Estudio comparativo aleatorizado de la utilidad de órtesis de compresión controlada frente al apósito compresivo en el postoperatorio inmediato de la cirugía conservadora del cáncer de mama / A randomised controlled trial of the efficacy of a controlled compression garment versus compressive bandaging in the immediate postoperative period after breast cancer-conserving surgery

Objetivos. Comparar la incidencia conjunta e individual de complicaciones postoperatorias, comodidad y calidad de vida dependiendo del uso de apósito compresivo o de órtesis específica de compresión controlada. Pacientes y método. Estudio prospectivo aleatorizado sobre 198 casos distribuidos en 2 grupos: apósito (n=88) y órtesis (n=99), recogiendo variables relacionadas con complicaciones inmediatas postoperatorias y satisfacción en la calidad de vida. Se realizó un estudio comparativo y de la evolución temporal de las variables durante el primer mes postoperatorio. Resultados. La incidencia de complicaciones totales fue significativamente menor con órtesis a 7 días (p=0,032) y a 15 días(p=0,009). Se evidenció una reducción significativa del dolor con órtesis a 7 días (p=0,002) y a 15 días (p=0,012) y en la incidencia de lesiones cutáneas: 0-2% en órtesis frente a 35% con apósito (p<0,0005). También se encontraron diferencias significativas en la calidad de vida a favor del uso de órtesis (p<0,0005). Conclusiones. El uso de órtesis de compresión controlada en el postoperatorio inmediato de la cirugía conservadora de cáncer de mama reduce del 32 al 15% la incidencia conjunta de complicaciones posquirúrgicas y mejora en términos de eficacia, seguridad y comodidad al apósito compresivo habitual (AU)

Objectives. To compare the overall and individual incidence of postoperative complications, comfort and quality of life resulting from the use of compressive bandaging versus a specific controlled compression garment. Patients and method. A randomised controlled trial was conducted in 198 patients distributed in 2 groups: bandaging (n=88) and compression garment (n=99). Variables related to immediate postoperative complications and satisfaction with quality of life were collected. Changes in the variables were compared in the 2 groups during the first postoperative month. Results. The incidence of total complications was significantly lower with the compression garment: 7 days (P=.032) and 15 days (P=.009). Pain was significantly reduced with the compression garment: 7 days (P=.002) and 15 days (P=.012). The incidence of skin injury was also significantly reduced: 0-2% with the compression garment versus 35% with bandaging (P<0.0005). Significant differences were found in quality of life in favour of the use of the compression garment (P<0.0005). Conclusions. The use of a specific controlled compression garment in the immediate postoperative period after breast cancer-conserving surgery reduces the likelihood of postoperative complications from 32 to 15% and enhanced efficacy, safety, and patient comfort compared with the usual compressive dressing (AU)

Factors Associated With Disease Recurrence in Breast Cancer Patients With Negative Sentinel Lymph Node Biopsy.

INTRODUCTION: The objective of our study was to assess recurrence after negative sentinel lymph node biopsy (SLNB) and to determine the risk factors related to local and distant recurrence in this group of patients. MATERIALS AND METHODS: We conducted a prospective observational study from 2006 to 2011. It included 607 patients with early-stage breast cancer and negative SLNB with a 5-year follow-up period. RESULTS: The disease-free survival rate was 98.5% and 96.5% at 2 and 5 years, respectively. Multivariate analysis identified the following prognostic factors for disease recurrence: tumor necrosis (hazard ratio [HR], 4.89; 95% confidence interval [CI], 1.61-14.89; P = .005), lymphovascular invasion (HR, 3.46; 95% CI, 1.14-10.55; P = .029), T2 tumor size (HR, 4.35; 95% CI, 1.40-13.52; P = .011), and moderate to severe lymphoplasmacytic stromal infiltration (HR, 3.06; 95% CI, 1.18-7.96; P = .022). CONCLUSION: Recurrence in patients with negative SLNB was satisfactorily low. Nevertheless, determining the prognostic factors related to a greater recurrence rate could help identify high-risk patients and influence systemic adjuvant therapy.

Effectiveness of an absorbable fibrin sealant patch to reduce lymphoceles formation after axillary lymphadenectomy for breast cancer: a matched-pair analysis.

