Resultados del tratamiento quirúrgico del cáncer de mama en mujeres hasta 40 años de edad / Outcome of surgical treatment of breast cancer in women under 40 years of age

Introducción: El cáncer de mama es el más frecuente y la principal causa de muerte por cáncer en la mujer. Es de peor pronóstico en las mujeres jóvenes por presentar una histología más agresiva y mayor índice de recidivas. Objetivo: Evaluar los resultados del tratamiento quirúrgico del cáncer de mama en mujeres hasta 40 años de edad en el Hospital Clínico Quirúrgico Hermanos Ameijeiras. Método: Se realizó un estudio descriptivo, longitudinal, retrospectivo y prospectivo en el período de mayo de 2005 a mayo de 2015. Se estudiaron 79 mujeres hasta 40 años que fueron operadas por diagnóstico de cáncer de mama. Resultados: Se encontró que 83,5 por ciento tenían entre 35 y 40 años, con solo 4 casos por debajo de los 30 años (5,1 por ciento). El 38,4 por ciento negaron historia familiar de cáncer. Las manifestaciones clínicas más frecuentes fueron la presencia de nódulos no dolorosos en 93,7 por ciento y nódulo de consistencia dura en 44,3 por ciento. Predominaron los tumores en estadio I con 48,1 por ciento, seguido del estadio II con 32,9 por ciento. La técnica quirúrgica más empleada fue la Mastectomía Radical Modificada en 58 casos (73,4 por ciento). En 37 pacientes (46,8 por ciento) hubo recaída de la enfermedad. Durante el seguimiento hubo 11 fallecidas (13,9 por ciento). El tiempo medio de supervivencia global fue de aproximadamente 9 años con una variación entre 7 y 10 años. El tiempo medio de supervivencia libre de enfermedad fue de 5,5 años con una variación entre 5 y 6 años para un intervalo de confianza del 95 por ciento. Conclusiones: En las mujeres menores de 40 años el cáncer de mama es de peor pronóstico por presentar una histología más agresiva y mayor índice de recidivas(AU)

Introduction: Breast cancer is the most frequent cancer and the main cause of death for cancer in women. It has a worse prognosis in young women due to more aggressive histology and higher recurrence rate. Objective: To assess the results of the surgical treatment of breast cancer in women up to 40 years of age in Hermanos Ameijeiras Clinical-Surgical Hospital. Method: A descriptive, longitudinal, retrospective and prospective study was carried out in the period from May 2005 to May 2015. Results: 79 women aged up to 40 years with a diagnosis of breast cancer who underwent surgery were studied. It was found that 83.5 percent were between 35 and 40 years old, with only 4 cases below 30 years (5.1 percent). 38.4 percent referred no family history of cancer. The most frequent clinical manifestations were the presence of non-painful nodules in 93.7 percent and nodule of hard consistency in 44.3 percent. The tumors in stage I predominated, with 48.1 percent, followed by other in stage II, with 32.9 percent. The most widely used surgical technique was modified radical mastectomy, in 58 cases (73.4 percent). In 37 patients (46.8 percent), there was relapse of the disease. During the follow-up, 11 patients (13.9 percent) deceased. The average time of overall survival was approximately 9 years, with a variation between 7 and 10 years. The mean time of disease-free survival was 5.5 years, with a variation between 5 and 6 years, which represents a 95 percent confidence interval. Conclusions: In women under 40 years of age, breast cancer has a worse prognosis due to a more aggressive histology and higher recurrence rate(AU)

Anesthetic management of a patient with hypertrophic obstructive cardiomyopathy undergoing modified radical mastectomy

Hypertrophic obstructive cardiomyopathy [HOCM] is a rare genetic disorder characterized by left ventricular outflow tract [LVOT] obstruction. Clinical presentation ranges from absence of symptoms to sudden death. Our 60 year old patient scheduled for left modified radical mastectomy had HOCM since seventeen years with severe LVOT obstruction and mitral regurgitation. An implantable cardioverter defibrillator [ICD] and permanent pacemaker [PPM] was inserted 15 months earlier for ventricular tachycardia. Anesthetic management of these patients presents considerable challenges and requires maintenance of desired hemodynamic parameters and management of specific complications. Factors like tachycardia, hypovolemia, vasodilation and increased cardiac contractility leads to exacerbation of the obstruction. In our patient there was the additional consideration of the ICD which required to be turned off during surgery with full provision for external defibrillation. We managed to successfully maintain the desired hemodynamics throughout the surgery and the patient was discharged home on the seventh postoperative day

Cirugía conservadora y mastectomía radical modificada en el cáncer de mama de etapas I y II / Conservative surgery and radical mastectomy in stage I and II breast cancer

