Preoperative Expectations of Women Undergoing Breast Reconstruction Surgery.

Background: The study investigated the expectations of patients undergoing immediate breast reconstruction after mastectomy, considering factors such as the cause for mastectomy (cancer versus prophylactic due BRCA1 or BRCA2 gene mutations), age, marital status, and education. Methods: The study had a cross-sectional design. Eligible patients at Oslo University Hospital received a link to the BREAST-Q Expectations questionnaire, which they filled out before surgery from 2019 to 2022. Results: One hundred forty-six patients completed the questionnaire (79.8% response rate). The mean age was 46.6 years, and the majority (95.1%) were undergoing reconstruction with implants. Most patients (86.9%) wanted to be involved in the decision-making. The highest expectation was for breast appearance and the lowest for sensation after surgery. Patients not diagnosed with cancer (n = 27) before surgery expected significantly more pain after surgery compared with patients diagnosed with cancer (P = 0.016). Patients 40 years or younger had higher expectation of pain after surgery than patients 41 years or older, 73.2 versus 54.2, P < 0.001, respectively. After 10 years, 26.7% of the patients expected that further reconstruction procedures might be necessary. Conclusions: Our study's results regarding patient's expectations with breast reconstruction, as assessed using the BREAST-Q Expectations module, align with previous research in terms of overall trends. However, our study provides a more nuanced understanding by exploring variations within different patient subgroups. These differences emphasize the need for personalized preoperative counseling and support to align patient's expectations with realistic outcomes.

[Laparoscopic surgery for colorectal cancer]. / Laparoskopi ved kolorektal kreft.

BACKGROUND: It has been possible to perform colorectal operations for cancer with a laparoscopic approach for several years, but most operations are still performed by laparotomy. A systematic overview of randomized studies that compare the two techniques is presented. MATERIAL AND METHODS: Pubmed and Embase were systematically searched for relevant randomized clinical trials. RESULTS: 11 randomized clinical trials were identified. Most trials showed that laparoscopic surgery for colorectal cancer was associated with significantly longer operating time (8/11), significantly less intraoperative blood loss (5/7) and a shorter hospital stay (8/10) than open surgery. There were significantly fewer complications after laparoscopic surgery in four of 11 studies. None of the studies showed any significant differences in mortality (6/6). Survival after colon cancer surgery was reported in five studies. In one case, improved disease-free survival after laparoscopic surgery was found whereas the other four showed no significant differences. Two of these studies also included rectal cancer but did not report separate data for these patients. One study that included 28 patients found no difference in cancer-related survival after laparoscopic and open surgery for rectal cancer. INTERPRETATION: Laparoscopic surgery is an acceptable alternative to open surgery in patients with colon cancer. The procedure can be offered to patients in hospitals where experienced laparoscopic surgeons are available. In rectal cancer surgery, evidence is scarce and results from large randomized trials have to be awaited.