Review of conservative surgery in early breast cancer. British Columbia experience.

Conservation mastectomy in combination with radiotherapy is becoming an accepted treatment for early breast cancer. No absolute guidelines exist as to appropriate patient selection or correct surgical technique, but certain unifying trends can be ascertained from the current literature. The purpose of this study was to review the literature and to identify areas of incongruence between present management of patients in British Columbia and suggestions in the current literature. One hundred patients were reviewed. Twenty-six percent of them did not receive preoperative mammograms, and tumor stage was inappropriate in 9 percent. Thirteen percent had excisional biopsies only. A quarter of the patients had tumor resection through unfavorably placed incisions. Eight percent did not have estrogen receptor determination. Thirty-nine percent of the pathology reports made no comment as to adequacy of resection margins. It is hoped that these areas that, with proper attention, can improve cosmetic results and decrease the incidence of local tumor recurrence.

Short-term follow-up of surgically treated sarcomas.

Seventy-four patients with soft tissue sarcomas received the initial diagnosis in Vancouver General Hospital between 1974 and 1979. The patients ranged in age from birth to 92 years, and all common types of sarcoma were encountered. All but 4 patients were treated surgically, and 30 received radiotherapy and 22 chemotherapy as well. The overall recurrence rate was 70 percent; a large majority or recurrences were local, suggesting inadequate excision. The average time to the first recurrence was 11.5 months and to the fourth recurrence, 30 months. The need for large, multicenter prospective studies combining various methods of treatment is stressed.

Pancreatic pseudocyst. Changing concepts in management.

One hundred seven patients with pseudocyst managed during the past decade were reviewed. The mortality rate of 11.2 percent compares favorably with the rates in other recent series. Twenty-two percent of the patients were managed conservatively, and 76 underwent exploration. None of the nonoperative patients died from complications of the cyst. In all five patients (4.8 percent) who died, the cause was sepsis and multiorgan failure unrelated to the cyst. Patients with external drainage had a 90 percent complication rate. In addition, in four of five patients attempts at treatment by needle aspiration failed. Internal drainage of all types was complicated in 50 percent of patients, with a surprising absence of complications associated with cystojejunostomy. Asymptomatic pseudocysts may be safely treated conservatively with a good expectation of spontaneous resolution. Eight patients had pseudocysts secondary to biliary tract disease alone. Perhaps the incidence of this complication would have been lower if the biliary disease had been treated. This would support the argument for early surgical intervention in patients with acute pancreatitis secondary to biliary stones.

Laparotomy for staging of Hodgkins' disease.

Laparotomy was used for staging Hodgkin's disease in a selected group of 71 patients over a 9-year period at the Cancer Control Agency of British Columbia. Operative results altered the staging in 30 patients and the treatment in 28 patients. Negative lymphangiograms were found to predict accurately the absence of abdominal lymph-node involvement. No investigation was as accurate as laparotomy in identifying subdiaphragmatic Hodgkin's disease. There were no operative deaths and the overall morbidity was 18%. The value of staging laparotomy depends on the adjustment of therapy to match the changes in staging made as a result of this procedure. Of specific advantage is the avoidance of unnecessary chemotherapy. Improved long-term survival as a result of staging laparotomy has yet to be proven.