Surgery for Early Stage Invasive Cervical Cancer. Experience of the Oncology Department of Ledantec Hospital

Background: Surgery is the treatment for early-stage cervical cancer. Radiochemotherapy is used in the treatment of locally advanced stages. But the choice of treatment can be difficult. Objective: The objective of this work was to evaluate the therapeutic aspects of cervical cancer in the early stages IA to IIA in the oncology department of A Ledantec Hospital in Dakar. Patients and methods: This was a descriptive retrospective study, from January 2015 to December 2020, in the oncology department of A Ledantec Hospital, including all the patients who had been treated for early-stage invasive cervical cancer. Results: We included 28 patients. The average age was 49.54 years old. There were 11 patients (39.3%) with a stage ≤ IB1. Surgery was the first in 14 patients (50%). The initial approach was a midline supra and subumbilical laparotomy. The surgery was R0 in 65.22%. Postoperative complications were found in 4 patients including 1 case of operative wound suppuration, 1 case of dysuria, 1 case of postoperative eventration and 1 case of rectovaginal fistula. Concomitant Radiochemotherapy was neoadjuvant in 7 cases (25%), adjuvant in 14 cases (50%). The chemotherapy was neoadjuvant in 09 cases (56.25%) and adjuvant in 7 cases (43.75%) with minor toxicities. We had recorded 2 deaths. Conclusion: The treatment of the early stages of invasive cervical cancer is based on surgery. Neoadjuvant treatments may be useful in particular situations.

Interest of the Padding in the Prevention of Lymphocele Production after Mastectomy with Axillary Dissection for Breast Cancer at Joliot Curie Cancer Center

Introduction: The principal postoperative complication of mastectomies with axillary dissection is the lymphocele that can last many months after surgery. The purpose of our study was to prevent its formation using the padding. Methods: Sixty-one patients have been included in our study. The follow-up was 6 months. The patients were divided in two groups through a random draw (simple drainage and drainage associated with padding). All patients had a mastectomy with axillary dissection following the Madden technique. All quantities of lymphoceles during postoperative hospitalization and ambulatory care have been noted. Results: Twenty-five patients had benefited from the padding and 36 of a simple axillary drainage. Six months after the surgery, the patients benefitting from the padding had a quantity of lymphocele equal to half that of the control group (761.83 mL against 1373.60 mL;p = 0.01). During the postoperative hospitalization, the quantities were of 362.80 mL for the padding group versus 630.83 mL;p < 0.01. The hospitalization period was shorter for the padding patients (3.72 days vs 5.14 days;p = 0.01). However, pain was greater for the padding group upon 6 months (0.26 vs 0.10;p = 0.04). On another note, padding does not influence the duration of the surgery. Conclusion: The production of postoperative lymphocele is heterogenous, varying from one patient to another. Nevertheless, the padding of the mastectomy compartment and of the axillary cavity allows a noticeable reduction of the produced quantity and of the hospitalization period at the expense of more pain.

Preservation of the Intercostobrachial Nerve during Axillary Dissection for Breast Cancer at the Surgical Oncology Unit of Cancer Department of Dakar University

The intercostobrachial nerve (ICBN) is responsible for the sensory innervation of a part of the inner side of the arm. Injury of the intercostobrachial nerve is a complication of axillary dissection during lymph node dissection. Objective: This study aimed to determine the effect of preservation of the intercostobrachial nerve on postoperative sensory disturbances. Methods: This is a prospective, single-center study which was carried out in 90 patients followed in the oncology department of the Aristide Le Dantec hospital in Dakar, suffering from breast cancer and having undergone breast surgery associated with axillary dissection, for a period of 6 months. The patients were divided into two groups depending on whether the intercostobrachial nerve (ICBN) was preserved or not. The two groups were compared in terms of the incidence of sensory disturbances. Results: Sixty patients without nerve preservation and 30 patients with nerve preservation were included in the study, i.e., 90 patients in total. ICBN was injured in 60 patients of which 41 patients (83.7%) developed numbness in the inner arm. While in the preserved group, only 8 patients suffered from numbness (16.3%) with a significant P value of 0.002;however, for other variables such as the incidence of neuropathic pain and hypoesthesia-like sensory deficit, there was no significant difference. Conclusion: Preservation of the intercostobrachial nerve during axillary dissection for breast cancer reduces the incidence of sensory disturbances on the upper limb.

Cystic Breast Cancer. A Confusing Entity. Study of 8 Cases at Dakar University Surgical Oncology Unit

Introduction: Cystic breast cancer is a rare entity. Breast cysts are most often benign. The clinical characteristics of malignancy are not specific. Objective: To report a series of malignant cystic tumors of the breast and to describe their different characteristics. Materials and Methods: This was an observational study carried out between January 2018 and October 2021 at the Dakar university surgical oncology unit. We studied the clinical appearance, imaging, histopathology, extent of disease and treatment. We did not include cases of pure, single, or multiple chronically progressive cysts. Results: There were 8 patients, 6 women and 2 men. The average age was 44. All patients presented with a palpable unilateral deforming skin mass without inflammatory character. One patient presented with a bloody discharge. The cyst was multilocular without intracystic growth in 2 cases and presented a growth signal in 6 cases. Imaging was ACR 3 in 5 cases and ACR 4 in 3 cases. Histopathology found 6 invasive carcinomas including 2 papillary, 3 Invasive Carcinoma of No Special Type (ICNST), 1 lobular carcinoma as well as one case of lobular carcinoma in situ of the comedocarcinoma type in women and 2 ICNST in men. The extension workup was found in only 1 male patient in the presence of metastases. Treatment included chemotherapy, mastectomy and radiotherapy for 6 of the patients. There wasn’t any complete response for invasive cases. Survival is 100% to date. Conclusion: Cystic breast tumors sometimes hide the cancer that is difficult to diagnose. The prognosis seems favorable, however.