Comparative study between using harmonic scalpel and electrocautery in modified radical mastectomy

The harmonic scalpel is a recent surgical instrument that allows intra-operative cutting and coagulation at the same time. The aim of this study was to compare between the usage of harmonic scalpel or electrocautery in modified radical mastectomy operation. This study included fourty patients with operable breast cancer. They were randomized into two equal groups to do modified radical mastectomy either using harmonic scalpel [group A] or using conventional electrocautery [group B]. The total operative time, the time of axillary dissection, the time for raising the flaps and the time of breast dissection were calculated. The days of drainage and the total drainage volume were also recorded. Calculating the time needed for axillary dissection revealed a significantly shorter time in patients operated on by harmonic scalpel. [p = 0.004]. The mean total draining volume in group [A] was lower than in group [B]. The difference was statistically significant. [p=0.02]. 15% of cases in group [A] and 25% of cases in group [B] suffered from postoperative seroma, the difference was statistically insignificant [p=o.677]. The use of harmonic scalpel in MRM shortening the axillary dissection time and decrease drainage volume, drainage day and hospital stay

Surgery or chemotherapy in locally advanced operable breast cancer; which comes first?

Background: Unfortunately, locally advanced cancer breast [LABC] represents more than 50% 0f the newly diagnosed breast cancer patients. There are 2 approaches for treating these patients. The first is modified radical mastectomy [MRM] 0r radical mastectomy [RM] followed by adjuvant systemic therapy and radiotherapy. While the second is preoperative chemotherapyfollowed by surgery and radiotherapy

Aim: The aim of this prospective randomized study was to evaluate two different lines in the management of operable LABC

Methods: This study had been conducted on 40 patients with operable LABC presented to surgical or medical oncology units, Alexandria University Hospital. These patients were equally divided at random by closed enve10pes method into two groups: Group 1. who received 6 cycles of neoadjuvant chemotherapy followed by surgery and postoperative Adjuvant radiotherapy. Group II. who had been treated by surgery with early postoperative chemotherapy where first cycle chemotherapy started immediate] y after tissue diagnosis independent of the time of surgery. In both groups completion of the adjuvant chemotherapy, radiotherapy and hormonal therapy had been applied

Results: After completion of neoadjuvant chemotherapy for group 1, two patients [5%] showed complete clinical response [CRc], while 10 patients [50%] had partial clinical response [PRC]. This gave a total clinical response rate of 55%. At pathologic examination of the mastectomy specimen; none of studied patients had CR, while 13 patients [65%] had smaller diameter tumors [PR]. No statistical significant difference was found in the postoperative wound complications in both groups. Postoperative pathological examination of mastectomy specimens in both groups showed that there were significant decrease in tumor size, nodal number and size in group I after Iry chemotherapy with significant increase in lymphocytic infiltration. 65 %of patients in group I survived with no evidence of loco-regional or distant recurrence compared to 70% in group II with no significant difference. Systemic recurrence alone or in combination with loco-regional was found in 18% and 20% of cases in each of the two groups respectively. 75% of patients in group I survived compared to 80% in group II with no significant statistical difference

Conclusions: Primary ehemotherapy in operable LABC resulted in significant reduction in tumor and nodal stage with reduction of their size and fixation that allowed their treatment with less radical surgery and direct wound closure. Complete clinical response to neoadjuvant chemotherapy doesn't mean complete pathological response. Preoperative chemotherapy had no impact on postoperative wound complications or patient tolerance to postoperative adjuvant chemo and radiotherapy. There was no significant disease free or overall sun'ival benefit of neoadjuvant over adjuvant chemotherapy in treatment of patients with operable LABC. Also better overall survival rates [OS] were correlated with better diseasefree survival rates [DFS]