Impacto asistencial de las técnicas oncoplásticas conservadoras en un programa quirúrgico para enfermas con cáncer de mama / Impact of conservative oncoplastic techniques in a surgery program for women with breast cancer

Objetivos. Evaluar el impacto asistencial de las técnicas oncoplásticas conservadoras en un programa quirúrgico de mujeres con cáncer de mama. Pacientes y método. El grupo a estudio lo constituyeron enfermas sometidas a una técnica oncoplástica conservadora mientras que el grupo control lo formaron mujeres intervenidas con técnicas conservadoras (tumorectomía/cuadrantectomía) y radicales (mastectomía). Los criterios de inclusión para una técnica oncoplástica comprendieron mujeres con tumores de diámetro inferior a 3 cm, tumores T2 tratados con quimioterapia neoadyuvante y reducidos a un tamaño menor de 3 cm, en estadios clínicos axilares N0-N1a-b y procesos multifocales (infiltrante y/o in situ). Se excluyó del estudio a las mujeres con tumores T3-4, imposibilidad para la radioterapia postoperatoria, volumen mamario reducido e imposibilidad de márgenes libres de enfermedad durante el estudio intraoperatorio. Resultados. Durante el período se intervino a 160 mujeres en las que se practicaron 50 técnicas oncoplásticas (29 para evitar una mastectomía y 21 para mejorar el resultado de la técnica conservadora), 57 técnicas conservadoras y 53 mastectomías. Las técnicas utilizadas para la remodelación mamaria fueron la mamoplastia horizontal (23 casos), la mamoplastia vertical de pedículo superior (10 casos), la mamoplastia vertical de pedículo inferior (10 casos), la mamoplastia de rotación (4 casos) y la mamoplastia lateral (3 casos). El grupo de técnicas oncoplásticas presentó un tiempo medio de intervención (131 min) superior a las técnicas conservadoras (56 min) y radicales (93 min). La incidencia de complicaciones postoperatorias fue mayor en las técnicas radicales (35%), fundamentalmente por seromas axilares tras linfadenectomía, respecto a las técnicas conservadoras (25%) y oncoplásticas (24%). Conclusiones. Las técnicas oncoplásticas constituyen una alternativa eficaz y eficiente a las técnicas quirúrgicas convencionales en la mujer con cáncer de mama (AU)

Objectives. To evaluate the impact of conservative oncoplastic techniques in a surgery program for women with breast cancer. Patients and method. The study group was composed of women who underwent a conservative oncoplastic technique and the control group consisted of women who underwent conservative (tumorectomy/quadrantectomy) and radical (mastectomy) techniques. Women with tumors smaller than 3 cm, axillary clinical stages N0-N1a-b and multifocal processes (infiltrating and/or in situ) were eligible for inclusion. Women with T3-4 tumors and reduced breast volume, and those in whom postoperative radiotherapy and disease-free margins during intraoperative study were not feasible were excluded. Results. One hundred sixty women underwent surgery during the study period. Fifty oncoplastic techniques (29 to avoid mastectomy and 21 to improve the result of a conservative technique), 57 conservative techniques and 53 mastectomies were performed. The techniques used for breast reconstruction were superior mammoplasty with transversal scar (23 patients), mammoplasty with superior pedicle (10 patients), mammoplasty with inferior pedicle (10 patients), J-shapped mammoplasty (four patients) and oblique mammoplasty (three patients). The mean operating time in the group undergoing oncoplastic techniques (131 minutes) was higher than that in the group undergoing conservative (56 minutes) and radical (93 minutes) techniques. The incidence of postoperative complications was higher with radical techniques (35%), mainly due to axillary seromas after lymphadenectomy, than with conservative (25%) and oncoplastic (24%) techniques. Conclusions. Oncoplastic techniques are an effective and efficient alternative to conventional surgical techniques in women with breast cancer (AU)

Resultado de una entrevista personal realizada a mujeres intervenidas de cáncer de mama en Cirugía Ambulatoria / Results of a personal interview with women undergoing ambulatory surgery for breast cancer

