Outcome after total mesorectal excision in the management of rectal experience of 150 patients

To assess oncological outcomes including local recurrence and cancer-specific survival as well as functional outcomes including urinary and sexual functions in 150 cases of rectal cancer underwent total mesorectal excision [TME]. Patients with mid or low rectal cancer underwent TME with preservation of autonomic pelvic plexus. Oncological and functional outcomes were prospectively recorded and analyzed. A total of 150 patients of middle and lower rectal cancer underwent either APR or LAR with total mesorectal excision and pelvic nerve preservation between 1997 and 2007 were collected. Anastmotic leak was the commonest complication [16.6%]. Isolated local pelvic recurrence was 10.6%.The 5-year overall survival and cancer-specific survival rale were 45% and 52% respectively. All patients could void urine spontaneously and no patient became incontinent or went on chronic retention requiring catheterization. Postoperative urodynamics revealed normal mean maximal urinary flow rate and voided volume in 90% of patients. Erection was possible in 93%; penetration ability was possible in 69 patients [80%]. Doppler US was normal on both sides in 80%. Advances in rectal cancer surgical techniques allows improving overall survival and quality of life through local control and preservation of sphincter, sexual and urinary function

Oncoplasty for breast carcinoma

To assess the oncologic and cosmetic outcomes in women with breast carcinoma who were treated with breast-conserving surgery using oncoplastic techniques with concomitant symmetrization of the contra lateral breast. Although breast-conserving surgery is the standard form of treatment for invasive breast tumors up to 4cm, cosmetic results may be poor and clear resection margins difficult to obtain in patients with large, ill-defined, or poorly situated tumors. The integration of oncoplastic techniques with or without a concomitant contralateral symmetrization procedure is a novel surgical approach that combines both oncologic and plastic surgical procedures and allows wide excisions and prevents breast deformities. This is a prospective study of 32 patients who were operated on for breast carcinoma between August 2004 and Mars 2006 by the author. The procedure was proposed for patients in whom conservative treatment was possible on oncologic grounds but where a standard lumpectomy would have led to poor cosmetic outcomes. Standard treatment protocols were followed. All patients received postoperative radiotherapy except 2. Mean follow-up was 1.5 years. They were compared to a control group including 43 patients with the same inclusion criteria. Mean weight of excised material on the tumor side was 393 g. The actuarial 2-year local recurrence rate was about 6%, contra lateral procedure was needed in 10%. Cosmoses was favorable in 88% of cases. The use of oncoplastic techniques with or without concomitant symmetrization of the contra lateral breast allows extensive resections for the treatment of breast carcinoma and results in favorable both oncologic and esthetic outcomes. This approach might be useful in extending the indications for conservative breast therapy

Value of preoperative axillary ultrasonography as a useful guide to sentinel LN biopsy in clinically node negative with large sized breast carcinoma

Breast carcinoma is most'y diagnosed beyond stage I in Egyptian patients. Here, we evakiate the use of preoperative ultrasonography to predict axillary lymph nodes involvement. We speculate that preoperative ultrasonographic evaluation may be of paramount importance in the era of sentinel node biopsy. Consecutive 110 clinically node-negative breast carcinomas were ultrasonographically examined for axillary nodes using 10 MHz linear transducer The images were recorded for analysis. Descriptive statistics of morphologic features of the examined lymph node in relation to final pathology were performed. Mean age was 47.5 years. Axillary lymph nodes were pathologically invaded in 80 patients [72.7%] with an average infiltration of 4.2 nodes per axilla. Compared to pathologic find ings, gray sca'e ultrasonography was highly significant in differentiating malignant from benign tumors [p<0.001], Gray sca'e examination had a sensitivity for detecting nodal metastases of 85.0%, specificity of 63.3% and overall accuracy of 79.1%. Surgeon-performed axillary ultrasonography is a helpful adjunct to clinical examination to improve preoperative staging in clinically node negative breast cancer especially in larger-sized tumors. However if sonography is negative sentinel node biopsy should be done due to considerable percentage of false negative results