Parallel pathways:A chronicle of evolution in rectal and breast cancer surgery

In this editorial,we have analyzed the historical evolution of rectal and breast cancer surgery,focusing on the progressive reduction of demolitive approaches and the increasing use of more conservative strategies,accompanied by a growing emphasis on perioperative treatments aimed at enhancing surgical outcomes.All of these changes have been made possible due to an increased awareness and understanding of oncological diseases and improved perioperative treatments.

Toxicity of Hypofractionated Radiotherapy Following Breast Conservative Surgery in Breast Cancer

Background:Adjuvant radiotherapy has increased disease-free and overall survival rates in breast cancer. Conventionally fractionated radiotherapy delivers 50 Gy over 5 weeks which is the standard approach. A shorter duration of hypofractionated radiotherapy (HFRT) will be more convenient for patients and treatment providers if found safe and equally effective. Material and Methods: Fifty-four breast cancer patients who underwent breast conservative surgery (BCS) were enrolled in this study. The patients received 4005 cGy/15 fractions. A boost to the tumor bed was administered in all patients. In this study, radiotherapy induced toxicity was evaluated. Results: In this study, the median age of our patients was 48 years with age ranged from 28 to 69 years. Acute skin toxicity was assessed, and it was noted that grade 2 skin toxicity was shown in only 6 patients (11.1%) at the end of radiotherapy and disappeared after 6 weeks of treatment. Late skin toxicity (telangectasia, hyperpigmentation, and subcutaneous fibrosis) was assessed and showed that most patients had grade 0 toxicity with no grade 3 toxicity at all. Regarding pulmonary toxicity, 5 patients (9.3%) developed acute pneumonitis and as regards chronic lung toxicity, it was evident in only 3 patients, 2 patients (3.7%) were grade 1 and 1 patient (1.9%) was grade 2. Cardiac toxicity was evident in 2 patients (7.1%) of the left breast cancer patients. Regarding lymphoedema, most patients that showed lymphoedema were grade 1. Conclusion: The results confirm the safety and feasibility of adjuvant hypofractionated whole breast radiotherapy in breast cancer patients in terms of acute and late toxicity.

The 10-Year Local Recurrence and Partial Breast Radiotherapy for Early Breast Cancer Treated by Conservative Surgery

To study the local recurrence and the role of whole breast radiotherapy for early breast cancer treated by conservative surgery. METHODS From April 1990 to December 2000, 49 patients with early primary breast cancer were treated by conservative surgery in our hospital. The cases were comprised of Stage 0, 1; Stage Ⅰ, 31; and Stage Ⅱa, 17. Forty cases underwent quadrantectomy plus axillary lymph node dissection, and the other 9 cases had lumpectomy alone. Irradiation, which was received by 39 patients, was administered by using low tangential half fields with 6 MV X-ray to decrease the pulmonary irradiative volume. The dose to the whole breast was 45 Gy/22 ～23f/4.5W, then a 15 Gy boost dose was delivered to the tumor bed by an electron beam. The other patients underwent an irradiated regional field according to postoperative pathology. RESULTS All patients were followed-up for 10 years or more. The 10- year local recurrence rates, distant metastasis rates and survival rates were 6.1%, 4.1% and 98.0% respectively. All of the 3 patients who had a local recurrence had infiltrative carcinomas and negative lymph nodes. The 10-year local recurrence rate was higher （2.6% vs. 20.0%） with nonpostoperative whole breast radootherapy, but the statistical difference was not marked because of the low number of cases. All of the recurrent lesions localized within 3 cm of the primary lesion. CONCLUSION Original recurrence of the tumor was the main type of local recurrence. Radiotherapy after conservative surgery is very essential. After conservative surgery it is feasible that irradiation can be delivered alone to the neighboring region of the tumor bed. Partial breast radiotherapy can substitute for whole breast radiotherapy.

Concomitant Boost Radiotherapy after Conservative Breast Surgery in Early Breast Cancer

Background: Radiation therapy after breast conserving surgery is a standard part of treatment for invasive breast cancer. Based on radiobiological models, it was found that shorter radiation schedules offered the promise of equivalent local control to standard radiation therapy by giving larger doses per fraction in shorter period of time. Methods: This study included 36 female patients with operable invasive stage I-II breast cancer. These patients underwent microscopic wide local excision of the primary tumor and lymph node dissection. They received adjuvant radiotherapy. The radiation dose was 40 Gy total dose in 15 fractions for whole breast and additional dose of 9 Gy in three consecutive fractions was delivered to tumour cavity simultaneously. Results: Mean age was 52 years (range: 30 - 67);most patients were of stage II disease and Grade II was the most common one. Invasive ductal carcinoma was reported in 94.4% and 72.2% of patients were hormone receptor positive. After median follow-up of 52 months, all patients were alive and ipsilateral local recurrence was reported in 1 case only. Grade IV radiation toxicity was not observed;moist desquamation was the most common acute reaction (61%) with grade III in 5.5% followed by dry desquamation in 55.6% of grade I only. Grade I erythema was recorded in 41.7% and grade II in 11%. Fibrosis was the most frequent late reaction (44.3%) with grade II in 11% followed by telengectesia then pigmentation (41.7%, 33.3% respectively). Conclusion: The regimen used in this study appears promising with acceptable acute toxicities and convenient for our patients and has the advantage of economic use of radiation facilities. However, larger number of patients and longer period of follow-up are needed for further evaluation.

Is breast conservative surgery a reasonable option in multifocal or multicentric tumors?

