Prognosis of Isolated Local Recurrence after Modified Radical Mastectomy for Early Breast Cancer

PURPOSE: Isolated local recurrence (ILR) after mastectomy is associated with increased risk of cancer-specific survival. This study evaluated the long-term survival and prognostic factors after ILR. METHODS: Between January 1988 and December 2004, 1,169 patients with early breast cancer (stage I or II) were treated with modified radical mastectomy at Kyungpook hospital. Retrospectively, 40 patients with isolated local recurrence (ILR) were found by medical records and we investigated their clinicopathologic factors and conducted analyses of prognostic factors, calculated overall survival, and relapse-free survival. RESULTS: The median follow-up times after initial operation and ILR were each 91 (range, 18~219) months and 40 (range, 1~205) months. There were 18 patients of 2nd recurrence and 15 expired by distant metastasis. The overall survivals at 5 years and 10 years after ILR were 65% and 49%. The relapse-free survivals at 5 years and 10 years after ILR were 54% and 29%. After 2nd recurrence, the mean survival time was 21 months and the 3-year overall survival rate was 21%. By univariate and multivariate analyses, the time interval between initial operation and ILR was only statistically significant independent prognostic factor of overall survival after ILR. The 10 year-overall survival rates of 24 months to ILR were each 26% and 70%. There was no independent prognostic factor of relapse-free survival after ILR. CONCLUSION: For patients who developed isolated local recurrence after modified radical mastectomy for early breast cancer, shorter time interval to ILR is a poor prognostic factor of overall survival after ILR.

Analysis of the Surgical Outcome and Quality of Life after Pancreaticoduodenectomy for Nonneoplastic Disease

PURPOSE: Pancreaticoduodenectomy for mass-like lesions that are suspicious of malignancy sometimes reveals only nonneoplastic disease, especially in those cases where adequate tissues for biopsy are unavailable. In this study, we evaluated the outcomes and quality of life (QOL) after pancreaticoduodenectomy for treating nonneoplastic disease. METHODS: The clinical data of 28 patients who underwent pancreaticoduodenectomy for nonneoplatic disease and trauma from Jan. 1992 to Feb. 2006 were reviewed retrospectively. The QOL was evaluated using the FACT-Hep questionnaire. The patients who underwent laparoscopic cholecystectomy for benign gallbladder disease were utilized as the control group. RESULTS: 13.8% (28/203) of all the pancreaticoduodenectomized patients had nonneoplatic disease and trauma. Male patients were predominant (25/28) and all the trauma patients were male. The mean age was 48 (23~72) years old. The indications for surgery included lesions suspicious for malignancy (16 cases), pancreaticoduodenal artery aneurysm (1 case), and pancreatoduodenal injury (11 cases). The histologic findings of the nonneoplastic lesions revealed benign inflammation of the bile duct (6 cases), chronic pancreatitis (8 cases), pancreatic pseudocyst (1 case), and fibrosis of the Ampulla of Vater (1 case). No surgical mortality occurred. However, the trauma patients group had higher morbidity (72.7% Vs 23.5%, respectively, P=0.01) and a longer hospital stay (68.0 days Vs 32.6 days, respectively, P=0.02) after surgery compared to the nonneoplastic disease patient group. The QOL of the patient who underwent pancreaticoduodenectomy for nonneoplatic disease was not different from that of the control group. CONCLUSION: Since pancreaticoduodenectomy for nonneoplastic disease was safe and the QOL of the patients was acceptable, it should be performed more often when malignancies can not be excluded from the differential diagnosis.