RESUMEN
OBJECTIVE: To investigate the effect of various frequencies of bolus use on the superficial dose of volumetric modulated arc therapy after modified radical mastectomy for breast cancer. METHODS: Based on the computed tomography images of a female anthropomorphic breast phantom, a 0.5 cm silicone-based 3D-printed bolus was created. Nine points evenly distributed on the breast skin were selected for assessing the skin dose, and a volume of subcutaneous lymphatic drainage of the breast (noted as ROI2-3) was delineated for assessing the chest wall dose. The treatment plans with and without bolus (plan_wb and plan_nb) were separately designed using the prescription of 50â Gy in 25 fractions following the standard dose constraints of the adjacent organ at risk. To characterize the accuracy of treatment planning system (TPS) dose calculations, the doses of the nine points were measured five times by thermoluminescence dosimeters (TLDs) and then were compared with the TPS calculated dose. RESULTS: Compared with Plan_nb (144.46 ± 10.32â cGy), the breast skin dose for plan_wb (208.75 ± 4.55â cGy) was significantly increased (t = -18.56, P < 0.001). The deviation of skin dose was smaller for Plan_wb, and the uniformity was significantly improved. The calculated value of TPS was in good agreement with the measured value of TLD, and the maximum deviation was within 5%. Skin and ROI2-3 doses were significantly increased with increasing frequencies of bolus applications. The mean dose of the breast skin and ROI2-3 for 15 and 23 times bolus applications were 45.33â Gy, 50.88â Gy and 50.36â Gy, 52.39â Gy, respectively. CONCLUSION: 3D printing bolus can improve the radiation dose and the accuracy of the planned dose. Setting Plan_wb to 15 times for T1-3N+ breast cancer patients and 23 times for T4N+ breast cancer patients can meet the clinical need. Quantitative analysis of the bolus application frequency for different tumor stages can provide a reference for clinical practice.
Asunto(s)
Neoplasias de la Mama , Mastectomía Radical Modificada , Fantasmas de Imagen , Dosificación Radioterapéutica , Planificación de la Radioterapia Asistida por Computador , Radioterapia de Intensidad Modulada , Humanos , Femenino , Radioterapia de Intensidad Modulada/métodos , Neoplasias de la Mama/radioterapia , Neoplasias de la Mama/cirugía , Planificación de la Radioterapia Asistida por Computador/métodos , Mastectomía Radical Modificada/métodos , Radiometría/métodos , Órganos en Riesgo , Tomografía Computarizada por Rayos XRESUMEN
BACKGROUND: Inadequate acute postoperative pain control after modified radical mastectomy (MRM) can compromise pulmonary function. This work aimed to assess the postoperative pulmonary effects of a single-shot thoracic paravertebral block (TPVB) and erector spinae plane block (ESPB) in female patients undergoing MRM. METHODS: This prospective, randomized comparative trial was conducted on 40 female American Society of Anesthesiologists (ASA) II-III, aged 18 to 50 years undergoing MRM under general anesthesia (GA). Patients were divided into two equal groups (20 in each group): Group I received ESPB and Group II received TPVB. Each group received a single shot with 20 ml volume of 0.5% bupivacaine. RESULTS: Respiratory function tests showed a comparable decrease in forced vital capacity (FVC) and forced expiratory volume (FEV1) from the baseline in the two groups. Group I had a lower FEV1/FVC ratio than Group II after 6 h. Both groups were comparable regarding duration for the first postoperative analgesic request (P value = 0.088), comparable postoperative analgesic consumption (P value = 0.855), and stable hemodynamics with no reported side effects. CONCLUSION: Both ultrasound guided ESPB and TPVB appeared to be effective in preserving pulmonary function during the first 24 h after MRM. This is thought to be due to their pain-relieving effects, as evidenced by decreased postoperative analgesic consumption and prolonged time to postoperative analgesic request in both groups. GOV ID: NCT03614091 registration date on 13/7/2018.
