Total mastectomy and partial axillary dissection as advised in the DBCG (Danish Breast Cancer Cooperative Group) protocols was performed in 104 consecutive females with operable primary invasive breast cancer, aged 34-82 years, median 47 years. The glandular removal was complete as assessed by microscopic examination of side resection planes and deep fascia of the surgical specimen. The number of removed axillary lymph nodes ranged from 1 to 28, median 8. The mortality was zero. There were no general complications. Wound complications comprised seroma (47.1 %), flap margin necrosis (5.8%) and infection (1.9%). The pitfalls in securing total mastectomy are discussed as is the extent of axillary dissection for staging purposes. Furthermore, the problem of axillary dissection and axillary irradiation in node positive patients is considered.
BACKGROUND
Surgery at the cervicomedullary junction carries a risk of damaging vital brainstem functions. Because the nucleus of the solitary tract (NS) is involved in the baroreceptor reflex, damage to its integrity may lead to orthostatic hypotension.
OBSERVATIONS
A 56-year-old man with a medical history of hypertension, von Hippel-Lindau disease, and previous bilateral adrenalectomy due to pheochromocytoma was referred with symptoms of dysphagia and paralysis of the left vocal cord. Paralysis of the left vagus nerve was suspected. Magnetic resonance imaging revealed a contrast-enhancing cystic process in the cervicomedullary junction. Twenty-three years earlier, the patient had undergone surgical treatment for a hemangioblastoma in the same region. After repeated surgery, the patient temporarily developed orthostatic hypotension. At discharge, the patient no longer needed antihypertensive medication.
LESSONS
Surgery near the cervicomedullary junction can affect the NS, leading to disruption of the baroreceptor response that regulates blood pressure.
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