Skin sparing mastectomy in large tumor breast cancer

Skin sparing mastectomy [SSM] with immediate reconstruction has been approved to be safe treatment approach for early-stage [T1 or T2] breast carcinoma. This prospective study was undertaken to assess both the feasibility and oncological safety of SSM in patients with large tumor breast cancer. Twenty patients with large T2 and T3 breast cancer were included. All patients were subjected to [SSM] with immediate reconstruction with either Transverse Rectus Abdominis Myocutaneous [TRAM] flap or Latissimus Dorsi [LD] myocutaneous flap with an implant. The patients were followed up for a period ranged from 12-22 months with a mean of 14.55 +/- 2.96 months. The mean tumor size was 5 +/- 0.73 cm [range 4-6cm]. Postoperatively, 3 cases [15%] developed necrosis of a part of their native skin flaps, one case [5%] had partial TRAM flap necrosis, and 5 cases developed seroma. All cases received postoperative chemotherapy that was initiated in a mean of 21.5 +/- 7.87 days, then radiotherapy after chemotherapy completion. Throughout the follow up period, none of the patients developed local recurrence while only one case [5%] developed distant bony metastases. SSM is feasible and oncologically safe in large tumor breast cancer; however, longer period of follow up is required

role of total mesorectal excision for treatment of rectal cancer

Colo-rectal cancer is the most common gastrointestinal cancer in the world. One of the main problems in the treatment of rectal cancer is the development of local recurrences. This study was undertaken to evaluate the results of surgical treatment, with adjuvant and neo-adjuvant modalities, after the introduction of the concept of total mesorectal excision for lower and middle rectal cancer. 25 patients with rectal carcinoma were treated in the period between March 1998-till March 2003. They were 12 males with a mean age of 50.1 +/- 6 [average 28-81 years] and 13 females with the mean age of 52 +/- 3 [average 35-72 years]. 14 patients had a middle rectal tumor [7 +/- 2cm form the anal verge], underwent low anterior resection with a coloplasty reservoir reconstruction. Abdomino-perineal resection was done for 11 patients with lower tumours [3 +/- 1cm form the anal verge]. Fourteen patients received neo-adjuvant chemo-irradiation, 19 received adjuvant chemotherapy and only 7 received adjuvant postoperative radiotherapy. The operative complications included ureteric injury [1], urethral injury [1], and pre-sacral bleeding [2]. Immediate postoperative complications include 1 anastmotic leakage, and 1 pulmonary embolism [died and excluded from the study]. During the follow up period 2 patients developed pelvic recurrence [19 +/- 4 months], and 2 others developed liver metastases [18 +/- 6 months]. The overall, 3 years, disease free survival was 78.3%.Total mesorectal excision with neo-adjuvant and adjuvant treatment can improve the outcome for treatment of cancer rectum

comparative study between colonic J-pouch and coloplasty anastomosis after ultra-low anterior resection for middle and low rectal cancer

Rectal cancer is the second common gastrointestinal tumour and its surgical treatment varies according to its distance from anal verge. After low anterior resection and colorectal anastmosis, for upper 1/3 rectal tumour, patients usually have normal habits with minimal affection. However, for middle and lower rectal cancer, they require a pouch to minimize the functional disorders resulting from the rectal pouch and may be also related to the loss of normal anorectal sensation. To compare the functional results of coloplasty pouch [CP] versus the colonic J- pouch [JP], after low anterior resection. Thirty patients diagnosed to have an operable middle and low rectal carcinoma, were randomized into two equal groups, the J-pouch and the coloplasty group. All the patients underwent low anterior resection with temporary ileostomy diversion, after colo-anal asnastmosis with CP or JP formation. The patients had a preoperative and postoperative anal manometric study, at 6 months and 12 months interval after closure of ileostomy. This includes resting anal pressure, maximum squeeze pressure, and maximum tolerable volume, as well as the recto-anal inhibitory reflex. Patients had a questionnaire based on Hida et al. scoring system where different variables [evacuation, continence, urgency, perineal soiling and others] were graded from zero to two to quantify the overall functional results. There was no significant difference between both groups regarding intra-operative or postoperative complications, or hospital stay. Bowel evacuation was better for CP patients, at 6 months, however, it equalized in both groups with no significant difference at 1-year interval. Although, the resting anal pressure and the maximum squeeze pressure were lower than the preoperative values, but there was no significant difference between both groups after six months or one year duration. Finally there was a significant inverse correlation between the total functional score and the anasto-motic distance from the anal verge for both groups, the smaller the distance from the anal verge, the higher was the functional score [poorer function]. Patients with colo-plasty pouches were able to defer their bowel movement better, and had less nocturnal leak, at 6 months, however, bowel function equalized in both groups at 1 year, with no significant difference between both groups

Management of soft tissue sarcoma of extremities in adults

Soft-tissue sarcomas [STS] are a group of rare malignant tumors, many of which arise in the limbs. To review the results of managements of STS of extremities in adults treated in the period between December 1997 till December 2000, in Oncology Unit Menufia University Hospital [MUH]. Sixteen adult patients had STS in their extremities. Seven males and 9 females with a mean age of 45.3 years. Variables studied were; clinical presentation and its duration, tumor characteristics [site, size, pathological type and grade, lymph node status], treatment given, and its outcome, as well as the disease free survival [DFS]. The most common type of presentation was a painless mass for 5 months +/- 2. Most sarcomas were located in the lower extremity [81%]; all the patients underwent conservative surgical excision except one underwent disarticulation. Eight patients had adjuvant radiotherapy and 5 patients had chemotherapy. The commonest histopathology found was liposarcomas [7 cases, 43%], followed by fibrosarcoma [4 cases, 18%], and 50% of patients had high-grade tumours. The tumour size, type, and grade were independent risk factors for poorer disease free survival. The disease free survival for all patients, for 5 years was 81.25%. With limb salvage surgery and radiotherapy delivery, local control of STS in the extremity has become feasible. Other modalities, as hormonal treatment and immunetherapy should be further studied to optimize the outcome and improve DFS