Breast conserving therapy for early breast cancer: long term follow-up

Breast conserving surgery followed by breast irradiation for appropriately selected patients with early stage breast cancer gives the same long term survival rates as radical mastectomy. The large breast volume of female Egyptian patients allows for a wide resection margin during wide local excision without a marked alteration in the aesthetic breast contour. Between 1995 and 2004, 101 female patients with early stage breast cancer were diagnosed and treated, at the Cairo National Cancer Institute hospital, by breast conserving surgery followed by postoperative radiotherapy and adjuvant systemic therapy. Patients were regulary followed up till the end of the study. Mean age of patients was 47.1 years [SD +/- 10.2]. The median time of follow-up of patients was 34 months [range: 3-127]. Kaplan-Meier estimate of 5-year local recurrence rate was 11.5% [95% confidence interval]. There was no axillary nodal recurrence. The cumulative 5 year disease tree survival was 80%. 44.5% of patients showed a good cosmetic results while 40.6% showed a fair cosmetic result. It is concluded that, inappropriately selected patients with an early stage breast cancer, they should be offered breast conserving surgery followed by breast radiation. BCT do not affect patient's survival, it preserves the breast in an acceptable cosmetic result and avoid the mutilating result of mastectomy

Nerve sparing radical cystectomy for stage T2 bilharzial bladder cancer: surgical technique and outcome

The exact anatomy and the precise topographic anatomy of the nervi erigents became well established. This technique of nerve sparing radical cystectomy is based on the principle of do not disrupt or interrupt the pathway of the neural fibres of the nervi erigents, that will conform the cavernous nerves. Throughout the steps of this procedure, the integrity of these nerves was protected without compromising the principles of oncologic surgery. Between January 1999 and December 2003, 40 male patients [median age: 50 years, range: 30-67] with stage T[2] bilharzial bladder cancer were treated by this technique of nerve sparing radical cystectomy and urinary diversion at Cairo National Cancer Institute hospital and in the Pyramid hospital at Cairo. The patients were followed up for 3 years after surgery to detect any local or distant recurrence of the disease and to evaluate their potency. Assessment of potency began one month after hospital discharge. All specimens showed a negative prostatic urethral surgical margin. Sixteen [40%] out of 40 patients reported early normal erections to occur in the period from 1 to 6 weeks after hospital discharge. Seventeen patients [42.5%] reported weak unsatisfactory erections and were helped by Sildenafil tablets and gained normal erections and satisfactory sexual activity. Seven [17.5%] out of 40 patients reported no erection to occur up to 12 months after surgery. They were considered to be impotent due to lack of sparing of the neural fibres that supply the corpora cavernosa. The median follow-up period was 53 months [range: 25-84]. For all the forty patients, there were no clinical or radiological evidence of Val or nodal recurrence of the disease. We can conclude that the described modifications of the technique of standard radical cystectony reduced the morbidity of radical cystectomy without altering its therapeutic efficacy

Partial laryngectomy for carcinoma of the larynx: a study of 12 cases

Twelve patients underwent partial laryngectomy for carcinoma of the larynx. Transverse partial laryngectomy was done in three supraglottic tumours. Two of these patients were radiotherapy failures. The vocal cord was fixed in six patients and in three cases the tumour involved the anterior commissural with a mobile cord. The subglottic extension in cordial lesions was less than 1 cm anteriorly to allow for radical excision of the tumour. A satisfactory result with preservation of phonation, deglutition and respiration was achieved in ten patients. In two patients, laryngeal stenosis necessitated traceostomy. Post-operative radiotherapy was administered after excision of a carcinoma of the epiglottis, and to another patient in whom the surgical margin was found involved with tumour after a frontolateral hemilaryngectomy. Local recurrence of tumour occurred in one patient who underwent a subsequent total laryngectomy, and cervical node metastases occurred in another, for whom a radical neck dissection was performed