Is conservative surgery a good option for patients with "triple negative" breast cancer?

BACKGROUND: Triple negative breast cancers (negative estrogen receptor, progestagen receptor and no overexpression of HER2) seems to be more aggressive than other breast carcinoma subtypes. Therefore, it is necessary to analyze if a more aggressive surgical treatment should be offered to this subgroup of patients. PATIENTS AND METHODS: The Castellon Cancer Registry Database (C.Valenciana, Spain) was used to identify eligible breast cancer patients. Female patients who were diagnosed and/or treated from January 2000 to December 2008 with primary, invasive, unilateral breast cancer at our hospital were included. A total of 410 patients make up the study population. Kaplan-Meier curves and log-rank tests were used to estimate 5-year local recurrence functions and to compare them across strata. Cox proportional hazards models were used to calculate hazard ratios and 95% confidence intervals to fit the effect of conservative surgery and other independent variables on local recurrence. RESULTS: Median follow-up time was 60 months (1-127 months). A total of 21 patients (5%) presented a local recurrence during follow-up. There was a 9% difference in terms of local recurrence between conservative and non-conservative techniques for triple negative patients, whereas such difference was only 1% for no triple negative patients. On univariate analysis for local recurrence, only tumor size and lymph node metastasis were statistically associated with local recurrence. All other variables (type of surgery, triple negative status, molecular classification, tumor grade, age, adjuvant treatments, and total number of analyzed lymph nodes) were not statistically significant. On multivariate analysis, independent prognostic factors were breast conservative surgery (HR 4.62 95%CI 1.12-16.82), number of positive lymph nodes (HR 1.07 95%CI 1.01-1.17) and millimetre tumor size (HR 1.02 95%CI 1.01-1.06). In contrast, triple negative status trended to be a risk factor but without statistical significance (HR 1.59 95%CI 0.42-8.04). CONCLUSIONS: It was not possible to find statistically significant differences between conservative and non-conservative surgery for triple negative breast cancer. However, a trend was observed for higher recurrence rates after breast conservative surgery for this group of patients. Prospective clinical trials are needed to confirm this observation.

Gallstone ileus: management options and results on a series of 40 patients.

INTRODUCTION: Controversy remains about the management of gallstone ileus. While some authors propose enterotomy, others defend the one-stage procedure (simultaneously fistula repair). The objective of the present study was to analyze management options and comparative study their results. MATERIAL AND METHODS: Retrospective and descriptive study with revision of clinical stories of patients with the diagnosis of gallstone ileus between 1987 and 2008. All the following variables were recorded: dates of hospital admission, surgery and discharge, age, sex, pathological antecedents, preoperative or intraoperative diagnosis, treatment, location of the fistula and location of the obstruction. End-result variables were: postoperative complications, mortality, complications during the follow-up and biliary complications. RESULTS: A total of 40 patients were included of 46,648 admissions. Age, comorbidity, and intraoperative diagnosis were related with poorer short- and long-outcomes. The percentage of postoperative complications was similar for groups with and without fistula repair. Mortality was higher in the group with fistula repair (15 vs. 25%). Biliary complications were more frequent in the group without fistula repair (11 vs. 0%). Sex, location of the fistula and location of the obstruction did not be related with the prognosis. CONCLUSION: One-stage procedure is related with higher mortality rate than enterotomy alone. Nevertheless, fistula repair reduces the number of biliary complications during the follow-up.

Íleo biliar: opciones terapéuticas y resultados en una serie de 40 casos / Gallstone ileus: management options and results on a series of 40 patients

Introducción: todavía existe gran controversia sobre el mejor tratamiento del íleo biliar. Algunos autores proponen la enterotomía aislada, mientras otros defienden la reparación de la fístula bilioentérica en el mismo acto quirúrgico. El objetivo del presente estudio fue analizar las opciones terapéuticas en estos pacientes y estudiar sus resultados. Material y métodos: estudio retrospectivo y descriptivo, con revisión de las historias clínicas de los pacientes diagnosticados de íleo biliar desde 1987 hasta 2008. Se recogieron las fechas de ingreso, de intervención y del alta, edad, sexo, antecedentes patológicos, diagnóstico preoperatorio o intraoperatorio, tratamiento, lugar de la fístula y lugar de la obstrucción. Como variables de resultado se utilizaron las complicaciones postoperatorias, mortalidad, complicaciones en el seguimiento y complicaciones biliares. Resultados: se incluyeron 40 pacientes sobre 46.648 ingresos. La edad, la comorbilidad y el diagnóstico intraoperatorio se relacionaron con peores resultados a corto y largo plazo. El porcentaje de complicaciones postoperatorias fue similar para el grupo con abordaje de la fístula y para el grupo con enterotomía aislada. La mortalidad fue superior en el grupo con abordaje de la fístula (15 frente a 25%). Las complicaciones biliares fueron más frecuentes en el grupo sin abordaje de la fístula biliar (11 frente a 0%). El sexo, lugar de la fístula o el lugar de la obstrucción no demostraron diferencias. Conclusión: la cirugía en un solo tiempo se relaciona con mayor mortalidad que la enterotomía aislada. No obstante, añadir la reparación de la fístula reduce el número de complicaciones biliares en el seguimiento(AU)

Introduction: controversy remains about the management of gallstone ileus. While some authors propose enterotomy, others defend the one-stage procedure (simultaneously fistula repair). The objective of the present study was to analyze management options and comparative study their results. Material and methods: retrospective and descriptive study with revision of clinical stories of patients with the diagnosis of gallstone ileus between 1987 and 2008. All the following variables were recorded: dates of hospital admission, surgery and discharge, age, sex, pathological antecedents, preoperative or intraoperative diagnosis, treatment, location of the fistula and location of the obstruction. End-result variables were: postoperative complications, mortality, complications during the follow-up and biliary complications. Results: a total of 40 patients were included of 46,648 admissions. Age, comorbidity, and intraoperative diagnosis were related with poorer short- and long-outcomes. The percentage of postoperative complications was similar for groups with and without fistula repair. Mortality was higher in the group with fistula repair (15vs. 25%). Biliary complications were more frequent in the group without fistula repair (11 vs. 0%). Sex, location of the fistula and location of the obstruction did not be related with the prognosis. Conclusion: one-stage procedure is related with higher mortality rate than enterotomy alone. Nevertheless, fistula repair reduces the number of biliary complications during the follow-up(AU)