BACKGROUND: This study evaluated the use of TachoSil as an adjunctive therapy for reducing axillary lymphocele formation. METHODS: Eighty-six patients diagnosed with breast cancer N+ and treated with axillary lymphadenectomy received a TachoSil patch in the axillary wound. Using a database of patients without placing a hemostatic patch, we applied a matched case-control in a 1-to-2 fashion. Multiple and logistic regression analyses were used to evaluate postoperative results. RESULTS: Patient group with TachoSil showed a significantly lower drainage volume (P < .001) and the length of stay was significantly shorter (P < .001). The number of patients with evacuative punctures was 24.5% in the group with patch versus 51.2% in the control group (P < .001). In multivariate analysis, the use of TachoSil was a significant predictor of reducing axillary drainage volume (P < .001), mean length of hospital stay (P = .001), and number of evacuative punctures of lymphocele (odds ratio .264, 95% confidence interval .144 to .484, P < .001). CONCLUSION: The use of TachoSil in axillary lymphadenectomy may be a safe and useful treatment option for reducing axillary drainage volume, incidence of symptomatic lymphocele, and hospital stay.

Los márgenes de resección en la cirugía conservadora del cáncer de mama / Resection margins in conservative breast cancer surgery

La cirugía conservadora del cáncer de mama plantea un nuevo problema: la posible afectación tumoral de los márgenes de resección. Esta eventualidad se relaciona de forma negativa con la supervivencia libre de enfermedad. Diversos factores pueden incrementar la probabilidad de que los márgenes estén afectados, en su mayoría relacionados con características del tumor, de las pacientes o de la técnica quirúrgica. En la última década, muchos han sido los estudios que han tratado de identificar factores que puedan predecir la afectación de los márgenes quirúrgicos, aunque en la actualidad, son las nuevas técnicas utilizadas en el estudio de los márgenes y en la localización tumoral las que están propiciando una disminución significativa de las reintervenciones en la cirugía conservadora del cáncer de mama (AU)

Conservative breast cancer surgery is facing a new problem: the potential tumour involvement of resection margins. This eventuality has been closely and negatively associated with disease-free survival. Various factors may influence the likelihood of margins being affected, mostly related to the characteristics of the tumour, patient or surgical technique. In the last decade, many studies have attempted to find predictive factors for margin involvement. However, it is currently the new techniques used in the study of margins and tumour localisation that are significantly reducing reoperations in conservative breast cancer surgery (AU)

[Resection margins in conservative breast cancer surgery]. / Los márgenes de resección en la cirugía conservadora del cáncer de mama.

Conservative breast cancer surgery is facing a new problem: the potential tumour involvement of resection margins. This eventuality has been closely and negatively associated with disease-free survival. Various factors may influence the likelihood of margins being affected, mostly related to the characteristics of the tumour, patient or surgical technique. In the last decade, many studies have attempted to find predictive factors for margin involvement. However, it is currently the new techniques used in the study of margins and tumour localisation that are significantly reducing reoperations in conservative breast cancer surgery.

Multidisciplinary breast units

En los últimos años, los cambios en la demanda de asistencia sanitaria relacionada con la patología mamaria, y en concreto con el cáncer de mama, unidos a las nuevas tendencias diagnósticas y terapéuticas, han impulsado el desarrollo de equipos multidisciplinarios dedicados a esta enfermedad. En la mayoría de los centros sanitarios que atienden patología mamaria se han creado unidades multidisciplinarias de mama siguiendo las directrices de determinadas instituciones y sociedades científicas. En el presente trabajo se revisan las recomendaciones más importantes al respecto, se valoran la experiencia y los aspectos organizativos que han permitido adaptarse a esta nueva situación, y se plantean estrategias futuras (AU)

In recent years, demand changes in health care related to breast disease, and in particular with breast cancer, together with new diagnostic and therapeutic trends, have driven the development of multidisciplinary teams dedicated to this condition. Multidisciplinary units for treating breast diseases have been established in most of health centers under the guidance of certain institutions and scientific societies. This paper reviews the most important recommendations for these units, and evaluates the experience and organizational aspects that have allowed them to adapt to this new situation, and proposes future strategies (AU)

Carcinoma suprarrenocortical. Abordaje terapéutico en estadio avanzado / Adrenal cortical carcinoma: therapeutic approach in advanced-stage disease

Presentamos el caso clínico de una mujer de 33 años diagnosticada de carcinoma suprarrenocortical en estadio avanzado. Describimos la forma de presentación clínica, los métodos diagnósticos empleados y el tratamiento, especialmente en su aspecto quirúrgico, que puede precisar en determinadas ocasiones conocimientos y habilidades en cirugía hepática y vascular para intentar conseguir la resección completa del tumor y mejorar la supervivencia en estos pacientes, generalmente muy jóvenes; asimismo, realizamos una actualización bibliográfica diagnosticoterapéutica de esta neoplasia, rara en su frecuencia pero agresiva en su evolución (AU)