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Mastectomía Radical Modificada , Bloqueo Nervioso , Dolor Postoperatorio , Humanos , Femenino , Bloqueo Nervioso/métodos , Estudios Prospectivos , Adulto , Dolor Postoperatorio/prevención & control , Persona de Mediana Edad , Mastectomía Radical Modificada/métodos , Ultrasonografía Intervencional/métodos , Capacidad Vital , Volumen Espiratorio Forzado , Adulto Joven , Bupivacaína/administración & dosificación , Anestésicos Locales/administración & dosificación , Anestesia General/métodos , Músculos Paraespinales/inervación , Pruebas de Función RespiratoriaRESUMEN
PURPOSE: Breast-conserving surgery (BCS) plus radiotherapy and mastectomy exhibit highly comparable prognoses for early-stage breast cancer; however, the safety of BCS for T1-2N3M0 breast cancer remains unclear. This study compared long-term survival for BCS versus (vs.) modified radical mastectomy (MRM) among patients with T1-2N3M0 breast cancer. METHODS: Data of patients with T1-2N3M0 breast cancer were extracted from the Surveillance, Epidemiology, and End Results database. Eligible patients were divided into 2 groups, BCS and MRM; Pearson's chi-squared test was used to estimate differences in clinicopathological features. Propensity score matching (PSM) was used to balance baseline characteristics. Univariate and multivariate analyses were performed to investigate the effects of surgical methods and other factors on breast cancer-specific survival (BCSS) and overall survival (OS). RESULTS: In total, 2124 patients were included; after PSM, 596 patients were allocated to each group. BCS exhibited the same 5-year BCSS (77.9% vs. 77.7%; P = 0.814) and OS (76.1% vs. 74.6%; P = 0.862) as MRM in the matched cohorts. Multivariate survival analysis revealed that BCS had the same BCSS and OS as MRM (hazard ratios [HR] 0.899 [95% confidence intervals (CI) 0.697-1.160], P = 0.413 and HR 0.858 [95% CI 0.675-1.089], P = 0.208, respectively); this was also seen in most subgroups. BCS demonstrated better BCSS (HR 0.558 [95% CI 0.335-0.929]; P = 0.025) and OS (HR 0.605 [95% CI 0.377-0.972]; P = 0.038) than MRM in those with the triple-negative subtype. CONCLUSIONS: BCS has the same long-term survival as MRM in T1-2N3M0 breast cancer and may be a better choice for triple-negative breast cancer.
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Neoplasias de la Mama , Mastectomía Radical Modificada , Mastectomía Segmentaria , Estadificación de Neoplasias , Puntaje de Propensión , Programa de VERF , Humanos , Femenino , Neoplasias de la Mama/cirugía , Neoplasias de la Mama/patología , Neoplasias de la Mama/mortalidad , Persona de Mediana Edad , Mastectomía Radical Modificada/métodos , Mastectomía Segmentaria/métodos , Adulto , Anciano , Estudios Retrospectivos , PronósticoRESUMEN
Effective pain management is crucial for modified radical mastectomy (MRM) surgeries. The Serratus Posterior Superior Intercostal Plane Block (SPSIPB), introduced in 2023, shows promise for postoperative analgesia. This study was designed to demonstrate the analgesic efficacy of the SPSIPB in MRM surgeries. SPSIPB was administered to 7 patients who underwent MRM for postoperative analgesia. NRS scores of patients were ≤4 and total tramadol consumption was 0 mg in 3 of 7 patients. In conclusion, SPSIPB appears to be an effective, safe, and easily applicable option for analgesia.
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Mastectomía Radical Modificada , Bloqueo Nervioso , Dolor Postoperatorio , Humanos , Femenino , Bloqueo Nervioso/métodos , Mastectomía Radical Modificada/métodos , Persona de Mediana Edad , Dolor Postoperatorio/prevención & control , Dolor Postoperatorio/tratamiento farmacológico , Ultrasonografía Intervencional , Neoplasias de la Mama/cirugía , Adulto , Anciano , Manejo del Dolor/métodos , Nervios IntercostalesRESUMEN
BACKGROUND: Combining hydromorphone with ropivacaine in ultrasound-guided erector spinae plane blocks enhances postoperative analgesia and reduces interleukin-6 expression in breast surgery patients. METHODS: In this study, breast cancer patients undergoing modified radical mastectomy were randomized into 3 groups for anesthesia (30 patients in each group): standard general (group C), Erector Spinae Plane Block (ESPB) with ropivacaine (group R), and ESPB with ropivacaine plus hydromorphone (group HR). Diagnosis: Breast cancer patients. Postsurgery, pain levels, IL-6, anesthetic doses, additional analgesia needs, and recovery milestones were compared to evaluate the efficacy of the ESPB enhancements. RESULTS: The 3 groups were not significantly different in baseline characteristics, operation time, number of cases with postoperative nausea, and serum IL-6 concentrations at T1 (the time of being returned to the ward after surgery). At T2 (at 6:00 in the next morning after surgery), the serum IL-6 concentration in group HR was significantly lower than that in groups R and C (Pâ <â .05); the intraoperative doses of remifentanil, sufentanil, and propofol were significantly lower in groups HR and R than those in group C (Pâ <â .05); Groups HR and R had significantly lower visual analog scale scores at T3 (4 hours postoperatively), T4 (12 hours postoperatively), and T5 (24 hours postoperatively) than those in group C (Pâ <â .05); the proportions of patients receiving postoperative remedial analgesia were significantly lower in groups HR and R than in group C (Pâ <â .05); groups HR and R had significantly lower proportions of patients with postoperative nausea than group C (Pâ <â .05); the time to the first anal exhaust and the time to the first ambulation after surgery were significantly shorter in groups HR and R than those in group C (Pâ <â .05). CONCLUSION: Hydromorphone combined with ropivacaine for ESPB achieved a greater postoperative analgesic effect for patients receiving MRM under general anesthesia. The combined analgesia caused fewer adverse reactions and inhibited the expression level of the inflammatory factor IL-6 more effectively, thereby facilitating postoperative recovery. ESPB using hydromorphone with ropivacaine improved pain control post-MRM, reduced adverse effects, and more effectively suppressed IL-6, enhancing recovery.
