Is Survival with Conservative Breast Therapy Becoming Superior to That with Modified Radical Mastectomy Alone for the Treatment of Early Breast Cancer in This Era?

This study aims to assess survival rates in early breast cancer patients treated by conservative breast therapy (CBT), including radiotherapy, compared with those treated by modified radical mastectomy (MRM) alone. The South Egypt Cancer Institute and the Assiut University Oncology Department patients' records, from January 2010 to December 2017, were searched for T1-2N0-1M0 breast cancer patients treated by CBT or MRM. Patients who did not receive chemotherapy were excluded to reduce the treatment variation. The 5-year locoregional disease-free survival (LRDFS) was 97.3% for the CBT patients was and 98.0% for the MRM patients (P = .675). The 5-year distant disease-free survival (DDFS) was 93.6% for CBS and 85.7% for MRM (P = 0.033). The DFS was 91.9% for the BCT patients and 85.3% for the MRM patients (P = 0.045). The 5-year OS was 98.2% for the CBT patients and 94.3% for the MRM patients, (P = 0.02). By Cox regression analysis, the CBT resulted in significantly better OS, (P = 0.018) and the HR = 0.350, 95% CI 0.146-0.837. The adjusted OS, estimated by the propensity score-based weights, remained superior in CBT than in MRM patients (P < 0.001). CBT resulted in better DDFS, DFS, and OS than MRM. Future randomized trials are needed to confirm these findings and determine the cause.

Role of video-assisted thoracoscopic surgery in pulmonary metastasectomy.

Introdcution: There are sparse prospective studies investigating the role of video-assisted thoracoscopic surgery (VATS) in management of pulmonary metastasis. Aim: To prospectively investigate short-term surgical and pathological outcomes for PM patients operated on by VATS or open thoracotomy (OT) for management of lung secondaries. Material and methods: Between October 2017 and December 2020, patients undergoing pulmonary metastasectomy were recruited. Patients were assigned to undergo resection with either thoracotomy (group 1) or VATS (group 2) after multidisciplinary team discussions based on the number, size and location of pulmonary metastasis and underlying lung function. All related short-term surgical and pathologic outcomes for both groups were collected for analysis. Results: Of 58 patients enrolled, 21 were in group 1 and 37 in group 2. Colorectal cancer primary represented 40% of the cases. Patients in the VATS group were more likely to have solitary lesions that are peripherally located and removed by wedge resection, as opposed to patients in the thoracotomy group, who had more anatomical lung resections. More new nodules were likely to be detected during surgery in thoracotomy than VATS cases (p = 0. 027). However, 8 (out of 15) of the newly detected lesions were not malignant. Operative time, blood loss and hospital stay were in favor of VATS procedures. Conclusions: In a highly selected cohort of pulmonary metastasis patients with favorable criteria (peripherally located, small, solitary/oligo-metastasis and cN0), VATS may provide acceptable onco-pathologic outcomes as compared to the standard open thoracotomy.

Role of subxiphoid uniportal video-assisted thoracoscopic surgery in pulmonary metastasectomy.

Optimal management for patients with pulmonary metastasis is still debated. True survival benefit from widely practiced pulmonary metastasectomy (PM) is yet to be proved from high-quality randomized controlled trials. The ideal surgical approach for PM is also not generally agreed. VATS offers enhanced recovery and superior functional outcomes but at the expense of less detection of lung nodules and higher possibility of narrow/positive resection margins. The subxiphoid uniportal VATS (uVATS) approach is an evolving new approach with potential advantages including simultaneous access to both lung fields, less pain and faster rehabilitation. These advantages make it a favorable approach for PM, particularly in the setting of bilateral metastases. However, its use is still limited to case reports of a small number of patients. There is room for improvements in subxiphoid uVATS due to reported technical challenges and limitations. Herein, we aim to publicize a comprehensive review of literature on applications of subxiphoid uVATS in PM.

Bladder preservation versus radical cystectomy in transitional cell carcinoma and squamous cell carcinoma muscle invasive bladder cancer.

BACKGROUND: Randomizing patients to bladder preservation or radical cystectomy (RC) for the treatment of bladder cancer has not been practical, due to patient and physician preferences. Therefore, continually comparing the 2 treatment modalities is needed, in order to make the proper choice for each patient. PATIENTS AND METHODS: The records of T1-4N0M0 bladder cancer patients, who presented to the South Egypt Cancer Institute between 2007 and 2017 and were treated by either bladder preservation or RC were reviewed. RESULTS: Out of the 166 included patients, 81 (48.8%) patients were treated by bladder preservation and 85 (51.2%) patients had RC. For the patients treated by bladder preservation and the patients treated by RC, the 5-year overall survival (OS) was 56% and 60% (p = 0.67), the 5-year local recurrence-free survival was 69% and 73% (p = 0.69), and the 5-year disease-free survival was 45% and 53% (p = 0.16), respectively. After propensity matching analysis, the mean 5-year OS was 58% for the bladder preservation patients and 61% for the RC patients (p = 0.51). It is notable that among the bladder preservation group, 8 patients (10%) had squamous cell carcinoma (SCC) pathology and refused RC. Their OS was 56% compared to 53% for the SCC patients treated by RC (p = 0.6). CONCLUSION: Bladder preservation is a safe alternative to cystectomy in transitional cell carcinoma stages T1-4aN0M0, and its use in SCC bladder cancer should be further studied, as it could be feasible to spare them from initial cystectomy.