Prognostic Factors of Treatment Failure for Early Breast Cancer after Breast Conserving Surgery

Aldaqaf, Mohammad; Brătucu, E

doi:10.21614/chirurgia.113.2.253

Cited by 3 publications

(3 citation statements)

References 17 publications

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“…It is interesting to notice the inconsistent findings/lack of statistical significance for individual risk factors of pancreatic tumor nature, histopathologic type, and dimension, and several patient characteristics findings (age, sex, patient comorbidities including cardiovascular disease, diabetes mellitus, obesity) for the risk of fistula development and patient prognosis are similar to the reports of other authors as well [2,8]. At the same time, such findings regarding pancreatic/periampullary tumors are similar to the reports on other types of retroperitoneal tumors, such as primary retroperitoneal tumors [62,63].…”

Section: Discussionsupporting

confidence: 86%

Pancreaticogastrostomy versus Pancreaticojejunostomy and the Proposal of a New Postoperative Pancreatic Fistula Risk Score

Mastalier,

Cauni,

Tihon

et al. 2023

JCM

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Despite the substantial decrease in mortality rates following a pancreaticoduodenectomy to less than 5%, morbidity rates remain significant, reaching even 73%. Postoperative pancreatic fistula is one of the most frequent major complications and is significantly associated with other complications, including patient death. Currently, there is no consensus regarding the ideal type of pancreatic anastomosis, as the question of the choice between a pancreaticogastrostomy and pancreaticojejunostomy is still open. Furthermore, worldwide implementation of an ideal pancreatic fistula risk prediction score is missing. Our study found several significant predictive factors for the postoperative occurrence of fistulas, such as the soft consistency of the pancreas, non-dilated Wirsung duct, important intraoperative blood loss, other perioperative complications, preoperative patient hypoalbuminemia, and patient weight loss. Our study also revealed that for patients who exhibit fistula risk factors, pancreaticogastrostomy demonstrates a significantly lower pancreatic fistula rate than pancreaticojejunostomy. The occurrence of pancreatic fistulas has been significantly associated with the development of other postoperative major complications, and patient death. As the current pancreatic fistula risk scores proposed by various authors have not been consensually validated, we propose a simple, easy-to-use, and sensitive score for the risk prediction of postoperative pancreatic fistula occurrence based on important predictors from statistical analyses that have also been found to be significant by most of the reported studies. The new pancreatic fistula risk score proposed by us could be extremely useful for improved therapeutic management of cephalic pancreaticoduodenectomy patients.

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Section: Discussionsupporting

confidence: 86%

Pancreaticogastrostomy versus Pancreaticojejunostomy and the Proposal of a New Postoperative Pancreatic Fistula Risk Score

Mastalier,

Cauni,

Tihon

et al. 2023

JCM

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“…Clear margins were associated with reduced distant recurrence by an absolute value of 5% 5 across all studies, a level of benefit for which chemotherapy is commonly offered to patients as an adjuvant therapy. 44 45 The American Society of Clinical Oncology meta-analysis highlighted the importance of reducing re-excision rates after breast conserving surgery but its focus was on local not distant recurrence. 4 …”

Section: Discussionmentioning

confidence: 99%

Margin status and survival outcomes after breast cancer conservation surgery: prospectively registered systematic review and meta-analysis

Bundred

Michael

Stuart

et al. 2022

BMJ

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Objective To determine if margin involvement is associated with distant recurrence and to determine the required margin to minimise both local recurrence and distant recurrence in early stage invasive breast cancer. Design Prospectively registered systematic review and meta-analysis of literature. Data sources Medline (PubMed), Embase, and Proquest online databases. Unpublished data were sought from study authors. Eligibility criteria Eligible studies reported on patients undergoing breast conserving surgery (for stages I-III breast cancer), allowed an estimation of outcomes in relation to margin status, and followed up patients for a minimum of 60 months. Patients with ductal carcinoma in situ only or treated with neoadjuvant chemotherapy or by mastectomy were excluded. Where applicable, margins were categorised as tumour on ink (involved), close margins (no tumour on ink but <2 mm), and negative margins (≥2 mm). Results 68 studies from 1 January 1980 to 31 December 2021, comprising 112 140 patients with breast cancer, were included. Across all studies, 9.4% (95% confidence interval 6.8% to 12.8%) of patients had involved (tumour on ink) margins and 17.8% (13.0% to 23.9%) had tumour on ink or a close margin. The rate of distant recurrence was 25.4% (14.5% to 40.6%) in patients with tumour on ink, 8.4% (4.4% to 15.5%) in patients with tumour on ink or close, and 7.4% (3.9% to 13.6%) in patients with negative margins. Compared with negative margins, tumour on ink margins were associated with increased distant recurrence (hazard ratio 2.10, 95% confidence interval 1.65 to 2.69, P<0.001) and local recurrence (1.98, 1.66 to 2.36, P<0.001). Close margins were associated with increased distant recurrence (1.38, 1.13 to 1.69, P<0.001) and local recurrence (2.09, 1.39 to 3.13, P<0.001) compared with negative margins, after adjusting for receipt of adjuvant chemotherapy and radiotherapy. In five studies published since 2010, tumour on ink margins were associated with increased distant recurrence (2.41, 1.81 to 3.21, P<0.001) as were tumour on ink and close margins (1.44, 1.22 to 1.71, P<0.001) compared with negative margins. Conclusions Involved or close pathological margins after breast conserving surgery for early stage, invasive breast cancer are associated with increased distant recurrence and local recurrence. Surgeons should aim to achieve a minimum clear margin of at least 1 mm. On the basis of current evidence, international guidelines should be revised. Systematic review registration CRD42021232115.

