Resultados oncológicos de la cirugía oncoplástica: seguimiento a largo plazo de pacientes tratados en un instituto oncológico de Latinoamérica. Un análisis de cohortes / Oncological results of oncoplastic surgery: Long-term follow-up of patients treated in an oncology institute in Latin America. A cohort analysis

Objetivo. La cirugía oncoplástica forma parte del grupo de cirugías de conservación mamaria, la cual permite la resección oncológica y la remodelación mamaria en el mismo acto quirúrgico. Actualmente es ampliamente usada en Latinoamérica, sin embargo, no cuentan con grandes reportes de resultados oncológicos. El propósito del estudio es evaluar la seguridad de la cirugía oncoplástica en el tratamiento del cáncer de mama invasivo. Método. Se comparan de forma retrospectiva 124 pacientes que recibieron cirugía oncoplástica por cáncer de mama invasivo no metastásico (grupo de estudio) con 302 pacientes que recibieron cirugía de conservación mamaria convencional (no oncoplástica; grupo control) durante el periodo 2007-2015. Resultados. El tiempo medio de seguimiento fue de 61 meses, la sobrevida global fue mayor en el grupo de cirugía oncoplástica frente al grupo control a 10 años (97,7 vs. 89.8%, p=0,04), así como la sobrevida libre de enfermedad (93 vs. 86,7% a 10 años, p=0,05). Discusión. Se han comparado pacientes que tuvieron cirugía primaria oncoplástica por cáncer de mama invasivo no metastásico (124) con un grupo control (302), realizándose un seguimiento por un periodo prolongado de tiempo, proporcionando el presente estudio evidencia para plantear que la cirugía oncoplástica es una opción de tratamiento seguro y confiable en pacientes con cáncer de mama en Latinoamérica (AU)

Objective. Oncoplastic surgery is a type of breast conservation surgery, which allows oncologic resection and breast remodelling in the same surgical procedure. It is now widely used in Latin America, but large studies of its results are lacking. The aim of this study was to evaluate the safety of oncoplastic surgery in the treatment of invasive breast cancer. Method. A total of 124 patients who underwent oncoplastic surgery between 2007 and 2015 for non-metastatic invasive breast cancer (study group) were retrospectively compared with 302 patients who underwent conventional (non-oncoplastic surgery) breast conservation surgery (control group) in the same period. Results. The mean length of follow-up was 61 months. Overall survival and disease-free survival was higher in the oncoplastic surgery group than in the control group at 10 years (97.7 vs. 89.8%, P=.04; 93 vs. 86.7% at 10 years, P=.05). Discussion. We compared patients who had oncoplastic primary surgery for non-metastatic invasive breast cancer (n=124) with a control (n=302) group who were followed-up for a long period, providing evidence to suggest that oncoplastic surgery is a safe and reliable treatment option in patients with breast cancer in Latin America (AU)

La cirugía oncoplástica de la mama: una técnica quirúrgica que mejora la calidad de vida de las pacientes / Oncoplastic breast surgery: a surgical technique that improves the quality of life of patients

La cirugía oncológica de la mama ha evolucionado desde técnicas mutiladoras hasta las modernas técnicas conservadoras como “tumorectomía” o a la cirugía oncoplástica. La cirugía oncoplástica surgió de la fusión dela cirugía oncológica con la cirugía plástica reconstructiva de la mama. Esta serie de técnicas quirúrgicas permite mejorar los resultados quirúrgicos y cosméticos sin alterar el manejo oncológico de las pacientes, traduciéndose en una mejor calidad de vida sin alterar el pronóstico de la enfermedad. En la técnica quirúrgica oncoplástica de la mama también interviene, en ocasiones, la mama contralateral al realizar la nivelación, mejorando la estética. Estanovedosa técnica viene beneficiando pacientes desde el año 2012, implementándo se por primera vez en el Instituto Nacional de Enfermedades Neoplásicas, donde se han obtenido resultados similares a los reportados por la literatura especializada. En este artículo de revisión describimos a la cirugía oncoplástica de la mama así como resultados de estudios realizados en nuestra Institución.

Breast cancer surgery has evolved from mutilating techniques to lumpectomy and most recently, the oncoplastic breast surgery. This series of surgical techniques arose from the fusion of oncologic surgery and plastic reconstructive surgery of the breast. Oncoplastic breast surgery improves surgical outcomes and cosmetics without altering the oncological management, resulting in a better quality of life without altering the prognosis of the disease. The oncoplastic surgical technique involves sometimes, reduction of the contralateral breast for simetrization, improving the aesthetics. This novel technique is benefiting patients since 2012, and was implemented in Peru for first time in the Instituto Nacional de Enfermedades Neoplásicas, with similar results to those reported by the literature. In thisreview article we describe the oncoplastic breast surgery as well as results of studies done in our Institution.

