Sophocles Lanitis

Comparison of skin-sparing mastectomy versus non-skin-sparing mastectomy for breast cancer: a meta-analysis of observational studies

Objectives:To evaluate differences in outcomes of breast cancer patients undergoing either conventional mastectomy without reconstruction (NSSM) or skin-sparing mastectomy (SSM) with immediate reconstruction. Data Sources:All comparative studies published between 1997 and 2009 were used to evaluate local recurrence and distant relapse in the 2 study groups. Review Methods:Meta-analytical models were used to evaluate the study outcomes. Sensitivity analysis, was carried out to evaluate the robustness of the pooled estimates and assess the between-study heterogeneity. Results:Nine studies, comprising of 3739 patients (1104 SSM and 2635 NSSM) were included in the analysis. There were no significant differences in the disease stage or the proportion of invasive cancers between groups (73.9% vs. 83.8%, P = 0.65). There was no significant difference in local recurrence between the SSM versus NSSM groups (7 studies, 3436 patients, 6.2% vs. 4.0%, odds ratio = 1.25, 95% CI: 0.81–1.94) and there was no significant heterogeneity between the studies. The SSM group had a lower proportion of distant relapses compared with the NSSM group (5 studies, 2122 patients, 10.0% vs. 12.7%, odds ratio = 0.67, 95% CI: 0.48–0.94) but this should be interpreted with caution since the grade of the tumors was not adequately reported in the studies considered. Conclusions:Our results suggest that in breast cancer patients, SSM was not significantly different from NSSM, in terms of rates of local recurrence. As no randomized control trial has addressed this question to date, the present meta-analysis reports the best evidence on the subject.

Surgical management of Gynaecomastia: Outcomes from our experience

The study aims to assess the morbidity and outcomes associated with gynaecomastia surgery. Between 1998 and 2007, 748 males with a mean age 44.67 years (10-90) were referred to us with breast-related symptoms. From these only 65 patients (102 breasts), with a median age of 26 years (11-82) had an operation for gynaecomastia. We considered for the purpose of the study each operated breast as an individual case. Overall, 42 cases of grade I gynaecomastia, 40 with grade II and 20 with grade III were treated mainly with subcutaneous mastectomies, 22 with skin reduction. Acute major complications requiring intervention occurred in 12 cases. Twenty-three cases required a late corrective operation for unsatisfactory results. The surgical approach appears to be the most important determinant of good cosmesis with the circumareolar approach to give the better results. The majority of the patients can be managed conservatively. Surgical candidates should be made aware of the significant morbidity.

Axillary metastatic disease as presentation of occult or contralateral breast cancer.

INTRODUCTION Atypical axillary metastasis may arise from an occult ipsilateral or contralateral breast cancer or from primary non-breast tumour. The treatment of this entity is challenging and presents various options. We present our experience with a brief review of the literature. RESULTS A study of atypical axillary metastasis done at St Marys hospital, from 1998 to 2008, identified six cases. Radiological investigations and immunohistochemistry excluded non-breast primary tumour. Three patients had occult breast cancer on presentation, two patients had previously treated contralateral breast cancer and one patient developed a primary metachronous contralateral breast cancer, which had a completely different histological profile from the involved lymph nodes on the same side. Axillary nodal clearance was done for all patients except for the patient with lymphoedema. Four patients were alive with no evidence of disease and two patients died of the disease at a median follow-up of 23 months. CONCLUSION Atypical axillary metastasis from ipsilateral occult or contralateral breast cancer should be treated with axillary node clearance and further endocrine or chemotherapy. Radiation treatment or a watchful policy to the ipsilateral breast should be validated by further studies.