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Analgésicos Opioides , Anestésicos Locales , Neoplasias de la Mama , Hidromorfona , Mastectomía Radical Modificada , Bloqueo Nervioso , Dolor Postoperatorio , Ropivacaína , Humanos , Ropivacaína/administración & dosificación , Ropivacaína/uso terapéutico , Femenino , Hidromorfona/administración & dosificación , Persona de Mediana Edad , Bloqueo Nervioso/métodos , Dolor Postoperatorio/prevención & control , Dolor Postoperatorio/tratamiento farmacológico , Estudios Prospectivos , Anestésicos Locales/administración & dosificación , Anestésicos Locales/uso terapéutico , Neoplasias de la Mama/cirugía , Mastectomía Radical Modificada/métodos , Analgésicos Opioides/administración & dosificación , Analgésicos Opioides/uso terapéutico , Adulto , Interleucina-6/sangre , Músculos Paraespinales/efectos de los fármacos , Ultrasonografía Intervencional/métodos , Quimioterapia Combinada , Dimensión del DolorRESUMEN
Background: Regional anesthesia as a primary anesthetic can offer merits over general anesthesia for patients having multiple comorbidities who are at a high risk of perioperative morbidity and mortality. Thoracic paravertebral block (TPVB) and interscalene block (ISB) have been used widely to improve the quality of postoperative analgesia after breast surgery. Objective: There are limited data on the feasibility of combining TPVB-ISB as a sole anesthetic technique for extensive breast surgery with axillary lymph nodes dissection. Case presentation: In this report, the author presented a successful use of a combined TPVB and ISB as a sole anesthetic with conscious sedation in a 52-year-old patient with multiple comorbidities, including heart failure with reduced ejection fraction, who underwent modified radical mastectomy with left axillary lymph nodes dissection. Conclusion: Combining TPVB-ISB can be used as a sole anesthetic for extensive breast surgery in patients with a high risk for general anesthesia.
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Anestésicos , Neoplasias de la Mama , Bloqueo Nervioso , Humanos , Persona de Mediana Edad , Femenino , Mastectomía Radical Modificada/métodos , Mastectomía , Neoplasias de la Mama/cirugía , Bloqueo Nervioso/métodosRESUMEN
Sensory innervation of the breast is complex, thereby making it difficult to perform any surgical procedure with a single regional anesthesia technique. Because of the involvement of pectoral muscles and extension of the incision into the axilla, a modified radical mastectomy makes it further challenging and requires multiple techniques. We have used a new combination of regional techniques in this case series and found that it provided complete surgical anesthesia with a smaller volume of local anesthetic.
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Anestesia Epidural , Bloqueo del Plexo Braquial , Neoplasias de la Mama , Bloqueo del Plexo Braquial/métodos , Neoplasias de la Mama/cirugía , Femenino , Humanos , Mastectomía , Mastectomía Radical Modificada/métodosRESUMEN
WHAT IS KNOWN AND OBJECTIVE: A previous randomized clinical trial concluded that an optimal concentration of 0.3% ropivacaine could provide satisfactory analgesia for breast cancer patients undergoing modified radical mastectomy. We wondered if a smaller volume (30 ml vs. 40 ml) of 0.3% ropivacaine could still provide adequate analgesia in an ultrasound-guided PECS II block in modified radical mastectomy. METHODS: We performed a prospective parallel randomized double-blind controlled clinical trial. Eligible patients were assigned to either the P30 or P40 group (30 or 40 ml of 0.3% ropivacaine, respectively). The skin area of hypoesthesia, anaesthetic plane determined with ultrasound, pain visual analogue scale (VAS), anaesthetic dosages, and complications were recorded. Serum levels of interleukin-1ß and interleukin-6 were measured postoperatively. RESULTS AND DISCUSSION: A total of 40 patients completed the trials, with 20 patients in each group. Although the skin area of hypoesthesia and the anaesthetic planes were significantly larger in the P40 group compared with the P30 group (p < 0.05), the VAS, analgesic and opioid doses, serum cytokine levels, anaesthetic toxicity, and complications had no significant differences between the two groups. WHAT IS NEW AND CONCLUSION: Compared with 40 ml, 30 ml of 0.3% ropivacaine could provide adequate analgesia and reduce surgical stress in patients undergoing modified radical mastectomy for breast cancer.
