Epidemiology and management of breast carcinoma in Egyptian males: experience of a single Cancer Institute.

OBJECTIVE: To assess the epidemiological and clinico-pathological features, surgical and reconstructive techniques, adjuvant treatments and clinical outcome of breast carcinoma in males (BCM) at the Egyptian National Cancer Institute (NCI). PATIENTS AND METHODS: Thirty-two males with breast carcinoma presented to NCI between January 2000 and December 2002. They were evaluated by complete history, physical examination, laboratory and radiological investigations. RESULTS: Median age was 59 years. Left sided and retroareolar breast lumps were the commonest presentations. Grade II tumors positive for hormone receptors were very common. Stages I, II, III and IV of the disease were encountered in 6.2%, 34.4%, 34.4% and 25.0% of patients, respectively. Curative surgery was done in 22 patients; they received adjuvant hormonal therapy, chemotherapy and radiotherapy in 22, 16 and 10 patients, respectively. Eight metastatic patients were treated with palliative measures. Surgery was done in 25 patients; the most common procedure was modified radical mastectomy (40.6%). Primary closure was feasible in 17 patients (68%), local flaps were needed in 4 cases (16%), while myocutaneous flap was done in 3 cases (12%). The commonest complication was the development of seroma (9 cases). The overall survival (OS) at 5 years was 65.4%. The disease free survival (DFS) at 5 years was 53.9%. Stage and curative surgery significantly affected OS, while type of surgery was the only variable significantly affecting DFS. CONCLUSION: Male breast carcinoma occurs at older ages than females, usually in advanced stage. This necessitates directing attention of males and awareness on the prevalence and risk factors for this disease.

Continuous validity of pedicled myocutaneous and myofascial flaps in reconstruction after surgery for head and neck cancer.

PURPOSE: The aim of this study was to reevaluate the role and effectiveness of pedicled myocutanous and myofascial flaps in reconstruction after resection of head and neck cancer. PATIENTS AND METHODS: This study represents the authors own experience using pedicled myocutanous and myofascial flaps in reconstruction after resection of malignant tumors of different sites in the head and neck. The study included 121 patients with head and neck cancer operated upon at the National Cancer Institute, Cairo University and Alminia Cancer Center over 3 years duration, between July 2005 and the end of July 2008. Four types of flaps were used namely the Pectoralis major (Group I), lower trapezius (Group II), Latissimus dorsi (Group III), and the temporalis ((Group IV) flaps. Utility of the different types of these flaps was reevaluated in terms of indications, advantages, and postoperative complications. RESULTS: This study included 121 patients, 83 males and 38 females. The mean age was 56 years (range, 14- 65 years). Oral malignancies represented most of the cases (71 cases). Pectoralis major myocutaneous (PMMC) flap was the most commonly used flap (84 cases) and its main indication was oral and pharyngeal defects. Lower trapezius and Latissimus dorsi myocutaneous flaps were used in 14 and 12 cases respectively. Their main indications were tumors in the occiput, ear pinna, parotid and neck regions. The Latissimus dorsi myocutaneous flap was also used for reconstruction of oral and pharyngeal defects in 7 female patients with large breasts and for salvage reconstruction after failure of reconstruction by (PMMC) flap in one patient and for reconstruction after excision of local recurrence on top of previous (PMMC) flap in another patient. Temporalis myofascial flap was used in 12 cases and the main indication was orbital defects. The overall postoperative complications was 19.8% (24/121). It was 20% (17/84) in group I, 28.6% (4/14) in group II, and 25% (3/12) in group III. No flap related complications were reported in group IV. All complications were successfully managed except for one case in (Group I), in which a major flap loss developed and was successfully salvaged by pedicled latissimus dorsi myocutaneous flap. CONCLUSION: Pedicled myocutanous and myofascial flaps are still indicated in composite head and neck reconstruction. Their reliability, safety, and high degree of resistance to infection make them essential specially the (PMMC) flap previously described as the spare wheel of head and neck reconstructive surgery. It is suitable for lateral mandibular defects in edentulous patients and in partial pharyngeal defects in irradiated patients. Other pedicled myocutaneous flaps are still valid in certain occasions and sites. KEY WORDS: Head and neck cancer - Pectoralis major - Trapezius - Latissimus dorsi - Temporalis myocutaneous - Myofascial flaps - Reconstruction.