Atypical Anaphylactic Reaction to Patent Blue During Sentinel Lymph Node Biopsy for Breast Cancer

INTRODUCTION We present an unusual case of severe anaphylaxis to Patent Blue dye with atypical clinical features during sentinel lymph node biopsy (SLNB). The medical personnel involved with sentinel node biopsies should be alert, and familiar with this unusual entity. We also present current data from the literature. CASE REPORT During a wide local excision for primary breast cancer and SLNB, and early during the operation, the patient became severely tachycardic and hypotensive without any signs of urticaria, rash, oedema, or bronchospasm. Resuscitation required the addition of noradrenaline infusion followed by an overnight admission to the intensive care unit. Raised serum tryptase levels supported the diagnosis of anaphylactic shock while skin tests showed a severe reaction to Patent Blue dye. CONCLUSIONS Severe, life-threatening anaphylaxis to Patent Blue dye may present without obvious previous exposure to the dye and without the cardinal signs of oedema, urticaria and bronchospasm making the diagnosis and management of such cases challenging. Correct diagnosis and identification of the causative factor is important and requires a specific set of laboratory tests that are not commonly requested in every-day medical practice. It is not clear from the literature whether the condition is common enough to justify pre-operative prophylactic or diagnostic measures.

Microdochectomy for single-duct pathologic nipple discharge and normal or benign imaging and cytology.

This study evaluates microdochectomy as a means for diagnosis and treatment of patients with pathological nipple discharge (PND) but with benign or normal imaging and cytology. From 1999 until 2006, in St. Marys Hospital, 76 patients with the aforementioned condition underwent microdochectomy because of the presence of epithelial cells on nipple smear or for symptomatic relief. Most of the patients had intraductal papillomas (48.7%), duct ectasia (15.8%) or a combination of the two (13.2%). Other benign causes occurred in 11.8% of the patients. Eight patients, including one who was operated for symptomatic relief, had cancer. Of those patients with benign condition, 98% had symptomatic relief while PND recurred twice in one patient. Pre-operative workup and imaging may not be suspicious in patients with single-duct PND and underlying malignancy, therefore, microdochectomy should be considered in such cases.

Laparoscopic totally extraperitoneal versus open preperitoneal mesh repair for inguinal hernia recurrence: a decision analysis based on net health benefits

BackgroundThe aim of this study is to evaluate the most cost-effective treatment strategy using preperitoneal mesh for patients with recurrent inguinal hernia. Currently, the issue of cost-effectiveness is entirely unresolved.MethodsA decision analysis was carried out based on the results of a systematic literature review of articles concerning recurrent inguinal hernia repair that were published between 1979 and 2011. A virtual cohort was programmed to undergo three different treatment procedures: (1) laparoscopic totally extraperitoneal hernia repair (TEP), (2) open preperitoneal mesh repair according to Stoppa, and (3) open preperitoneal mesh repair according to Nyhus. We carried out a base-case analysis and varied all variables over a broad range of reasonable hypotheses in multiple one-way and two-way sensitivity analyses.ResultsThe average cost-effectiveness ratio of Nyhus, Stoppa, and TEP per quality-adjusted life year was US

Breast conserving surgery with preservation of the nipple-areola complex as a feasible and safe approach in male breast cancer: a case report

(

Laparoscopic versus Open Adrenalectomy for Stage I/II Adrenocortical Carcinoma: Meta-Analysis of Outcomes

)1,942,

Synchronous Bilateral Breast Cancer with Different Biological Profile and Estrogen-Progesterone Receptor Status

1,948, and

The Impact of Educational Status on the Postoperative Perception of Pain.

2,011, respectively. In terms of the incremental cost-effectiveness ratio (ICER), Stoppa was dominated. The choice between TEP or Nyhus procedure depends on the combination of a specific center’s rates of recurrence and morbidity as disclosed by three-way sensitivity analysis.ConclusionsNyhus and TEP repairs are possible optimal choices depending primarily on the institution’s rates of recurrence and morbidity. Based on our net benefit-related decision analysis, a hypothetical “fixed budget trade-off” suggests potential annual incremental health system cost savings of