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“…Según otros estudios, la sobrevida informada para este grupo de pacientes a 3 y 5 años fue 97.0% y 92.3%, respectivamente. 14,15 También se ha informado que pacientes estadio II presentaron hazard ratio de muerte de 1.81 (IC95% 1.65-1.99) comparado al estadio I, aumentando la mortalidad en estadio II y alta comorbilidad. 16 En nuestro estudio, la sobrevida a 36 meses en pacientes con radioterapia y hormonoterapia fue de 95.7%, y en quienes recibieron la combinación de quimio-radiación y hormonoterapia fue 80.0%.…”

Section: Discussionunclassified

Resultado oncológico de cirugía conservadora con adyuvancia en cáncer de mama, Hospital San Felipe, Tegucigalpa

Chicas

Jerez

Alger³

2020

RMH

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Antecedentes: El cáncer de mama es la malignidad más frecuentemente diagnosticada en mujeres, representando casi 1 de cada 4 casos de cáncer. Objetivo: Describir los resultados oncológicos de las pacientes tratadas con cirugía conservadora y adyuvancia por cáncer de mama estadios clínicos I-II, Hospital San Felipe, Tegucigalpa, 2017-2019. Métodos: Estudio descriptivo transversal retrospectivo. Extracción de información de expedientes clínicos de pacientes con diagnostico nuevo de cáncer de mama. Se registró datos sociodemográficos, estadio clínico pre- y post-operatorio, tratamiento y sobrevida. Resultados: De 49 pacientes, 59.2% (29) >50 años, 71.4% (35) procedencia urbana, 61.2% (30) estadio IIA, las modalidades terapéuticas fueron radioterapia 73.5% (36), hormonoterapia 69.4% (34), quimioterapia 40.8% (20). La combinación más frecuente fue radioterapia/hormonoterapia 46.9% (23); 26.5% (13) recibió monoterapia. El tiempo promedio de inicio de radioterapia fue 25 semanas (rango 4-90 semanas) y 13 semanas (rango 4-35 semanas) para quimioterapia. La sobrevida a 36 meses en estadio IA y IIB con adyuvancia fue 100.0% (5) y 86.0% (12), respectivamente. La sobrevida global a 36 meses fue 95.9% (47). Discusión: La sobrevida global identificada es comparable a estudios que siguen las guías internacionales. Recomendamos implementar las recomendaciones de las guías internacionales para el manejo de cáncer de mama estadios tempranos, donde la adyuvancia debe iniciar en un periodo no mayor a 8 semanas postoperatorias. Este manejo contribuiría a reducir la morbilidad y el impacto psicosocial que presentan abordajes terapéuticos más radicales. Es necesario y urgente contar con equipo y medicamentos adyuvantes de acuerdo a los avances científicos y tecnológicos.

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Prognostic Factors of Treatment Failure for Early Breast Cancer after Breast Conserving Surgery

Cited by 3 publications

References 17 publications

Pancreaticogastrostomy versus Pancreaticojejunostomy and the Proposal of a New Postoperative Pancreatic Fistula Risk Score

Pancreaticogastrostomy versus Pancreaticojejunostomy and the Proposal of a New Postoperative Pancreatic Fistula Risk Score

Margin status and survival outcomes after breast cancer conservation surgery: prospectively registered systematic review and meta-analysis

Resultado oncológico de cirugía conservadora con adyuvancia en cáncer de mama, Hospital San Felipe, Tegucigalpa

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