INTRODUCCIÓN. El cáncer de mama es la primera causa de muerte por cáncer en la mujer y se ha convertido en una pandemia que amenaza continuar si no se halla la forma de prevenirlo. El objetivo de este trabajo fue evaluar la supervivencia global y el intervalo libre de enfermedad en pacientes que recibieron como tratamiento inicial cirugía conservadora más radioterapia y mastectomía radical modificada; y determinar otras variables pronósticas, como la edad, clínicas histológicas, recaídas y tiempo entre la cirugía y la radioterapia. MÉTODOS. Entre enero del 2000 y diciembre del 2005 se realizó en el Hospital «Julio Trigo López¼ un estudio retrospectivo y descriptivo de un grupo de pacientes con cáncer primario de mama, en etapas I y II. Los datos se extrajeron de las historias clínicas y de encuestas. Se creó una base de datos y se realizó un análisis descriptivo de los datos, frecuencia y porcentajes para el caso de las variables cualitativas y medias, y desviaciones estándares para las cuantitativas. Se estimó la supervivencia y el intervalo libre de enfermedad utilizando el método de Kaplan Meir y se compararon en curvas según las variables de interés de Sug Rank. El análisis de las variables pronósticas de supervivencia e intervalo libre de enfermedad se realizó mediante análisis de regresión de Cox. RESULTADOS. El intervalo libre de enfermedad fue mayor en la cirugía conservadora que en la mastectomía radical modificada, y de igual manera se comporto la supervivencia global. Las pacientes con Rh positivo presentaron mayor intervalo libre de enfermedad (88 por ciento). El carcinoma infiltrante fue la variedad más frecuente y de mayor número de recaídas, en las cuales influyó el tiempo entre la cirugía y la radioterapia. La frecuencia más alta de cáncer de mama se observó en las mujeres mayores de 50 años. En la cirugía conservadora predominó la conducta terapéutica de cirugía más radioterapia y quimioterapia y en la mastectomía radical modificada, la quimioterapia. En la cirugía conservadora fueron más frecuentes las recaídas locorregionales, mientras que en la mastectomía radical, las recaídas más frecuentes se registraron a distancia. CONCLUSIONES. El tipo de cirugía no influyó significativamente en el intervalo libre de enfermedad, pero sí hubo diferencias entre las técnicas conservadoras. Los factores pronósticos tamaño del tumor, estado ganglionar y receptores hormonales influyeron en la supervivencia y en el intervalo libre de enfermedad en todas las pacientes(AU)

INTRODUCTION. Breast cancer is the first cause of death from cancer in females and it has become a pandemic threatening to continue if the way to prevent it is not found. The objective of this paper was to evaluate global survival and the disease free interval in patients that underwent conservative surgery plus radiotherapy and modified radical mastectomy as initial treatment, and to determine other prognostic variables, such as age, histological clinics, relapses and time elapsed between surgery and radiotherapy. METHODS. A retrospective and descriptive study was conducted in a group of patients with stage I and II primary breast cancer at «Julio Trigo López¼ Hospital from January 2000 to December 2005. Data were taken from the medical histories and surveys. A database was created and a descriptive analysis was made of the data, frequency and percentages for the case of qualitative and mean variables, and of the standard deviations for the quantitative variables. Survival and the disease free interval were estimated by Kaplan Meir's method and they were compared by curves according to the Sug Rank's variables of interest. The analysis of the prognostic variables of survival and disease free interval was carried out by Cox's regression analysis. RESULTS. The disease free interval was longer in conservative surgery than in the modified radical mastectomy. Global survival had a similar behaviour. Patients with positive Rh presented a longer disease free interval (88 percent). The infiltrating carcinoma was the most frequent variety and it had the greatest number of relapses, which were influenced by the time elapsed between surgery and radiotherapy. The highest frequency of breast cancer was observed in females over 50. The therapeutic conduct of surgery plus radiotherapy and chemotherapy prevailed in conservative surgery, whereas chemotherapy predominated in the modified radical mastectomy. The locoregional relapses were more common in conservative surgery; however, the most frequent relapses in radical mastectomy were registered at a distance. CONCLUSIONS. The type of surgery did not exert a significant influence on the disease free interval, but there were differences among the conservative techniques. The prognostic factors size of the tumor, ganglionic state and hormone recipients influenced on the survival and on the disease free interval of all patients(AU)

Nodal status, C-ERBB-2 expression combined with lymphovascular invasion creates a more powerful tool for predicting outcome in breast cancer

