Morbidity comparison of sentinel lymph node biopsy versus conventional axillary lymph node dissection for breast cancer patients: results of the sentinella-GIVOM Italian randomised clinical trial.

AIMS: To compare physical morbidity and health-related quality of life (HRQOL) in breast cancer patients who received standard axillary dissection (ALND) or sentinel lymph node biopsy (SLNB), followed by axillary dissection only in the case of sentinel-node positivity, within a randomised clinical trial. PATIENTS AND METHODS: Patients with early breast cancer < or =3cm and clinically negative axilla were randomly allocated to ALND or SLNB. All patients underwent physical examination every 6 months in order to assess any arm-related symptoms. A subset of patients completed the SF-36 quality of life questionnaire and the Psychological General Well Being Index (PGWBI) before randomisation, at 6 and 12 months after surgery and yearly thereafter. Results of the first 24 months are reported. RESULTS: Six-hundred and seventy-seven patients were available for analysis: 341 patients randomised to the ALND group and 336 to the SLNB group. Six months after surgery, the SLNB group had significantly less lymph-oedema, movement restrictions, pain and numbness with respect to the ALND group. Lymph-oedema was also significantly reduced at 12 months and numbness remained significantly less frequent in the SLNB arm at all time points. Three-hundred and ten patients participated in the HRQOL assessment. The mean scores of the PGWB questionnaire general index and anxiety domain were significantly better in the SLNB group than in the ALND group but the difference ceased to be significant at 24 months. CONCLUSIONS: The SLNB is associated with reduced arm morbidity without evidence of a negative impact on psychological well being. While waiting for long-term results of ongoing randomised clinical trials, the SLNB may be proposed for early stage breast cancer patients after adequate information on the expected advantages and the possible risks.

[How to prevent saphenous nerve injury. A personal modified technique for the stripping of the long saphenous vein]. / Come prevenire le lesioni del nervo safeno. Una tecnica personale modificata per lo stripping della grande safena.

BACKGROUND: In literature the incidence of paresthesia caused by long stripping (LS) of the saphenous vein (SV) varies widely. Best results have been reported with the invagination technique by Van Der Stricht. However, this technique is associated with a high incidence of vein rupture and incomplete stripping. The aim of this study is to test a personal technique to avoid the SV rupture and to reduce the incidence of saphenous nerve injury. METHODS: Sixty-eight patients underwent LS of the SV from groin to ankle under monolateral spinal anesthesia on a one-day surgery basis using a personal technique combining external and invaginated saphenous stripping. All patients underwent a clinical re-evalutation 1, 3, 6, 12, 24 and 48 months after the operation. RESULTS: No intraoperative complications were recorded. Stripping of the long saphenous vein was complete in all cases without any rupture of the veins. Only one postoperative hematoma of the leg (1.5%) which was naturally reabsorbed, was recorded; four patients (5.9%) had transitory saphenous nerve injury. Permanent saphenous nerve damage was found in only one of 68 patients (1.5%). All the patients were discharged on the day of operation and we did not register any prolonged hospitalization. CONCLUSIONS: The result of our approach was a very low postoperative complication rate (1.5% of permanent neurological damage) without any rupture of the vein.

Modified Sujura operation: long-term results.

From January 1980 to January 1986 a total of 93 patients with portal hypertension (59 males, 34 females; average age 51.5 years) underwent the modified Sujura's operation. All patients presented with esophageal varices during the preoperative endoscopic workup. Child's risk category was A in 6 patients and B in the remaining 87. Our technique consisted of: (1) devascularization of the upper half of the gastric corpus and fundus; (2) devascularization of the last 10 to 12 cm of the thoracic esophagus; (3) pyloric divulsion; (4) resection and anastomosis at the esophagogastric junction; and (5) antireflux fundoplication. In the presence of severe hypersplenism we added splenectomy. The surgical approach was through a xiphoumbilical laparotomy, extended to the left side when splenectomy was anticipated. We observed 19.8% early mortality (10% with elective procedures and 27.2% with emergency operations) and two cases of early rebleeding from acute mucosal lesions. Long-term follow-up of 82 patients revealed 30 cases of rebleeding (36.6%). Ruptured esophageal varices occurred in 12 patients (11 were treated with endoscopic sclerotherapy), whereas in 11 patients the cause of bleeding was a hemorrhagic gastritis. Of the remaining patients, two had rebleeding from a gastric ulcer, one from gastric varices, one from duodenal varices; in three patients the source of the hemorrhage remains unknown. The survival for elective procedure patients was 59.2% at 5 years and 40.7% at 10 years.