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Analgesia , Neoplasias de la Mama , Nervios Torácicos , Analgésicos Opioides , Neoplasias de la Mama/cirugía , Método Doble Ciego , Femenino , Humanos , Hipoestesia/cirugía , Interleucina-1beta , Interleucina-6 , Mastectomía , Mastectomía Radical Modificada/métodos , Dolor Postoperatorio/tratamiento farmacológico , Dolor Postoperatorio/prevención & control , Estudios Prospectivos , Ropivacaína , Ultrasonografía IntervencionalRESUMEN
Background: This study investigated the reconstruction effect of skin-preserving breast cancer modified radical mastectomy combined with one-stage breast prosthesis implantation in female patients to analyze relevant factors and observe the effect of prosthesis reconstruction on short-term breast satisfaction, psycho-social functions, and quality of life (QOL) in patients with breast cancer after the operation. Methods: Patients were divided into two groups based on the reconstruction effect (an excellent effect group and a good and general effect group). Patients' short-term cosmetic effect on the breast after breast cancer modified radical mastectomy combined with one-stage breast prosthesis implantation was prospectively followed up to analyze influencing factors. At post-operative 6 months, the breast satisfaction dimension, psycho-social dimension, upper limb breast health dimension, and surgical satisfaction dimension in the prosthesis reconstruction module in the BREAST-Q scale were used for follow-up evaluation. Results: The excellent rate of prosthesis reconstruction was 91.3%. A significant correlation was observed among the reconstruction effect, implant volume, and number of children born by the patient (P < 0.05). The correlation with age, BMI (body mass index), operation time, nipple and areola retention, operation method, and incision was not statistically significant (P > 0.05). At post-operative 6 months, the Breast-Q score was significantly different in the overall breast satisfaction dimension and outcome satisfaction dimension between the two groups (P < 0.05). Conclusion: Breast cancer modified radical mastectomy combined with one-stage breast prosthesis implantation can not only fulfill patients' physical aesthetic needs but also positively affect their psychosocial behavior to improve post-operative QOL.
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Implantación de Mama , Neoplasias de la Mama , Niño , Femenino , Humanos , Neoplasias de la Mama/cirugía , Neoplasias de la Mama/etiología , Mastectomía Radical Modificada/métodos , Mastectomía/métodos , Calidad de Vida , Implantación de Mama/efectos adversos , Implantación de Mama/métodos , Satisfacción del PacienteAsunto(s)
Neoplasias de la Mama , Ecocardiografía/métodos , Electrocardiografía/métodos , Trasplante de Corazón/métodos , Cardiomiopatía de Takotsubo , Traumatismos Torácicos/complicaciones , Anciano , Protocolos Antineoplásicos , Neoplasias de la Mama/psicología , Neoplasias de la Mama/cirugía , Cardiomiopatía Dilatada/cirugía , Femenino , Humanos , Mastectomía Radical Modificada/métodos , Periodo Posoperatorio , Distrés Psicológico , Trastornos por Estrés Postraumático/etiología , Trastornos por Estrés Postraumático/fisiopatología , Cardiomiopatía de Takotsubo/diagnóstico , Cardiomiopatía de Takotsubo/fisiopatología , Cardiomiopatía de Takotsubo/psicología , Cardiomiopatía de Takotsubo/terapia , Resultado del Tratamiento , Heridas no PenetrantesRESUMEN
INTRODUCTION: Routine anesthesia modality for modified radical mastectomy (MRM) includes general anesthesia (GA), epidural blockade-combined GA and nerve blockade-combined GA. However, GA has been associated with postoperative adverse effects such as vertigo, postoperative nausea and vomiting and requirement for postoperative analgesia, which hinders recovery and prognosis. Moreover, combined blockade of thoracic paravertebral nerves or intercostal nerves and adjuvant basic sedation for massive lumpectomy provided perfect anesthesia and reduced opioid consumption, whereas the excision coverage did not attain the target of MRM. Regional anesthesia strategies involving supplementation of analgesics in ultrasound-guided multiple nerve blocks have garnered interests of clinicians. Nevertheless, the precise effects of intercostal nerves, brachial plexus and supraclavicular nerves in MRM in patients with breast cancer remain obscure. METHODS: Eighty female patients with breast cancer scheduled for MRM were recruited in the present trial between May, 2019 and Dec., 2019 in our hospital. The patients ranged from 30 to 65âyears of age and 18â¼30âkg/m2 in body-mass index, with the American Society of Anesthesiologists I or II. The patients were randomized to ultrasound-guided multiple nerve blocks group and GA group. The patients in multiple nerve blocks group underwent ultrasound guided multiple intercostal nerve