To evaluate the prognostic role of peritumoral vascular invasion [PVI] and its association with axillary nodal status and c-erbB-2 expression. Seventy five patients with stage I and II breast carcinoma who underwent conservative breast surgery or modified radical mastectomy were assessed clinically and pathologically for tumor size, grade, axillary lymph node status and peritumoral vascular invasion [PVI]. The immunophenotype of the tumor was determined as: the expression of oestrogen [ER] and progesterone [PgR] receptors, and c-erbB2. Thirty eight patients [50.7%] showed PVI. It was found that extensive PVI was significantly more likely to be associated with nodal positivity, higher tumor grade and c-erbB-2 over-expression. - 52/75 [69.3%] patients showed positive nodal status. The analysis showed that nodal positivity was significantly associated with tumor size, higher grade, presence of PVI and c-erbB-2 overexpression. - PVI and nodal positivity showed no significant association with receptor status. These data suggest that assessment of PVI together with axillary nodal status and c-erbB-2 expression creates a more powerful tool for predicting outcome in patients with breast cancer

Modified radical mastectomy sparing one or both pectoral muscles in the treatment of breast cancer: intra and postoperative complications / Mastectomia radical modificada com conservação de um ou de ambos músculos peitorais no tratamento do câncer de mama: complicações intra e pós-operatórias

CONTEXT AND OBJECTIVE: Modified radical mastectomy is widely utilized in breast cancer treatment. However, no prospective comparison has yet been made between the Madden technique (preservation of the pectoralis minor muscle) and the Patey technique (resection of this muscle). The aim of this work was to compare these two modified radical mastectomy techniques, by analyzing their degrees of difficulty and complications. DESIGN AND SETTING: Randomized trial at the Breast Unit of Hospital Araújo Jorge, Goiás; and Faculdade de Medicina da Universidade Federal de Goiás. METHODS: 430 patients with breast cancer with an indication for modified radical mastectomy were included in the program, of whom 426 patients were available for analysis (225 allocated to Patey and 201 to Madden). The chi-squared and Student t tests were used for analysis. RESULTS: The patients' demographics were well balanced between the two groups. The mean duration of the surgical procedures was 105 (± 29.9) and 102 minutes (± 33), for the Patey and Madden groups, respectively (p = 0.6). Hospitalization duration was 2.3 days for both groups. The mean number of lymph nodes resected was 20.3 (± 7.6) for Patey and 19.8 (± 8.1) for Madden (p = 0.5). There were no differences in terms of vascular or nerve sections, hematomas or infections. The surgeons reported the same degree of difficulty for the two methods. CONCLUSION: The removal of the pectoralis minor muscle did not influence any of the variables studied. Therefore, either technique can be performed, at the surgeon's discretion.

CONTEXTO E OBJETIVO: A mastectomia radical modificada continua a ser amplamente usada para o tratamento de câncer de mama. Porém, até agora, a preservação do músculo peitoral secundário (técnica de Madden) não foi prospectivamente comparada à técnica de Patey. O objetivo deste trabalho foi comparar as duas técnicas de mastectomias radicais modificadas, analisando o grau de dificuldade e as complicações. TIPO DE ESTUDO E LOCAL: Estudo randomizado, realizado na Unidade de Mama do Hospital Araújo Jorge, Faculdade de Medicina da Universidade Federal de Goiás, Goiás, Brazil. MÉTODOS: 430 pacientes portadoras de câncer de mama com indicação de mastectomia radical modificada foram incluídas no programa. Foram disponíveis para análise 426 pacientes, das quais 225 alocadas no grupo Patey e 201 no grupo Madden. A análise foi feita por intenção de tratamento, usando-se o Qui-quadrado ou o teste t de Student, quando aplicáveis. RESULTADOS: A distribuição das características demográficas pacientes foi semelhante entre os grupos. A duração média da cirurgia foi de 105 minutos (DP ± 29.9) e 102 (DP ± 33) para o grupo Patey e Madden, respectivamente (p = 0,6). O tempo de internação foi de 2,3 dias para ambos os grupos. A média de linfonodos ressecados foi de 20,3 (DP ± 7,6) para Patey e 19,8 (DP ± 8,1) para Madden (p = 0,5). Não houve diferenças entre as complicações vasculares, nervosas, hematomas, infecções, bem quanto à dificuldade relatada pelo cirurgião. CONCLUSÃO: A retirada do músculo pequeno peitoral não influenciou nenhuma das variáveis estudadas. As técnicas de mastectomias radicais modificadas, Patey e Madden, foram semelhantes em todos os critérios observados, podendo ser executadas de acordo com a preferência do cirurgião.