OBJETIVO: Conocer el estado general y nivel de autonomía al alta, en las pacientes sometidas a tratamiento quirúrgico conservador de cáncer de mama, en un programa de Cirugía Ambulatoria. PACIENTES Y MÉTODO: Estudio prospectivo no aleatorizado en 55 mujeres diagnosticadas de carcinoma de mama con criterios de inclusión en un programa de cirugía sin ingreso para ser sometidas a cirugía conservadora, tumorectomía/cuadrantectomía y biopsia del ganglio centinela /linfadenectomía axilar. Para conocer el estado general y nivel de autonomía de la mujer al alta se realizó entrevista personal a las 48 horas post-intervención. RESULTADOS: Durante el período a estudio se realizaron un total de 64 intervenciones quirúrgicas (55 actos principales y 9 cirugías de rescate por afectación del ganglio centinela). El 93,7% de los procedimientos (60 intervenciones) se realizaron en régimen ambulatorio y en un 6,3% (4 intervenciones) de los casos fue necesario ingreso hospitalario por complicaciones postoperatorias, siendo éstos excluidos del estudio. A las 48 horas la entrevista reveló ausencia de dolor en el 78,3% de las pacientes y tolerancia a la alimentación en el 86,7% de los casos. A su llegada al domicilio el 43,3% se encontraban asintomáticas y el 61,7% durmieron sin incidencias. El 60 % fueron independientes en su autocuidado diario para el aseo y el 58,3 % no precisaron ayuda para vestirse. Eran capaces de iniciar su actividad habitual el 43,4 % de las mujeres, ninguna paciente requirió asistencia de urgencia y no se registraron reingresos hospitalarios. CONCLUSIONES: La cirugía conservadora del cáncer de mama en régimen ambulatorio es una alternativa segura al ingreso ordinario. En el circuito asistencial de la mujer con cáncer de mama, la atención de enfermería es elemento clave para poder incluir con éxito en programas ambulatorios a estas mujeres (AU)

AIM: To evaluate general health and self care on discharge of patients undergoing conservative surgical treatment for breast cancer included in a program for Ambulatory Surgery. PATIENTS AND METHODS: A non aleatory prospective study of 55 women diagnosed with breast cancer and fulfilling inclusión criteria for conservative surgical treatment, lumpectomy/ segmental mastectomy and excisional biopsy of centinel lymph node/ axillary lymphadenectomy in an ambulatory program was designed. To evaluate the degree of well-being and self care after discharge, a personal interview was held 48 hours alter the operation. RESULTS: During the period studied, a total of 64 operations were performed ( 55 operations and 9 rescue surgeries when centinel lymph node was positive). 93,7% of the procedures (60 operations) were ambulatory and in 6,3% (4 operations) patients were admitted to the hospital due to complications and were excluded from the study. An interview held after 48 hours showed absence of pain in 78.3% of the patients and that 86.7% tolerated food. On arrival home 43.3% had no symptoms and 61.7% slept well with no problem. 60% could take care of themselves on a daily basis and 58.3% could dress by themselves. 43.4% were able to resume their daily axctivities, none needed emergency assistanse and there were no hospital admissions. CONCLUSIONS: Ambulatory conservative surgery for breast cancer is a safe alternative to hospital admission. Nursing care is one of the main pillars in the management of breast cancer in ambulatory surgical programs (AU)

[Impact of conservative oncoplastic techniques in a surgery program for women with breast cancer]. / Impacto asistencial de las técnicas oncoplásticas conservadoras en un programa quirúrgico para enfermas con cáncer de mama.

OBJECTIVES: To evaluate the impact of conservative oncoplastic techniques in a surgery program for women with breast cancer. PATIENTS AND METHOD: The study group was composed of women who underwent a conservative oncoplastic technique and the control group consisted of women who underwent conservative (tumorectomy/quadrantectomy) and radical (mastectomy) techniques. Women with tumors smaller than 3 cm, axillary clinical stages N0-N1a-b and multifocal processes (infiltrating and/or in situ) were eligible for inclusion. Women with T3-4 tumors and reduced breast volume, and those in whom postoperative radiotherapy and disease-free margins during intraoperative study were not feasible were excluded. RESULTS: One hundred sixty women underwent surgery during the study period. Fifty oncoplastic techniques (29 to avoid mastectomy and 21 to improve the result of a conservative technique), 57 conservative techniques and 53 mastectomies were performed. The techniques used for breast reconstruction were superior mammoplasty with transversal scar (23 patients), mammoplasty with superior pedicle (10 patients), mammoplasty with inferior pedicle (10 patients), J-shapped mammoplasty (four patients) and oblique mammoplasty (three patients). The mean operating time in the group undergoing oncoplastic techniques (131 minutes) was higher than that in the group undergoing conservative (56 minutes) and radical (93 minutes) techniques. The incidence of postoperative complications was higher with radical techniques (35%), mainly due to axillary seromas after lymphadenectomy, than with conservative (25%) and oncoplastic (24%) techniques. CONCLUSIONS: Oncoplastic techniques are an effective and efficient alternative to conventional surgical techniques in women with breast cancer.