blocks, interscalene brachial plexus and supraclavicular nerve blocks, (local anesthesia with 0.3% ropivacaine: 5âml for each intercostal nerve block, 8âml for brachial plexus block, 7âmL for supraclavicular nerve block) and basic sedation and intraoperative mask oxygen inhalation. The variations of hemodynamic parameters such as mean arterial pressure, heart rate (HR) and pulse oxygen saturation were monitored. The visual analog scale scores were recorded at postoperative 0âhour, 3âhour, 6âhour, 12âhour and 24âhour in resting state. The postoperative adverse effects, including vertigo, postoperative nausea, and vomiting, pruritus, and urinary retention and so on, as well as the analgesic consumption were recorded. CONCLUSIONS: The ultrasound guided multiple intercostal nerve blocks, brachial plexus and supraclavicular nerve blocks could provide favorable anesthesia and analgesia, with noninferiority to GA and the reduced incidence of adverse effects and consumption of postoperative analgesics.
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Neoplasias de la Mama/cirugía , Sedación Consciente/métodos , Mastectomía Radical Modificada/métodos , Bloqueo Nervioso/métodos , Anestesia General/efectos adversos , Femenino , Humanos , Persona de Mediana Edad , Bloqueo Nervioso/efectos adversos , Dimensión del Dolor , Dolor Postoperatorio/prevención & control , Ultrasonografía Intervencional/métodosRESUMEN
Appropriate drainage duration is vital for the postoperative rehabilitation of patients with breast cancer (BC) undergoing modified radical mastectomy (MRM). To provide better and individualized postoperative management for these patients, this study explored independent predictors of postoperative drainage duration in patients with BC. This was a single-center retrospective cohort study. Patients diagnosed with BC and treated with MRM from May 2016 to April 2020 were randomly divided into training (n = 729) and validation (n = 243) cohorts. Univariate and multivariate Cox analyses revealed that the body mass index, serum albumin level, hypertension, number of total dissected axillary lymph nodes, and ratio of positive axillary lymph nodes were independent predictors of postoperative drainage duration in the training cohort. Based on independent predictors, a nomogram was constructed to predict the median postoperative drainage duration and the probability of retaining the suction drain during this period. This nomogram had good concordance and discrimination both in the training and validation cohorts and could effectively predict the probability of retaining the suction drain during drainage, thus assisting clinicians in predicting postoperative drainage duration and providing individualized postoperative management for patients with BC.
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Neoplasias de la Mama/cirugía , Drenaje , Mastectomía Radical Modificada , Adulto , Anciano , Anciano de 80 o más Años , Neoplasias de la Mama/diagnóstico , Toma de Decisiones Clínicas , Manejo de la Enfermedad , Drenaje/métodos , Femenino , Humanos , Mastectomía Radical Modificada/métodos , Persona de Mediana Edad , Nomogramas , Curva ROC , Resultado del TratamientoRESUMEN
RATIONALE: Locoregional recurrence of breast cancer is a challenging issue for clinicians. Treatment options for unresectable recurrent estrogen receptor positive (ER+) breast cancer in previously irradiated area are limited. Some studies showed concomitant fulvestrant with radiation therapy might increase radiosensitivity compared with radiation alone in vitro, no in vivo reports yet. PATIENT CONCERN: Here, we present a case report and make a narrative review of concomitant fulvestrant with radiation therapy for unresectable locoregional recurrent ER+ breast cancer. The patient was treated with modified radical mastectomy in 2015, adjuvant chemotherapy, radiotherapy, followed by exemestane until November 2018, relapsed in internal mammary lymph nodes with sternum involved. DIAGNOSIS: The final diagnosis was breast cancer internal mammary lymph nodes metastasis with sternum involved. INTERVENTIONS: After diagnosis was made, concurrent fulvestrant with reirradiation as a palliative treatment were proposed under multiple disciplinary team. OUTCOMES: There was a good clinical response, enabling curative chance with radiation therapy to a total dose of 60âGy. Computed tomography scan revealed no evidence of residual tumor. LESSONS: As far as we know, this is the first report concerning concomitant fulvestrant with reirradiation for unresectable locoregional recurrent ER+ breast cancer. Since no severe adverse events were observed, this strategy could be a suitable "loco-regional rescue therapy" to further reduce tumor progression or even reach a curative effect. Studies of this treatment strategy in randomized clinical trials are warranted to further assess its safety and effectiveness.
