Electrothermal bipolar vessel sealing system in axillary dissection: a prospective randomized clinical study.

We assessed whether axillary dissection using the electrothermal bipolar vessel sealing system (LigaSure) improved perioperative outcome when compared with conventional axillary dissection, in a prospective randomized study of 100 women with breast cancer. Those needing axillary dissection were randomized to the use of LigaSure or to conventional axillary dissection (with 50 patients in each group, all of whom had a closed suction drain in the axilla). The LigaSure patients had less intraoperative blood loss (exceeding 199 mL in 30.8% vs. 69.2%, P < 0.001), quicker axillary dissection (mean 48 vs. 63.2 min, P = 0.004), fewer days of suction drainage (4.3 vs. 5.7 days, P = 0.012), and shorter hospitalization (5.1 vs. 6.5 days, P = 0.021). No difference was found in the rate of hematomas, reoperations or infection. The use of LigaSure in axillary surgery reduced the surgical time and length of hospital stay, favoring early drain removal without increasing postoperative complications.

Sentinel node biopsy in patients with previous breast aesthetic surgery.

BACKGROUND: Sentinel lymph node biopsy (SLNB) is the standard method for axillary staging of early breast cancer. Recent studies have focused on questioning the initial contraindication to the technique. There has been insufficient data to recommend SLNB in patients with previous aesthetic breast surgery. MATERIALS AND METHODS: Between April 2001 and June 2007, 70 patients with previous breast aesthetic surgery underwent SLNB. Fifty had a previous breast augmentation and 20 had breast reduction mammoplasty. All patients underwent lymphoscintigraphy with 99Tc according to our standard technique and sentinel node was identified in all cases. RESULTS: Mean age at cosmetic surgery was 38 years. Mean number of years from aesthetic surgery to the development of the tumour was 10 years. Forty-nine patients underwent conservative breast surgery and 21 patients underwent mastectomy. The sentinel node identification rate was 100%. SLN was positive in 23 patients (32%); there were 18 cases with macrometastasis and 7 cases with micrometastasis. After median follow-up of 19 months, no axillary recurrences have been observed. We observed two ipsilateral local recurrences, one contralateral tumour and one patient developed lung metastasis. CONCLUSIONS: Past history of breast augmentation or reduction is not a contraindication to SLNB technique.

Surgical closure of chest wall in noninflammatory locally advanced breast carcinoma with ulceration of the skin.

Patients with noninflammatory locally advanced breast cancer with ulceration of skin or muscle or parietal wall infiltration, better named "extended locally advanced breast cancer," may require cancer surgery and plastic reconstruction of the chest wall after multidisciplinary evaluation. The decision is made to improve quality of life, independently of prognosis, and severity of the disease. The aim of this study is to evaluate the best method for surgical closure of the chest wall and to check whether ablative surgery is an appropriate procedure in regards to the treatment of cancer. From October 1997 to June 2006, 27 patients with noninflammatory extended locally advanced breast cancer with ulceration of the skin, who were not candidate or did not respond to a neo-adjuvant treatment, underwent radical mastectomy and reconstructive surgery. Sixteen patients (59%) were affected by primary tumors of the breast, and eleven patients (41%) had local recurrence after mastectomy or conservative breast surgery. Two main techniques were used for breast reconstruction: transverse rectus-abdominis musculo cutaneous flap in 19 patients (70%), and a fasciocutaneous flap in eight patients (30%). The best procedure in each patient was chosen according to the extent of skin loss or previous radiotherapy to the chest wall. Fourteen patients (52%) died during the follow-up and the median length of survival was 16 months (range 3-79) in transverse rectus-abdominis musculo cutaneous group and 4 months (range 2-23) in fasciocutaneous flap group. The median length of follow-up after treatment for patients still alive was 32.5 months (range 0-96) in transverse rectus-abdominis musculo cutaneous flap group, and 18 months (range 8-41) in fasciocutaneous flap group. At the end of the follow-up, 10 patients were alive without evidence of disease and three patients developed metastatic lesion or local recurrence. The longest recorded disease free interval for a patient still alive and tumor free was 96 months. Only three patients (11%) had local complications: two wound infections and one partial necrosis of the transverse rectus-abdominis musculo cutaneous flap. Median hospital stay was 7 days (range 3-13) for transverse rectus-abdominis musculo cutaneous and 6 days (range 3-13) for fasciocutaneous flap. Our results confirmed that transverse rectus-abdominis musculo cutaneous group and fasciocutaneous flap flaps are good reconstructive options in patients with extended locally advanced breast cancer. Quality of life has improved in this group of patients, with acceptable survival periods and in some cases very important survival rates.

Controversies in the use of sentinel nodes: microinvasion, post surgery and after preoperative systemic treatment.

In the past 10 years, sentinel lymph node biopsy (SLNB) has become a safe and accurate method for axillary staging. Several recent publications worldwide have been progressively elucidating old controversies. The list of clinical scenarios in which SLNB was initially contraindicated seems to be dwindling as experience with this technique increases. Here we discuss the suitability of SLNB in the settings of microinvasive cancer, after breast or axillary surgery and after neoadjuvant chemotherapy.