Internal mammary lymph nodes status in breast cancer patients in the sentinel lymph node biopsy era

This study was carried out on 30 female patients with operable breast carcinoma, to determine the incidence of internal mammary lymph nodes [IMN] involvement and its correlations. All patients were submitted to modified radical mastectomy with axillary clearance and internal mammary lymph nodes [IMN] biopsy. IMN involvement by malignant cells was positive in 20% of the patients. Cases with inner breast half carcinoma had 50% incidence of IMN metastasis. Also cases with tumor size larger than 5cm had 66.7% incidence of IMIN metastasis. IMN involvement increased as the level of involvement of axillary lymph nodes increased. The results of the study emphasize the need for carrying out a sentinel IMAT biopsy especially from the first and second intercostal spaces in the cases with positive correlation as regards size of the tumor, its location and axillary lymph nodes status. This will provide additional prognostic information which might be of help to guide the administration of adjuvant therapy

Cáncer de mama bilateral en el Hospital Universitario Comandante Manuel Fajardo, 1982-2003 / Bilateral breast cancer at Comandante Manuel Fajardo Teaching Hospital (1982-2003)

En 1945, Foote y Stewart plantearon que el antecedente más frecuente de cáncer en un seno es haber tenido una neoplasia en el seno contrario. Se realizó un estudio sobre los casos de cáncer de mama bilateral atendidos en nuestro servicio entre 1982 y 2003. Métodos: El universo de nuestro trabajo está compuesto por 25 pacientes que fueron atendidas en los últimos 20 años por cáncer de mama bilateral, la mayoría de ellos metacrónicos (21 casos). En cada caso se analizó edad, etapas clínicas al momento del diagnóstico, tratamiento utilizado, tipo histológico y evolución, entre otras variables. Resultados: Se observó la mayor incidencia de esta enfermedad en la 5ta. y 6ta. décadas de la vida, con predominio de los tumores en etapa II. El tipo de operación más realizado fue la mastectomía radical modificada de Patey y prevalecieron las técnicas más conservadores en la segunda operación. Siete de las pacientes fallecieron por la enfermedad. Conclusiones: El pronóstico de las mujeres con cáncer de mama bilateral suele ser favorable y depende de la etapa de desarrollo de éste al momento del diagnóstico. El tratamiento del segundo primario fue más conservador que el primero. El seguimiento estricto y el uso de la ingeniería genética son elementos fundamentales para el diagnóstico precoz(AU)

In 1945, Foote and Stewart said: the most frequent antecedent of cancer in a breast is having had a neoplasia in the other breast. A study of the cases of bilateral breast cancer seen in our service between 1982 and 2003 was conducted. Methods: The universe of our work was composed of 25 patients attended in the last 20 years due to bilateral breast cancer. Most of them were metachronic (21 cases). Age, clinical stages at the time of diagnosis, treatment used, histological type and evolution, among other variables, were analyzed. Results: the highest incidence of this disease was observed in the 5th and 6th decades of life, with predominance of stage II tumors. Patev's modified radical mastectomy was the most common operation. The most conservative techniques prevailed in the second operation. Seven of the patients died as a result of the disease. Conclusions: the prognosis of women with bilateral breast cancer is usually favorable and it depends on its development stage at the time of the diagnosis. The treatment of the second was more conservative than the first one. The strict follow-up and the use of genetic engineering are fundamental elements for the early diagnosis(AU)

Mastectomy without drain at pectoral area: a randomized controlled trial.

OBJECTIVES: Mastectomy is still one of the standard alternative procedures for the management of female breast cancer. Axillary node dissection is also performed to establish the accurate staging. After operation, the axilla must be drained because of lymphatic leakage. Whether the raw surface at the pectoral area should be drained or not is an interesting controversial point. The authors conducted a randomized controlled trial to compare outcomes after modified radical mastectomy (MRM) with and without drainage at the pectoral area. METHODS: Sixty patients who agreed to be treated with MRM and had given their consent were enrolled. Mastectomy was performed to remove the breast tissue proper by scalpel in order to minimize tissue injury. The axillary contents were removed by sharp instrument. After bleeding had stopped, patients were randomly allocated to one or other of 2 groups: group I (n = 30): only 1 drain was inserted at the axilla area; group II (n = 30): 2 conventional drains were inserted into the pectoral area and axilla area. The size of tube drain and negative suction pressure were constant in all cases. Volume of contents was recorded daily. Subcutaneous seroma or hematoma were carefully observed and confirmed by ultrasonography 3-5 days after operation. Overall drainage contents and complications were compared. RESULTS: The mean weight of breast tissue of group I was 632.1 g and group II 654.0 g (p = 0.81). Total drainage contents (median) from the two groups were 250 cm3 and 231 cm3 respectively (p = 0.796). Complications occurred in 1 case in group I and 2 cases in group II (p = 0.35). None of the above differences were statistically significant. CONCLUSION: Mastectomy by scalpel can be performed without drainage at the pectoral area. Overall complications in the conventional group and the group without drain did not differ significantly.