Más consideraciones sobre el cáncer de mama / Further considerations on breast cancer

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Repercusión en la estancia hospitalaria de un programa educativo sobre el manejo de drenajes quirúrgicos en el postoperatorio de cáncer de mama / Repercussions of an educational programme on the length of hospital stay for postoperative breast cancer patients and the use of surgical drainage

OBJETIVO: El objetivo de este estudio es la evaluación de un programa educativo de manejo de drenajes quirúrgicos en enfermas intervenidas por un carcinoma de mama en una unidad de cirugía de corta estancia. PACIENTES Y MÉTODOS: Estudio retrospectivo de126 mujeres diagnosticadas de carcinoma ductal infiltrante, carcinoma lobulillar infiltrante, carcinoma ductal in situ y otros, de las cuales 104 cumplieron los criterios deeste estudio (se excluyeron 22 mujeres con cáncer de mama que fueron manejadas ambulatoriamente). La técnica que se indicó fue tumorectomía y linfadenectomía axilar (46 mujeres), mastectomía y linfadenectomía axilar(47 mujeres), mastectomía simple (7 mujeres) y otras (4mujeres). De estas 104 mujeres incluidas en el estudio, constituyeron el Grupo A 62 enfermas intervenidas un año antes de comenzar con el programa educativo(desde 1 de Abril de 2000 a 31 de Marzo de 2001), mientras que el Grupo B lo formaron 42 pacientes intervenidas después de haber iniciado el programa (desde 1 de Abril de 2001 hasta 31 de Marzo de 2002). Se valora la influencia sobre la estancia hospitalaria de la puesta enmarca de un programa educativo por parte de la enfermería sobre el manejo de drenajes quirúrgicos. La enfermería educa a las enfermas en el manejo de su drenaje quirúrgico (valoración del aspecto, evacuación, medición del contenido y anotación del débito). Las pacientes del Grupo A ingresan el día anterior a la intervención y el alta se produce tras la retirada del drenaje y las del Grupo B reciben educación sobre el manejo del drenaje quirúrgico y son dadas de alta a su domicilio con el drenaje (..) (AU)

OBJECTIVE: The objective of this study is to evaluate an educational programme dealing with surgical drainage in patients operated on for breast carcinoma in a short staysurgical unit. PATIENTS AND METHODS: A retrospective study of126 women diagnosed with infiltrating ductal carcinoma, infiltrating lobular carcinoma, ductal carcinoma-in-situ, and other types of breast cancer, 104 of whom fulfilled this study’s requirements (22 women with breast cancer were excluded since they were treated in ambulatory surgery). The techniques indicated were lumpectomy and axillary lymphnode dissection (46 women), mastectomy and axillary lymph node dissection (47 women), simple mastectomy (7women) and others (4 women). Of the 104 women included in the study, Group "A" was formed by 62 patients that had been operated on one year before the start of the educational programme (from 1st April 2000, to 31st March2001). Group "B" was formed by 42 patients operated on after the programme was started (from 1st April 2001, to 31stMarch 2002). The educational programme on the use of surgical drainage was started by the nurses. Nurses taught the patients how to care for their own surgical drainages (to evaluate the appearance, evacuate and measure the contents, and note down the debit). Group "A" patients were admitted the day before the operation and they were discharged after the drain was removed. Group "B" patients were taught to handle the surgical drainage system and then discharged and sent home with the drain. RESULTS: Before the nurses started the programme (..) (AU)

[Specifications on the lecithin/sphingomyelin ratio (L/S). Updated review]. / Matizaciones sobre el cociente lecitina esfingomielina (L/E). Revisión actualizada.

We review the lecithin/sphingomyelin ratio (L/E) studying the amniotic fluid to value the fetal lung maturity. We compare him with others biological parameters. We consider the modifications arising across pregnancy and in different diseases as well as the factors influencing its results.