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Neoplasias de la Mama/terapia , Antagonistas del Receptor de Estrógeno/uso terapéutico , Fulvestrant/uso terapéutico , Reirradiación/métodos , Androstadienos/uso terapéutico , Inhibidores de la Aromatasa/uso terapéutico , Neoplasias de la Mama/metabolismo , Neoplasias de la Mama/patología , Quimioterapia Adyuvante/métodos , Terapia Combinada , Femenino , Humanos , Metástasis Linfática/diagnóstico por imagen , Metástasis Linfática/patología , Mastectomía Radical Modificada/métodos , Persona de Mediana Edad , Medicina Narrativa/métodos , Recurrencia Local de Neoplasia/cirugía , Receptores de Estrógenos/metabolismoRESUMEN
BACKGROUND: Pectoral nerve block type I (PECS I Block) and type II (PECS II Block) with ropivacaine are relatively new analgesic methods for breast-cancer surgery. We evaluated the safety and efficacy of different concentrations of ropivacaine given in the same volume for the PECS II Block in patients undergoing modified radical mastectomy (MRM). PATIENTS AND METHODS: One hundred and twenty women undergoing elective MRM who met inclusion criteria were divided randomly into four groups of 30: control group without PECS II Block and R0.2%, R0.3%, and R0.4% groups, who received general anesthesia plus the PECS II Block with ropivacaine at 0.2%, 0.3%, and 0.4%, respectively, in a volume of 40 mL. RESULTS: The postoperative numerical rating scale (NRS) pain score at rest and active was significantly higher in the control group than that in the three ropivacaine groups (P<0.05 for all), and the postoperative NRS score in the R0.3% group and R0.4% group at 12, 24, and 48 h postoperatively were significantly lower than that in the R0.2% group (P<0.05 for all); there was no significant difference between the R0.3% group and R0.4% group. The time when pain was first felt after MRM, the total number of complaints during 3, 6, 12, 24, and 48 h after MRM, and the total analgesic requirement (tramadol consumption) during the first 24 h postoperatively in the R0.3% group and R0.4% group were significantly lower than those in the control group and R0.2% group (P<0.05 for all); there was no significant difference between the R0.3% group and R0.4% group. CONCLUSION: A dose of 0.3% ropivacaine was the optimal concentration for a PECS II Block for patients undergoing MRM because it provided efficacious analgesia during and >48 h after MRM. Increasing the ropivacaine concentration did not improve the analgesia of the PECS II Block significantly.
Asunto(s)
Anestésicos Locales/administración & dosificación , Bloqueo Nervioso/métodos , Dolor Postoperatorio/prevención & control , Ropivacaína/administración & dosificación , Nervios Torácicos/efectos de los fármacos , Anestésicos Locales/efectos adversos , Estudios de Casos y Controles , Femenino , Humanos , Mastectomía Radical Modificada/métodos , Persona de Mediana Edad , Bloqueo Nervioso/efectos adversos , Manejo del Dolor/métodos , Dolor Postoperatorio/dietoterapia , Periodo Posoperatorio , Ropivacaína/efectos adversosRESUMEN
AIM: Acute post-operative pain following modified radical mastectomy (MRM) in patients with breast cancer is challenging for anesthesiologists. This study aimed to prospectively compare the quality outcome of interfascial plane blocks performed with ultrasound guidance, and evaluate the consequences of sharing tasks with the breast surgeon. PATIENTS AND METHODS: The study involved 255 patients scheduled for unilateral MRM, who were divided into two groups: Pecs group: General anesthesia plus ultrasound-guided modified pectoral nerves blocks type I and II, including serratus and parasternal infiltration according to surgical requirements; and Control group: general anesthesia only. Quality was evaluated based on perioperative opioid consumption, reported pain intensity, rescue analgesic requirement, side-effects and length of hospital stay. Moreover, a breast surgeon with expertise in ultrasound-guided breast biopsy was trained to perform the blocks. The patient benefits from regional anesthesia delivered by a non-anesthesiologist were assessed. RESULTS: Significant reductions were noted in all of the following: Intraoperative opioid consumption (p<0.001), Numerating Rating Scale pain scores taken 0 and 24 h after surgery (p<0.001), post-operative analgesic administration (p<0.001), nausea and vomiting at 0, 6, and 12-h intervals (p<0.05), and hospital stay (p<0.001) were observed in the Pecs group compared with the control group. Furthermore, data obtained from patients receiving the block from the surgeon showed comparable benefits with no complications. CONCLUSION: Interfascial plane blocks may be an important alternative protocol in MRM, enhancing patient safety and cost benefits. Improvements in cross-disciplinary expertise through flexibility in the training of professionals with other backgrounds may provide effective analgesia and favorable outcomes.
