RESUMO
PURPOSE: Breast-conserving surgery is now accepted as one of the standard therapeutic options for stages I and II breast cancers. Although breast-conserving surgery can help retain a good breast shape, a long marked scar would be a disadvantage. Endoscopic surgery can be performed via a small and remote incision that becomes inconspicuous after surgery. To improve the cosmetic outcome, endoscopic breast-conserving surgery, which can be performed through minimal axillary and periareolar semicircular incisions, was undertaken. METHODS AND MATERIALS: From October 2002 to October 2004, 20 breast cancer patients whose tumor sizes were less than 3 cm and who were clinically node negative without invasion to the skin and pectoralis major muscle underwent endoscopic breast-conserving surgery. First, endoscopic dye-guided sentinel node biopsy was done through a low transverse axillary incision lateral to the pectoralis major muscle. The subpectoral pocket was gently created by Vein Harvest under the view of endoscopic monitor. We made the periareolar semicircular incision to create the skin flap and to resect the tumor-containing quadrant by using Visiport and PowerStar scissors. Frozen-section biopsies were done to rule out tumor invasion to the resection margin. Patient characteristics, tumor characteristics, operation time, and amount of bleedings were all evaluated. RESULTS: The mean age of patients was 45 (range: 25-64). The mean tumor size was 2.2 cm (range: 0.2-4.0 cm). The average operation time of the early 9 cases, except the 3 cases that underwent axillary-node dissection, was 178 minutes, and that of the later 8 cases was 130 minutes (P<0.001). The mean amount of operative bleeding was 184+/-130 ml. There were no major complications. CONCLUSION: Endoscopic breast-conserving surgery is a new technique that can minimize the long operation scar of classic breast-conserving surgery. In properly selected cases, our results showed the maximized cosmetic satisfaction of the breast cancer patients and a shortened operation time after the learning period, promising it could be an alternative to the classic breast-conserving surgery.
Assuntos
Neoplasias da Mama/cirurgia , Endoscopia/métodos , Mastectomia Segmentar/métodos , Adulto , Neoplasias da Mama/patologia , Terapia Combinada , Feminino , Humanos , Excisão de Linfonodo , Pessoa de Meia-Idade , Satisfação do Paciente , Complicações Pós-OperatóriasRESUMO
Leptin plays an important role in the regulation of body fat homeostasis, and potential associations of leptin receptor gene (LEPR) polymorphisms with obesity have been suggested. Obesity is considered to relate to breast cancer. We assessed the role of leptin in relation to breast cancer. We measured the serum leptin concentrations of 45 Korean pre-treatment patients with breast cancer and 45 age-matched controls. By direct sequencing, we investigated four leptin receptor gene (LEPR) polymorphisms at codons 109, 223, 656, and 1019. There was no significant difference between the mean leptin concentrations of the patient and control groups in both pre- and post-menopausal women. The frequencies of the wild-type for LEPR codons 109, 223, and 1019 were very low. No increased risk estimate was found for the four LEPR polymorphisms. Our results indicate that it is difficult to explain breast cancer on the basis of serum leptin concentrations or polymorphisms in the LEPR gene.
Assuntos
Neoplasias da Mama/sangue , Regulação Neoplásica da Expressão Gênica , Leptina/sangue , Receptores de Superfície Celular/sangue , Adulto , Neoplasias da Mama/genética , Neoplasias da Mama/patologia , Estudos de Casos e Controles , Feminino , Frequência do Gene , Genótipo , Humanos , Coreia (Geográfico)/etnologia , Pessoa de Meia-Idade , Polimorfismo Genético , Receptores de Superfície Celular/genética , Receptores para LeptinaRESUMO
Neck surgery is one of the newest fields of endoscopic surgical application. One hundred patients underwent endoscopic thyroidectomy. We used 3 incisions: 1 on both upper circumareolar areas and 1 approximately 3 cm below the clavicle on the tumor side. Subplatysmal and subcutaneous operative space was created with CO2 insufflation at 6 mm Hg of pressure. The thyroidal vessels and the parenchyma of the gland were dissected and divided with ultrasonic scalpel and commonly used laparoscopic instruments. The mean (+/-SD) operation time was 136 +/- 10 minutes before the year 2000 and 67 +/- 9 in the year 2000 (P < 0.05). There were six cases of conversion to conventional thyroidectomy. Postoperative complications occurred in five cases. There was no subcutaneous emphysema. The patients were satisfied with the cosmetic result. On the basis of our experience with these 100 patients, we believe that endoscopic thyroidectomy is feasible and safe for resection of thyroid tumors. Thus, this procedure will provide another surgical technique for treatment of thyroid tumors, with maximized cosmetic effect.(2)
