Oncologic Outcomes after Immediate Breast Reconstruction Following Total Mastectomy in Patients with Breast Cancer: A Matched Case-Control Study / 한국유방암학회지

PURPOSE: The use of immediate breast reconstruction (IBR) following total mastectomy (TM) has increased markedly in patients with breast cancer. As the indications for IBR have been broadened and more breast-conserving surgery-eligible patients are undergoing IBR, comparing the oncologic safety between TM only and IBR following TM becomes more difficult. This study aimed to analyze the oncologic outcomes between TM only and IBR following TM via a matched case-control methodology. METHODS: A retrospective review was conducted to identify all patients who underwent TM between 2008 and 2014. We excluded patients who underwent neoadjuvant chemotherapy, including palliative chemotherapy, and had a follow-up duration 0.050). Matching was considered successful for the matching variables and other factors, such as family history, histology, multiplicity, and lymphovascular invasion. There were no significant differences in overall survival (log-rank p=0.454), disease-free survival (log-rank p=0.186), local recurrence-free survival (log-rank p=0.114), or distant metastasis-free survival rates (logrank p=0.537) between the two groups. CONCLUSION: Our results suggest that IBR following TM is a feasible treatment option for patients with breast cancer.

Preoperative Breast Magnetic Resonance Imaging for the Assessment of the Size of Ductal Carcinoma In Situ

PURPOSE: The purpose of this study was to determine whether magnetic resonance imaging (MRI) could assess the size of ductal carcinoma in situ (DCIS) more accurately compared to mammography and ultrasonography using the histopathological dimension of the surgical specimen as the reference measurement. METHODS: This was a retrospective review study using data from our institution database of breast cancer. Preoperative contrast-enhanced MRI, mammography and ultrasonography were performed to detect and assess the size of DCIS in 131 patients. The greatest dimensions of DCIS determined by the imaging modalities were compared with the histopathological dimensions of the surgical specimens. Intraclass coefficients were calculated to examine the agreement among the MRI, mammography and ultrasonography measurements. The Wilcoxon signed-rank test was used to evaluate the statistical significance of the differences in size among MRI, mammography or ultrasonography and histopathology findings. RESULTS: Of the 131 DCIS lesions, 126 (96.2%) were detected by MRI, 103 (78.6%) were detected by mammography, and 121 (92.4%) were detected by ultrasonography. The mean lesion size was 38.8 mm on histopathology, 36.0 mm on MRI, 28.8 mm on mammography, and 23.3 mm on ultrasonography, and there were no significant differences between sizes determined by histopathology and MRI, while there were significant differences between histopathology and the other modalities. The correlation coefficient between histopathological measurement and MRI was 0.837, versus 0.461 between histopathology and mammography and 0.284 between histopathology and ultrasonography. The lesion size was correctly estimated (±5 mm), under-estimated (5 mm), respectively, by MRI in 52.7%, 30.5%, and 16.8% of cases; by mammography in 32.0%, 51.2%, and 16.8% of cases, respectively; and by ultrasonography in 24.4%, 62.6%, and 13.0% of cases, respectively. CONCLUSION: In our study, MRI was more accurate for detection and assessment the size of DCIS compared to mammography and ultrasonography.

Independent Prognostic Factors for Overall Survival after Salvage Operation for Ipsilateral Breast Tumor Recurrence Following Breast-Conserving Surgery / 한국유방암학회지

PURPOSE: Few studies address independent prognostic factors after ipsilateral breast tumor recurrence (IBTR) following breast-conserving surgery (BCS). Locoregional recurrence is associated with distant metastases and increased mortality rates. Therefore anticipating prognoses after IBTR and evaluating risk factors for overall survival following a second salvage operation are important. We evaluated independent prognostic factors affecting overall survival after a second operation for IBTR. METHODS: We retrospectively identified 11,073 patients who underwent breast cancer surgery between November 1995 and December 2011. Locoregional recurrence occurred in 787 patients. Among them, IBTR developed in 165 patients selected for analysis. Excluding eight patients who refused further treatment, we analyzed 157 patients who underwent a second operation (partial mastectomy, 28 [17.8%]; total mastectomy, 129 [82.2%]) for IBTR. Excluding 26 patients with incomplete data, we evaluated the clinicopathol-ogical features influencing overall survival at the first and the second operation in the 131 patients who underwent a second operation. RESULTS: The median age of patients at the first operation was 43.6 years (range, 27-69 years). The median duration from the first to the second operation was 45.0 months (range, 2.5-164.6 months). The 5-year overall survival rate after IBTR was 87.1%. In the multivariable analyses, duration from the first to the second operation, histopathology, lymph node status, and adjuvant chemotherapy, radiotherapy, and endocrine therapy at the first operation were independent prognostic factors for overall survival. Positive estrogen receptor status and endocrine therapy at the second operation were also associated with increased overall survival following salvage operations for IBTR. CONCLUSION: The time interval to IBTR following BCS is related to overall survival after salvage operation for IBTR and it is important to undergo optimal adjuvant treatments according to risk factors after the first operation because those risk factors affect overall survival for IBTR following BCS.

Complications Leading Reoperation after Gastrectomy in Patients with Gastric Cancer: Frequency, Type, and Potential Causes

PURPOSE: Reoperations after gastrectomy for gastric cancer are performed for many types of complications. Unexpected reoperations may cause mental, physical, and financial problems for patients. The aim of the present study was to evaluate the causes of reoperations and to develop a strategic decision-making process for these reoperations. MATERIALS AND METHODS: From September 2002 through August 2010, 6,131 patients underwent open conventional gastrectomy operations at Samsung Medical Center. Of these, 129 patients (2.1%) required reoperation because of postoperative complications. We performed a retrospective analysis of the patients using an electronic medical record review. Statistical data were analyzed to compare age, sex, stage, type of gastrectomy, length of operation, size of tumor, and number of lymph node metastasis between patients who had been operated and those who had not. RESULTS: The variables of age, sex, tumor stage, type of gastrectomy, length of operation, and number of lymph node metastases did not differ between the 2 groups. However, the mean tumor size in the reoperation group was greater than that in the non-reoperation group (5.0+/-3.7 [standard deviation] versus 4.1+/-2.9, P=0.007). The leading cause of reoperation was surgical-site infection (n=49, 0.79%). Patients with intra-abdominal bleeding were operated on again in the shortest period after the initial gastrectomy (6.3+/-4.2 days). Patients with incisional hernia were not reoperated on until after 208.3+/-81.0 days, the longest postoperative period. CONCLUSIONS: Tumor size was the major variable leading to reoperation after gastrectomy for gastric cancer. The most common complication requiring the reoperation was a surgical site-related complication.