Background: Today, thyroidectomy is a common operation used to treat various thyroid disorders. Nowadays, many high-volume thyroid surgeons are discharging patients on the same day of thyroidectomy. The incidence of complications following thyroidectomy is directly linked to the difficulty of the procedure. So, if we can predict the difficulty of thyroidectomy preoperatively, we can anticipate complications and decide on which patients will require in-patient care.Methods: A thyroidectomy difficulty scale was developed by Schneider and colleagues. This scale was used in our study to classify patients in to difficult thyroidectomy group and non-difficult thyroidectomy group. The association between preoperative variables and difficulty of thyroidectomy was studied.Results: Statistical analysis revealed that there was a significant association between hyperthyroidism and difficult thyroidectomy. Similarly, there was a significant association between positive anti-thyroid peroxidase antibody (which defines Hashimoto’s thyroiditis) and difficult thyroidectomy. Also, there was a significant association between positive anti-thyroglobulin antibody and difficult thyroidectomy. Difficult thyroidectomy was found to have a significant association with postoperative hypocalcemia. Statistical analysis also showed duration of surgery to have a significant association with difficulty of thyroidectomyConclusions: Patients with hyperthyroidism, positive anti-thyroid peroxidase antibodies, positive anti-thyroglobulin antibodies have a high probability of a difficult thyroidectomy, associated with longer operative times and increased complications. This information can improve preoperative risk counseling and lead to more efficient scheduling of the operating room.
BACKGROUNDThe improvement in the treatment of breast cancer is due to early diagnosis, better understanding of the natural history of this disease and therapeutic improvements over the years. There is a gradual shift away from radical surgery advocated by Halsted to the breast conservative surgery during the last few decades all over the world mainly influenced by the results of several large trials of lesser surgical procedures. The aim of the study is to compare the complications, duration of surgery and hospital stay, mental satisfaction of the patients, recurrence and survival of patients undergoing breast conservative surgery and modified radical mastectomy in early breast cancer. MATERIALS AND METHODSThis was a cohort study of patients who presented with early breast cancer to . Inclusion criteria were patients with early breast cancer, clinical stage I and II. All the patients were watched for different variables and were followed up for a period of five years. RESULTSMean hospital stay of 7.47 days was there for BCS group while MRM group stayed for 9.4 days on an average. The 5-year disease-free survival rate in BCS group was 83.33% and that of MRM group was 86.66%. The five-year Distant Disease Free Survival Rate in BCS group was 86.66%. The same was 90% in MRM group. For mental satisfaction by visual analogue scale for BCS group, the mean came as 7.9333 with std. deviation of 1.14269 and std. error of 0.20863. In MRM group, the mean was 6.8333 with std. deviation of 1.26173 and std. error of 0.23036. CONCLUSIONThe 5-year disease-free survival and 5-year Distant Disease Free Survival Rate were comparable between BCS group and MRM group. Duration of hospital stay is less for the breast conservative surgery. There is significantly better mental satisfaction for the patients who underwent conservative surgery.HOW TO CITE THIS ARTICLE: Sreelesh LS, Oommen A. A comparative study of breast conservative surgery and modified radical mastectomy in early breast cancer.
INTRODUCTIONWorldwide, breast cancer is the leading type of cancer in women, accounting for 25% of all cases.1 In those who have been diagnosed with cancer, a number of treatments may be used, including surgery, radiation therapy, chemotherapy, hormonal therapy and targeted therapy. Surgical intervention ranges from wide local excisions to palliative mastectomy.Modified Radical Mastectomy involves removal of the entire breast including the breast tissue, skin, areola, nipple and most of the axillary lymph nodes.Outcomes for breast cancer vary depending on the cancer type, extent of disease, and person's age. Survival rates in the developed world are high, with between 80% and 90% of those in England and the United States alive for at least 5 years.2 In developing countries survival rates are poorer. Drains remove blood, serum, lymph, and other fluids that accumulate in the wound bed after a procedure. If allowed to build, these fluids put pressure on the surgical site as well as adjacent organs, vessels, and nerves. The decreased perfusion delays healing and the increased pressure causes pain. In addition, fluid collection serves ABSTRACT Background: Active drains are routinely used after Modified Radical Mastectomy (MRM) and is an important factor contributing to increased hospital stay as the patients are often discharged only after their removal. Amongst various factors that influence the amount of post operative drainage, the negative suction pressure applied to the drain has been reported to be of great significance. Against this background a study was conducted to compare the amount and duration of drainage between suction and dependent drainage in patients following Modified Radical Mastectomy. Methods: Patients were randomised using randomly ordered sealed envelopes, which were opened immediately before the closure of the wound, to decide on whether suction or dependent drain was to be given. Drains were removed when output was less than 30 ml per day. Patients were followed up from the day of surgery till the day of drain removal. Statistical analysis was performed with SPSS. Results: There is significant increase in the drain per day in post MRM patients with active suction drain. But, there is no relation between the type of drain and either total drain output or the total number of days of drain. The study also revealed that there is no significant difference in the number of days of hospital stay in both groups of patients. Conclusions: Suction drains do not have any significant advantage over dependent drains after Modified Radical Mastectomy in breast cancer patients.
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