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Anestesia General/métodos , Neoplasias de la Mama/cirugía , Mama/cirugía , Mastectomía Radical Modificada/métodos , Bloqueo Nervioso/métodos , Nervios Torácicos/fisiopatología , Ultrasonografía Intervencional/métodos , Adulto , Anciano , Anestesiólogos , Mama/fisiopatología , Neoplasias de la Mama/fisiopatología , Femenino , Humanos , Mastectomía Radical Modificada/efectos adversos , Persona de Mediana Edad , Dimensión del Dolor , Dolor Postoperatorio/etiología , Dolor Postoperatorio/fisiopatología , Estudios ProspectivosRESUMEN
The present study aims to analyze the effects of breast-conserving surgery and modified radical mastectomy on operation indexes, Symptom checklist-90 scores and prognosis in patients with early breast cancer.The clinical data of 128 patients with breast cancer who were treated in our hospital from May 2015 to May 2016 were included into the analysis. These patients were divided into 2 groups, according to the different modes of operation (nâ=â64): control group, patients underwent modified radical mastectomy; observation group, patients underwent early breast conserving surgery. Then, the surgical indexes and prognosis were compared between these 2 groups.Intraoperative bleeding volume, incision length and hospitalization duration were better in the observation group than in the control group (Pâ<â.05). Furthermore, postoperative symptom checklist-90 scores in the observation group were better than scores before the operation, and were better than the scores in the control group (Pâ<â.05). Moreover, the incidence of postoperative complications was lower in the observation group (3.13%) than in the control group (21.88%, Pâ<â.05).Early breast-conserving surgery is more advantageous for breast cancers and results to lesser bleeding, rapid recovery, and fewer complications.
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Neoplasias de la Mama/cirugía , Lista de Verificación/métodos , Detección Precoz del Cáncer , Mastectomía Radical Modificada/métodos , Mastectomía Segmentaria/métodos , Adulto , Anciano , Pérdida de Sangre Quirúrgica , Neoplasias de la Mama/mortalidad , Estudios de Casos y Controles , China , Supervivencia sin Enfermedad , Femenino , Humanos , Complicaciones Intraoperatorias/epidemiología , Complicaciones Intraoperatorias/fisiopatología , Tiempo de Internación , Mastectomía Radical Modificada/mortalidad , Mastectomía Segmentaria/mortalidad , Persona de Mediana Edad , Tempo Operativo , Pronóstico , Valores de Referencia , Estudios Retrospectivos , Análisis de Supervivencia , Resultado del TratamientoAsunto(s)
Mastectomía Radical Modificada/métodos , Bloqueo Nervioso/métodos , Obesidad/cirugía , Dolor Postoperatorio/prevención & control , Pleura , Músculos de la Espalda/diagnóstico por imagen , Neoplasias de la Mama/diagnóstico por imagen , Neoplasias de la Mama/cirugía , Femenino , Humanos , Mastectomía Radical Modificada/efectos adversos , Persona de Mediana Edad , Obesidad/diagnóstico por imagen , Dolor Postoperatorio/etiología , Pleura/diagnóstico por imagenRESUMEN
Background: The reported rate of surgical site infection (SSI) in breast surgery is often higher than expected. Using antibiotic prophylaxis to reduce SSI is debatable because of the risk of developing bacteria resistance and the cost burden. In this study, we evaluated the effectiveness of antibiotic prophylaxis in breast surgery and the factors predisposing patients to SSI. Methods: A retrospective-prospective (ambispective) study was conducted in the Department of Breast Surgery, Qilu Hospital, P.R. China. The retrospective antibiotic-using group was composed of patients found to have breast cancer between January 2008 and October 2010. The prospective non-antibiotic-using group was composed of patients identified between November 2010 and November 2013. Pre-operative, peri-operative, and post-operative clinical data were analyzed. Results: The SSI rate of the non-prophylaxis and prophylaxis groups was 1.1% (11/1,022) and 1.2% (12/1,034), respectively. Neoadjuvant chemotherapy was related to SSI in the non-prophylaxis group (p = 0.026). Staphylococcus aureus was the predominant microorganism responsible for SSI, without obvious resistance to a widely used first-generation cephalosporin. Conclusions: Peri-operative antibiotic prophylaxis is of no significant value in preventing SSI in breast cancer surgery. Our results indicated that neoadjuvant chemotherapy might be a risk factor doe SSI, but further research is needed because of the sample size disparity between infected and uninfected groups.