Cirugía oncoplástica de la mama: primera experiencia en el Instituto Nacional de Enfermedades Neoplásicas / Oncoplastic surgery of the breast: first experience at the Instituto Nacional de Enfermedades Neoplasicas

Introducción: la cirugía oncoplástica de la mama es una técnica quirúrgica que ha tenido mucha difusión durante los últimos años. Su empleo está extendiándose rápidamente en diferentes centros alrededor del mundo. El objetivo de este estudio fue describir los resultados en un grupo de pacientes sometidos a cirugía oncoplástica de la mama y compararlos con un grupo sometido a tumorectomía. Métodos: Revisamos y comparamos las características y resultados del tratamiento del grupo sometido a cirugía oncoplástica (n=78) versus los del grupo sometido a tumorectomía (n=68) en el Instituto Nacional de Enfermedades Neoplásicas en el año 2012. Se usaron estadísticas descriptivas y las comparaciones se realizaron con las pruebas t-student y chi-cuadrado. Resultados Las características basales, incluyendo la distribución de las lesiones en los cuadrantes mamarios, fueron similares. Hubo diferencia significativa en el número de ampliación de márgenes dentro de sala de operaciones (53,7% vs 34,9%, para cirugía oncoplástica vs tumorectomía respectivamente; P=0,007), en el volumen de la pieza quirúrgica (325 cm3 vs 151,9 cm3 para la cirugía oncoplástica vs tumorectomía, respectivamente; P=0,033); asimismo se encontraron tendencias estadísticas con respecto a la tasa de reoperaciones (12,8% vs 25,4% para la cirugía oncoplástica vs tumorectom¡a, respectivamente; P=0,056). Conclusiones: la cirugía oncoplástica es un método tan seguro como la tumorectomía, con mejores resultados en términos de procedimientos quirúrgicos adicionales y puede implementarse en las principales Instituciones del país.

Introduction: Breast oncoplastic surgery is a surgical technique that has been quite spread in recent years while their use is spreading rapidly in different facilities around the world. The aim of this study was to describe the results in a group of patients undergoing oncoplastic breast surgery and compare the results with a group of patients undergoing lumpectomy. Methods: we reviewed the features and results of treatment of a group of patients undergoing oncoplastic surgery (n=78) against the results of a group that underwent lumpectomy (n=68) at the Instituto Nacional de Endermedades Neopl sicas in 2012. Descriptive statistics were used and comparisons were done with the Student's t-test and chi square test when appropriate. Results Baseline characteristics were similar between groups, including the distribution of lesions in breast quadrants. In the volume of the surgical specimen (151.9 cm3 vs 325 cm3; significant differences in the number of margin expansion in operating room (P=0.007 and 53.7% vs 34.9% for lumpectomy vs oncoplastic surgery, respectively) were found lumpectomy vs oncoplastic surgery, respectively, P=0.033) and also statistical trends were found with respect to the rate of reoperations (12.8% vs 25.4 % for lumpectomy vs oncoplastic surgery, respectively, P=0.056). Conclusions: oncoplastic surgery is as safe as lumpectomy with better results in terms of additional surgical procedures and may be implemented in the major institutions of the country.

Prognostic effect of hormone receptor status in early HER2 positive breast cancer patients.

BACKGROUND: This study was conducted to determine the prognostic effect hormone receptor (HR) status in early HER2 positive (HER2+) breast cancer patients, since it has not yet been established whether HR status can be used in the prognosis of patients with (HER2+) breast cancer. PATIENTS AND METHODS: We obtained data from 299 patients with early HER2+ breast cancer who underwent surgery and received standard adjuvant chemotherapy, hormonal therapy and/or radiation between 2000 and 2002 at the Instituto Nacional De Enfermedades Neoplasicas, Perú. Clinical and pathological features were compared. Endpoints analyzed were disease free survival (DFS) and overall survival (OS). RESULTS: Overall, 155 patients were HR-positive (HR+) and 144 were negative (HR-). The two groups had similar characteristics except for histologic grade and extracapsular extension. With a median follow-up of 93 months, 5-year DFS was statistically different between the two groups: 65.0% for (HER2+/ HR-) and 74.6% for the (HER2+/ HR+) patients (p=.045). OS at 5 years was not statistically different between the two groups with 75.5% for (HER2+/ HR-) patients and 82.4% for the (HER2+/ HR+)(p=.140). CONCLUSIONS: Patients with (HER2+/ HR-) breast cancers treated with surgery and standard adjuvant chemotherapy exhibited a statistically worse DFS compared to those with (HER2+/ HR+) tumors. However, OS was similar in both groups.

Compromiso del complejo areola pezón en mastectomía por cáncer de mama / Commitment nipple areola complex in mastectomy for breast cancer

Background: was to investigate the predictors of injection of the nipple areola complex in breast cancer patients to define the indications for mastectomy with immediate reconstruction preserving the skin and nipple areola complex, at Instituto Nacional de Enfermedades Neoplásicas. Methods: randomly reviewed 100 clinical records of patients diagnosed with breast cancer undergoing mastectomy, including patients with diagnosis in Instituto Nacional de Enfermedades Neoplasicas, excluding patients treated with surgery in another institution or tratmiento neoadjuvant chemotherapy or radiotherapy. Results: only 76 patients met the inclusion Criterior. The average age 47.32, the most common location in the breast was tunor the outer surface quadrants, the average distance from the nipple is 33,25 mm. .The average size of tumors is of 30.66 mm (range, 2 to 70 mm). The most common histological type is ductal cancer, 52 breast (68.4%). 25% of this undertaking paceintes nipple areola complex. Multicentricity correlate with the state of the nipple. Conclusions: We found a significant association between nipple areola commitment multicentricity.