Introduction: Breast cancer is the most common invasive neoplasm in women. When taken to mastectomy, breast reconstruction is an integral part of treatment. Objectives: The purpose of this study is to determine which factors are associated to post-operatory complications of breast reconstruction in patients with breast cancer treated with mastectomy. Methods: 306 patients taken to breast reconstruction were divided into three groups depending on technique: pedicled flaps, prosthetic material and deep inferior epigastric perforators (DIEP). Descriptive and comparative statistics were performed to find associations between the type of reconstruction and complications. Results: The factors associated to general were bleeding and reintervention. Reintervention was associated to loss of reconstruction. Factors associated to reoperation were immediate complications, late complications, and radiotherapy. Factors associated to loss of reconstruction where smoker status, presence of late complications, and reintervention. Conclusion: There is a higher percentage of immediate complications and loss of reconstruction with prosthetics. DIEP is an alternative with lower probability of loss of reconstruction. Multidisciplinary teams should establish the decision of the best type of reconstruction.
IntroductionAfter knowing the safety of the sentinel lymph node and the omission of axillary dissection inpatients with clinically negative and / or positive (1-2 lymph nodes) breast cancer withconservative surgery and the evidence from the ACOSOG Z011 randomized clinical trial andother evidence caution against proceeding with the use of axillary lymph node dissection inbreast cancer patients; a standardization of this practice is established globally, however indeveloping countries where treatments are affected by their availability, little is known aboutthe frequency of acquisition of these practices.MethodsAn online survey was carried out in different Latin American countries, which was distributedvia electronic link and QR code, with an open invitation to congresses and medical associations.The study lasted from August 16th, 2019 to April 30th, 2020. Surgeons with low, intermediateand high clinical practice in breast cancer were categorized, their type of clinical practice(private or public) and the period of clinical practice after discharge of the specialty.ResultsIn total, 260 replies were collected from surgeons from 10 different countries: Bolivia (1),Colombia (15), Ecuador (6), El Salvador (19), Guatemala (12), Nicaragua (12), Mexico (182),Paraguay (1), Peru (1) and Venezuela (11).Of these, the group that participated the most was the Surgical Oncologists (surgeons andgynecologists with a subspecialty in oncology), representing 82% of the participants, the rest ofthe participants being: Mastologists, Gynecologists and General Surgeons.The age group with the highest participation was 30-40 years old with 51.92% of the total(135), followed by the 41-50 year old group with 24% (63). 60% of the participants reported aprofessional practice of 10 years or less. In addition to referring to a mixed but mostly publicpractice in 48%, however, 56.93% of the participants reported a low practice (10 or less casesof breast cancer per month) of which between 60-100% of the occasions they offer earlysurgical treatment to their patients; responding that they always perform Sentinel Ganglion incN0 only 50% of the total, however it was mentioned that on average 85% of the occasions it isobtained between 2-3 lymph nodes number. The question was asked about completing theaxillary dissection when having 1-2 positive nodes with the scenarios of "always complete""almost always" "only in mastectomy" "only in breast conservation" and 63% answered thatalways or almost always will perform axillary dissection, 38.83% even referred the probabilityof doing it with micrometastasis in the setting of conservative surgery. In an exploratory manner, a question was added about the possibility of sentinel node after neoadjuvanttherapy, for which 52% answered that they would not perform such a procedure.ConclusionThe result of this survey shows a trend of resistance of less extensive surgical treatments in theaxilla for patients with breast cancer. Thus, reflecting that Latino populations are perhapsoverexposed to locoregional treatment; similar findings were reported by Dr. Morrow in astudy published in 2018 which showed the substantial variation in surgeon acceptance formore limited procedures. Citation Format: Nereida Esparza-Arias, Juan E Bargallo-Rocha, Sarish Del Real-Ordoñez, Yessica Pacheco-Vallejo, Sarina Navarro-Santiesteban, María A Salazar-Alvarez, Rafael E Vasquez-Cordoba, Karen A Girón-Orellana, Juan C Guerrero-Mogrovejo, Cesar E Alvarez. Surgical management of the axilla in breast cancer in Latin American countries: Surgeon´s conduct [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS1-45.
BACKGROUND: BREAST-Q is a patient-reported outcome (PRO) that has been designed to evaluate perception outcomes among women undergoing different types of breast surgery, the modules include evaluation for mastectomy, breast reconstruction, augmentation, reduction/mastopexy and breast-conserving therapy. OBJECTIVES: Generate a translated version that is conceptually equivalent to the original version and to validate for Mexican population. METHODS: A linguistic and psychometric validation was performed in 494 women. We carry out pre and postoperative test. Reliability and internal consistency were performed by Cronbach's alpha and intraclass correlation coefficient (ICC). RESULTS: The results of patient testing, number of participants, acceptability and reliability are shown in table 1. The average scores were in all cases >0.80. Summary of BREAST-Q validation analysisN =494Module=nMean age(range)Time to completion Test(minutes) average(range)Time to completion Retest(minutes) average(range)Number of itemsNumber of missing itemsCronbach's Alpha min-max*Test-Retest ICC min-max*Mastectomy=160Pre=6248(26-76)7.8(2-20)6.4(3-20)3700.81-0.940.72-0.94Post=9852(32-78)13(4-40)11(4-28)6310.87-0.970.87-0.96Breast Conserving Therapy=153Pre=8150(21-78)7(2-17)5.2(2-13)3220.88-0.950.82-0.95Post=7255(37-73)18.7(5-44)15.4(6-29)8720.92-0.980.92-0.98Reconstruction=181Pre=6544(23-64)7.9(3-22)6.4(2-20)4220.90-0.970.90-0.97Post=9246(24-74)18.5(8-41)15.7(5-42)11610.86-0.990.85-0.99Lattisimus Dorsi=2445(33-74)5(1-18)4(2-10)1910.95-0.960.96-0.96We report the low and the high value between all sub scales, per questionnaires The internal consistency and reproducibility support the reliability of the instrument; all of the scores were acceptable. DISCUSSION: The importance of measurements quality of life in patient whit cancer, become an essential end-point, we need validated tools that help us improve our performance in different methods of treatments. Is the first validation study of an instrument that measures the impact of surgical treatment on the quality of life of breast cancer patients in Mexico, our results support the equivalent Spanish version for Mexican population. Breast-Q will provide valuable metrics for a surgeon team to document and measure their clinical performance and improve quality of healthcare in our Hispanic patients. CONCLUSIONS: The Mexican Spanish version of tree Modules of Breast-Q is reliable and easy to implement in the population with breast cancer in different scenarios in México with the advantage to measure the quality of life and satisfaction on our population with a locally advanced stage that will help to improve quality of healthcare. The high acceptability of the questionnaire demonstrate that the version is well accepted for our population so we will include a significant number of patient in our country; therefore, more hospital centers will be invited to participate for further studies that allow us to evaluate the population in Latin America and thus compare our results. Citation Format: Bargalló-Rocha J, Gutiérrez-Zacarías L, Gallargo-Alvarado L, Maciel-Miranda J, Shaw-Dulin R, Esparza-Arias N, Figueroa-Padilla J, Vazquez-Romo R, Robles-Vidal C, Drucker-Zertuche M, Cabrera-Galeana P, Cantu-De Leon D. The BREAST-Q: Translation and validation for Mexican population [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P6-16-07.
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