Asunto(s)
Profilaxis Antibiótica/métodos , Neoplasias de la Mama/cirugía , Carcinoma Ductal de Mama/cirugía , Cefalosporinas/uso terapéutico , Mastectomía/métodos , Infecciones Estafilocócicas/prevención & control , Infección de la Herida Quirúrgica/prevención & control , Acinetobacter , Infecciones por Acinetobacter/epidemiología , Infecciones por Acinetobacter/prevención & control , Adulto , Factores de Edad , Anciano , Carcinoma Intraductal no Infiltrante/cirugía , Carcinoma Lobular/cirugía , China/epidemiología , Diabetes Mellitus/epidemiología , Infecciones por Escherichia coli/epidemiología , Infecciones por Escherichia coli/prevención & control , Femenino , Humanos , Hipertensión/epidemiología , Desnutrición/epidemiología , Mastectomía Radical Modificada/métodos , Mastectomía Radical/métodos , Mastectomía Segmentaria/métodos , Persona de Mediana Edad , Terapia Neoadyuvante/estadística & datos numéricos , Obesidad/epidemiología , Tempo Operativo , Sobrepeso/epidemiología , Estudios Prospectivos , Estudios Retrospectivos , Factores de Riesgo , Infecciones Estafilocócicas/epidemiología , Staphylococcus aureus , Infección de la Herida Quirúrgica/epidemiologíaRESUMEN
Breast surgery operations are generally performed by general anesthesia. In order to decrease postoperative pain, regional anesthesia is usually combined with general anesthesia. Pectoral nerve blocks is a novel technique to provide perioperative and postoperative pain control for patients underwent breast surgery. We performed pectoral nerve block I and pectoral nerve block II as a sole anesthetic technique with sedation by dexmedetomidine for modified radical mastectomy, for a 75-year-old female patient with multiple diseases. Pectoral nerve blocks with sedation could be a good technique for breast surgery than general anesthesia in comorbid patients.
Asunto(s)
Mastectomía Radical Modificada/métodos , Bloqueo Nervioso , Nervios Torácicos/efectos de los fármacos , Anciano , Femenino , HumanosRESUMEN
BACKGROUND: Triple-negative breast cancers (TNBCs) form a heterogeneous group of cancers typically exhibiting an aggressive behavior resulting in increased risk of locoregional relapse (LRR) and distant metastases. The effect of radiotherapy on LRR risk and overall survival (OS) in women treated with mastectomy alone for early-stage TNBC remains unclear. AIM: The aim of this study is to compare the locoregional recurrence rate, disease-free survival (DFS), and OS following breast conservation therapy (BCT) or modified radical mastectomy (MRM) alone in women with stage I and IIA TNBC and to assess the impact of tumor and treatment-related factors. MATERIALS AND METHODS: Patients with early-stage (pT1-2, N0) TNBC-treated between January 1, 2010, and December 31, 2011, were identified from the hospital-based registry records. The mean age was 48 years. Forty-nine patients underwent BCT, and 121 underwent MRM. The majority of the patients in both groups had T2 and grade 3 disease. None of the patients had margin positive status after surgery. Five patients had lymphovascular invasion (LVI). RESULTS: At a median follow-up of 50 months (range: 4-83 months), there was no locoregional recurrence (LRR) in either arm. Eight patients relapsed, six developed distant metastases, and one patient each had a new primary in the contralateral breast and ovary. Two patients died of disseminated cancer, one each in the BCT and MRM groups. The five-year DFS was 95.8% and 91.1% for the BCT group and MRM group, respectively, (P = 0.83). The corresponding 5-year OS was 98% and 97.5% (P = 0.527). There was no statistically significant difference in outcome based on age, grade, LVI, or margin status between both groups. CONCLUSION: This retrospective analysis identified no statistically significant difference in outcome regarding LRR, DFS, or OS in patients treated without adjuvant radiation for women with pT1-T2N0 TNBC who underwent MRM in comparison to BCT.