presence of malignant cells in post-mastectomy drainage for cancer predict the development of local recurrence?

Many factors predict local recurrence [LR] following surgery for breast cancer. Presence of malignant cells [MCs] in post-mastectomy drainage was not investigated as a factor before. This work was conducted to correlate between presence of MCs in post-mastectomy drainage for cancer and LR. Eighty nine patients with operable breast cancer, admitted to Alexandria Surgical Oncology Unit, performed modified radical mastectomy were included. Two closed suction tube drains were inserted, in the breast bed and the axillary fossa, with a common collecting serial bottle. Aspiration from the draining tubes was done, on the day of their removal. Fresh samples were prepared and examined cytologically for of MCs. Patients were followed for development of LR. Correlating was done between presence of MCs and LR. Fourteen cases [15.7%] had positive samples for MCs [four breast bed and ten axillary]. Over a mean follow-up of 38.37 +/- 9.01 months, nine LR [10.1%] developed [six axillary and three breast]. Seven patients [77.8%] out of nine with LR. Had malignant samples Multivariate analysis revealed that presence of MCs in the drainage was an independent predictive factor for risk of LR. Persistent presence of MCs in postmastectomy drainage for cancer is a predictor for LR. However, a large scale study with longer follow-up is needed to support this result

Long term results of truncal vagotomy and [uncut] roux gastrojejunostomy for management of chronic duodenal ulcer with reference to gastric emptying

In the previous reports, we described the surgical technique of truncal vagotomy and "uncut" Roux gastro-jejunostomy [TV+UCRGJ] in management of chronic duodenal ulcer [CDU]. Also, we demonstrated that it is not associated with significant increase in postoperative enterogastric reflux [EGR]. This work represents the long-term results of TV+UCRGJ, with assessment of gastric emptying using gastro-hydro-sonography. Fifty two patients, [mean age: 47.21+12.89 years], with CDU were managed by TV+UCRGJ and were followed-up for a mean duration of 54.71 +/- 9.21 months, for symptomatic outcome. Gastric emptying for semisolids was assessed ultrasonographically, by measuring the percent change of the post-prandial gastric antral area [AA] in patients, pre and at least 12 months post-operative. The results were compared to 50 matching controls. Excellent or fair symptomatic outcome was described by 47 patients [90.3%]. Four patients [7.7%] needed redo gastric surgery, two with ARG [one due to stapler line dehiscence] and two with severe gastric stasis. There was a significant drop in the mean preoperative symptomatic score, following surgery [2.98 +/- 0.92 Vs 0.827 +/- 1.279, p=0.000], to a figure matching the controls [0.827 +/- 1.279 Vs 0.667 +/- 1.046, p=0.514]. Ultrasonographic assessment of gastric emptying, showed insignificant difference in gatric emptying percent at 30 minutes between postoperative and controls values [66.73 +/- 11.75% Vs. 70.19 +/- 10.27%, P=0.810]. As well, there was insignificant difference between post and preoperative values [66.73 +/- 11.75% Vs. 69.85 +/- 11.88%, p=0.074]. Truncal vagotomy and "Uncut" Roux gastrojejunostomy carries good long-term symptomatic and functional outcome. Also, it is associated with normal gastric emptying. So, it can be included as an initial surgical option in the management of uncomplicated CDU

Management of peptic ulcer and enterogastric reflux following conventional gastrojejunostomy and "UNCUT" roux gastrojejunostomy

"Uncut" Row gastrojejunostomy had been described for management of postgastrectomy alkaline reflux gastritis and delayed gastric emptying, bus not as primary treatment of chronic duodenal ulcer. This work aims at assessment of enterogastric reflux after truncal vagotomy and uncut Roux gastrojejunostomy in management of chronic duodenal ulcer. Out of 29 patients with chronic duodenal ulcer. 12 were managed by truncal vagotomy [TV] and uncut Roux gastrojejunostomy [UCRGJ], while 17 patients were managed by truncal vagotomy and conventional gastrojejunostomy [GJ]. Enterogastric reflux [EGR] was assessed in both subgroups, before and after surgery, using milk-HIDA scan, and the results were compared to 20 matching healthy controls. EGR showed insignificant increase follows TV+UCRGJ, while it was significantly higher after TV+GJ 3-9 months after surgery, As well the mean EGR was significantly higher in patients with TV+GJ compared to those with TV UCRGJ and controls [16.3 +/- 9.58% Vs 2.6 +/- 3.5% and 1.4 +/- 2.53%] [F=39.931, p=0.000]. Also, patients with TV +UCRGJ had a significantly lower incidence of abnormal EGR compared to those with TV+GJ [16.7% Vs 88.2%] [X[2]=14.854, p=0.00012]. "Uncut" Row gostrojejunostomy is a physiological procedure to be performed as a primary management of chronic duodenal ulcer, as it is not associated with increased enterogastric reflux