Survival and risk of breast cancer recurrence after breast reconstruction with deep inferior epigastric perforator flap.

BACKGROUND: Women who undergo autologous breast reconstruction have been reported to have an increased risk of breast cancer recurrence compared with those who have mastectomy alone. It has been suggested that more extensive surgery possibly activates dormant micrometastases. The aim of this study was to evaluate whether delayed unilateral deep inferior epigastric perforator (DIEP) flap reconstruction after mastectomy increases the risk of breast cancer recurrence or affects mortality among women previously treated for breast cancer. METHODS: This was a matched retrospective cohort study including women with a previous unilateral invasive breast cancer who received a delayed DIEP flap breast reconstruction and a control cohort of individually matched women with unilateral breast cancer who underwent mastectomy but no autologous breast reconstruction. Matching criteria comprised: year of diagnosis (+/-3 years), age at diagnosis (+/-5 years), type of cancer and demographic region. The primary endpoints were local recurrence or distant metastasis, and overall mortality was a secondary endpoint. Absolute risk of recurrent disease and mortality was analysed, and relative risks were estimated using Cox proportional hazards analysis. RESULTS: There were 225 women in the DIEP cohort and 450 in the no-DIEP cohort. The median follow-up time was 125 months. There was no difference in absolute risk of recurrence between the cohorts. The hazard ratio for breast cancer recurrence in DIEP versus no-DIEP cohorts was 0·76 (95 per cent c.i. 0·47 to 1·21). CONCLUSION: There is no increased risk in breast cancer recurrence after delayed DIEP flap reconstruction compared with mastectomy alone.

Burns in Sweden: temporal trends from 1987 to 2010.

Our aim was to investigate the epidemiology of burned patients admitted to hospitals in Sweden, and to examine temporal trends during the last three decades. Our hypothesis was that there has been an appreciable decline in the number of patients admitted. Retrospective data about burned patients treated at Swedish hospitals 1987 - 2010 were obtained from the Swedish National Board of Health and Welfare. Patients with primary or secondary ICD diagnoses of burns were included, reviewed and statistically interpreted in terms of sex, age, incidence, mortality in hospital and duration of stay. A total of 30,478 patients were admitted to hospitals with burns. The absolute number of admissions declined by 42% (95% CI 39 to 44). There was a highly significant reduction of 45% (95% CI: 38 to 51) in the ageadjusted incidence (admissions/million population) over the years, and the reduction was significant for both sexes. Children aged 0-4 years (n=8308) were most likely to be admitted to hospital (27%). The median duration of stay shortened over time (p < 0.0001). There was an overall significant reduction in deaths at hospital/100 admissions over time (p <0.0001). We think that the improvements are the result of a combination of preventive measures, improved treatments and greater use of outpatient facilities. If we understand these trends and the relations between age-adjusted incidence and actual number of admissions, we can gain insight into what is needed for future provision of emergency health care.

Nous rapportons l'étude de l'épidémiologie des brûlures ayant nécessité une hospitalisation en Suède et son évolution au long des 3 dernières décennies, notre impression étant qu'il y avait eu une notable diminution de cette pathologie. Les données rétrospectives des 30,478 patients brûlés hospitalisés en Suède entre 1987 et 2010 ont été obtenues auprès de l'Office Public de la Santé et du Bien-être suédois. Les dossiers patients sortis avec un Diagnostic Principal ou un Diagnostic Secondaire « brûlure ¼ ont été revus. Les analyses ont porté sur l'âge, le sexe, l'incidence, la mortalité hospitalière et la durée de séjour. Le nombre total de patients a baissé de 42% (IC95 39 à 44%), réduction observable chez les 2 sexes et confirmée par une baisse de l'incidence (brûlés/million d'habitants) de 45% (IC95 38 à 51%). Les enfants de 0 à 4 ans (8,308), avaient un risque plus élevé (27%) d'être hospitalisés pour brûlure. La durée médiane d'hospitalisation s'est raccourcie (p<0,0001), la mortalité a diminué (p<0,0001). Nous pensons que ces améliorations peuvent s'expliquer par une combinaison de prévention, efficacité de la prise en charge et augmentation de l'ambulatoire. En intégrant plus finement ces données, il est possible d'explorer les paramètres de mise à disposition de soins d'urgence.