the mesh + simplified single “interrupted” suture (MIS) group was 35 (± 12) N and 48 (± 7) N for the mesh + continuous suture (MCS) group. There was no significant difference in the ultimate load between both groups (p> 0.05). This was also true for displacement at failure measured at 37 (± 12) mm and 36 (±5) mm respectively. There was also no significant difference in stiffness and failure modes. Conclusion Given the data above we must conclude that a continuous suture is not necessary in laparoscopic mesh / ileo-pectineal ligament fixation during pectopexy. Ultimate load and displacement at failure results clearly indicate that a single suture is not inferior to a continuous approach. The use of two single sutures may improve ligamental fixation. However, overall stability should not benefit since the surgical mesh remains the limiting factor.

Translationale Medizin steht im Vordergrund

„Illumination & Innovation – transforming data into learning“ so lautete das Motto der ASCO-Jahrestagung (29.5.–2.6.2015) in Chicago mit mehr als 37.000 Teilnehmern aus über 80 Ländern und fast 6.000 eingereichten Abstracts. Aus einer Vielzahl von Beiträgen zur gynäkologischen Onkologie haben unsere Experten einige neue Daten ausgewählt, welche die Behandlungsstandards in den nächsten Jahren verändern könnten.

COMBATing Breast Cancer Conference 2012 - Deciphering Breast Cancer

The meeting started with an update on recent developments since the last COMBATing in 2011. Anton Scharl (Amberg) predicted a paradigm shift from adjuvant to neoadjuvant chemotherapy as the standard concept in certain subtypes (triple negative, HER2 positive) of primary breast cancer thereby improving surgical outcome and allowing an early evaluation of therapy effectiveness. Furthermore, the question of the necessity of chemotherapy in nodal positive breast cancer, the role of Everolimus in bone health and the interaction of the tumor with its microenvironment were discussed. Breast cancer treatment has experienced several changes during the past decades due to discovery of specific prognostic and predictive biomarkers. Therefore, the next session focused on the evidence-based use of biomarkers in the clinic. Hans Kreipe (Hannover) gave an overview over traditional biomarkers, such as hormone receptors and the role of the proliferation marker Ki-67 in chemotherapy response and prognosis after neoadjuvant therapy. Unfortunately, the exact cut-off value for Ki-67 has not yet been validated and thus still has to be evaluated in ongoing studies like the WSG-ADAPTtrial. In addition, the medical and scientific benefit of the new molecular tests (e.g. Onkotype DX, Endopredict) and their role in DCIS were discussed. Novel discoveries for the therapy of hereditary breast cancer were presented by Rita Schmutzler (Cologne). 2012 was a very successful year for the German Consortium of Hereditary Breast and Ovarian Cancer with the detection of new potential high risk genes, which are currently under evaluation. The 5th COMBATing (Conference On Molecular Basics And Therapeutic implications in breast cancer) meeting was held in Munich, November 23-24, 2012. Breast cancer is a heterogeneous disease on the molecular, histopathological, and clinical level. For this reason, this year’s conference was dedicated to a better understanding of the diversity of breast cancer. Chaired by Nadia Harbeck (Munich), Achim Rody (Lübeck), and Michael Gnant (Vienna), COMBATing 2012 attracted over 260 physicians and medical scientists including national and international pioneers in breast cancer research. In two days, recent controversial aspects of translational breast cancer research and treatment were discussed, from the evaluation of traditional histopathological classifications, to clinical trials to the role of the molecular subtypes.

COMBATing Breast Cancer Conference 2011 – Stories of Success and Failure

On November 18–19, 2011 the 4th COMBATing (Conference On Molecular basics And Therapeutic Implications In Breast Cancer) meeting took place, for the first time in Munich. This years meeting had the motto ‘Stories of Success and Failure’ The congress, chaired by Nadia Harbeck (Cologne), Manfred Kaufmann (Frankfurt/M.), and Achim Rody (Homburg/Saar), was an outstanding success. For the more than 250 participants, predominantly young physicians and medical scientists, this conference offered a unique platform for the interdisciplinary exchange and translational networking in breast cancer research. An impressive number of invited national and international speakers gave an overview of recent scientific discoveries in breast cancer research. In 30 lectures they presented the newest developments in basic, translational and clinical research focusing on targeted therapy, predictive markers, subtypes, and tumorous stroma, evaluating their future clinical relevance.