Rate of residual tumor after repeat surgery for positive margins in ductal carcinoma in Situ, and predictive factors.

AIMS: To evaluate the rate of residual tumor in re-excision specimen of patients with positive margins in ductal carcinoma in situ (DCIS) following breast-conservative surgery, and to identify predictive factors of residual tumor. MATERIAL AND METHODS: We conducted a monocentric, retrospective study, from January 2010 to December 2020. All 103 patients who underwent re-excision for positive margins in DCIS following breast-conservative surgery for in situ or invasive breast carcinoma were included. Positive margins were defined as inferior to 2 mm from the DCIS component. Two groups were defined, depending on the presence of residual tumor or not, and were compared on their clinical and histopathological characteristics to identify predictive factors of residual tumor. RESULTS: Residual tumor was found in re-excision specimen of 46 patients (44.7 %). The risk of residual tumor was increased in patients with more than 2 tumor foci (aOR: 12.4; 95 % CI: 1.2 -124.1; p = 0.032) and in those with extensive margin involvement (aOR: 3.2; 95 % CI: 1.3-8.2; p = 0.013). Finally, surgery performed after 2013 was associated with a lower risk of residual tumor (aOR: 0.23; 95 % CI: 0.09-0.058; p = 0.002). CONCLUSION: The rate of residual tumor in re-excision specimen of patients with positive margins in DCIS is high. Both the number of tumor foci and the extension of positive margins were identified as risk factors. Finally, the surgical learning curve for this procedure seems to be significantly correlated with the risk of residual tumor and needs to be considered.

Lidocaine versus ropivacaine for perineal infiltration post-episiotomy.

OBJECTIVE: To evaluate maternal analgesia after an episiotomy during delivery. METHODS: The present case-control study compared 2 protocols of post-episiotomy infiltration: period A, 20 mL of lidocaine 10mg/mL; period B, 20 mL of ropivacaine 7.5mg/mL. The primary study endpoint was the visual analog scale (VAS) score at 24 hours after episiotomy; secondary endpoints were the VAS scores during suturing and at 2 and 48 hours, and patient satisfaction at 48 hours. RESULTS: In total, 102 women were included in the study. The median VAS score at 24 hours was significantly lower during the ropivacaine period (3 [1.5-4]) than during the lidocaine period (4 [2-6]; P=0.004). A VAS score below 4 at 24 hours was significantly more frequent with ropivacaine (71% versus 43%; P=0.009). The VAS scores at 2 and 48 hours were also lower in the ropivacaine group (2 hours, 0 [0-1] versus 1 [0-3], P=0.01; and 48 hours, 2 [0-3] versus 3 [2-5], P<0.001). Maternal satisfaction was significantly higher in the ropivacaine group. CONCLUSION: Analgesia and maternal satisfaction were improved during the period when ropivacaine was used as opposed to lidocaine. The effect lasted for up to 48 hours.