The incidence of multifocal(MF) and multicentric(MC) carcinomas varies widely among clinical studies,depending on definitions and methods for pathological sampling.Magnetic resonance imaging is increasingly used because it can help identify additional and conventionally occult tumors with high sensitivity.However,false positive lesions might incorrectly influence treatment decisions.Therefore,preoperative biopsies must be performed to avoid unnecessary surgery.Most studies have shown higher lymph node involvement rates in MF/MC tumors than in unifocal tumors.However,the rate of local recurrences is usually low after breast conservative treatment(BCT) of MC/MF tumors.It has been suggested that BCT is a reasonable option for MC/MF tumors in women aged 50-69 years,with small tumors and absence of extensive ductal carcinoma in situ.A metaanalysis showed an apparent decreased overall survival in MC/MF tumors but data are controversial.Surgery should achieve both acceptable cosmetic results and negative margins,which requires thorough preoperative radiological workup and localization of lesions.Boost radiotherapy techniques must be evaluated since double boosts might result in increased toxicity,namely fibrosis.In conclusion,BCT is feasible in selected patients with MC/MF but the choice of surgery must be discussed in a multidisciplinary team comprising at least radiologists,surgeons and radiotherapists.

Imaging of the treated breast post breast conservation surgery/oncoplasty: Pictorial review

Mammographic appearance of the normal breast is altered in the post-operative setting. It is essential to be aware of the normal findings as well as to identify features of recurrent disease with particular emphasis on radiologicalpathological concordance. Digital breast tomosynthesis and volumetric breast density add incremental value in this clinical setting. We present a pictorial review of various cases to illustrate normal post-operative findings as well as mammographic features suspicious for recurrent disease.

Breast Conserving Surgery and Sentinel Lymph Node Biopsy under Local Anesthesia for Breast Cancer

Background: Breast conserving surgery and sentinel lymph node biopsy has become the standard operation for early breast cancer. This operation has been performed under local anesthesia for patients that would like short-term admission or for those not indicated for general anesthesia due to complications. This report presents the outcomes of breast conserving surgery and sentinel lymph node biopsy under local anesthesia. Patients and Methods: The study included 61 patients with breast cancer that were all definitely diagnosed before surgery. The indications were preoperatively diagnosed localized DCIS, invasive carcinoma measuring less than 3 cm in tumor diameter on ultrasound, and tumors with negative axillary lymph nodes. The surgical procedures included breast conserving surgery associated with sentinel lymph node navigation biopsy. Results: The surgery could be performed under local anesthesia in all 61 patients, and no patient was converted to general anesthesia. Four patients had sentinel lymph node metastasis. Surgical stumps were positive in 18 patients (29.5%). Ten Gy of boost irradiation of the tumor bed was added to the conventional breast irradiation for these patients. There were no serious complications associated with surgery. Conclusion: Breast conserving surgery and sentinel lymph node biopsy for early breast cancer can be performed safely under local anesthesia. This procedure contributes to shortening the length of hospitalization and thereby saving medical resources without deceasing the quality of treatment.

Oncoplastic Breast Surgery Using Spindle Shaped-Partial Mastectomy for Early Breast Cancer in the Upper Quadrant Area

Background: Oncoplastic surgery is becoming more common, however, only several reports have been published in Japan. We report the results of simple oncoplastic surgery for Japanese patients with early breast cancer in the upper quadrant area. Methods: In seven patients with a past history of breast-feeding and ptotic breasts, we performed oncoplastic surgery involving partial mastectomy and the resection of excess skin and parenchymal tissue. Results: None of the patients received a contralateral operation to produce symmetrical breasts. The width of the resected excess skin tissue ranged from 20 to 50 mm, with the mean width being 30 mm, and its length ranged from 50 to 90, with the mean length being 77 mm. The width of the resected gland tissue ranged from 40 to 65 mm, with the mean width being 53 mm, and its length ranged from 70 to 100 mm, with the mean length being 97 mm. The cosmetic results were excellent. Conclusions: Oncoplastic surgery using spindle shaped-resection was successfully performed in patients with upper quadrant lesions, and the cosmetic results were excellent.

Magnetic resonance imaging findings of radiation-induced breast angiosarcoma:A case report

BACKGROUND Breast conservation surgery(BCS)with adjuvant radiotherapy has become a gold standard in the treatment of early-stage breast cancer,significantly reducing the risk of tumor recurrence.However,this treatment is associated with adverse effects,including the rare but aggressive radiation-induced angiosarcoma(RIAS).Despite its rarity and nonspecific initial presentation,RIAS presents a challenging diagnosis,emphasizing the importance of imaging techniques for early detection and accurate diagnosis.CASE SUMMARY We present a case of a 48-year-old post-menopausal woman who developed skin ecchymosis on the right breast seven years after receiving BCS and adjuvant radiotherapy for breast cancer.Initial mammography and ultrasound were inconclusive,showing post-treatment changes but failing to identify the underlying angiosarcoma.Contrast-enhanced breast magnetic resonance imaging(MRI)revealed diffuse skin thickening and nodularity with distinctive enhan-cement kinetics,leading to the diagnosis of RIAS.This case highlights the crucial role of MRI in diagnosing and determining the extent of RIAS,facilitating timely and appropriate surgical intervention.CONCLUSION Breast MRI is crucial for detecting RIAS,especially when mammography and ultrasound are inconclusive.

Two Modified Surgical Procedures for Treating Early Stage Breast Cancer in China

Conventional pedicled-flap based surgeries in treating breast cancer have their limitations. New surgical regimens are yet to be explored, which will follow the oncological principle of being “to- tal tumor free”, whilst fit into the unique characteristics of China＇s own medical system as well as pa- tients＇ demand. From 2007 to 2013, 143 patients with early stage breast cancer were included in the study, with the average age of 46.1 years. Fifty-three patients were subjected to modified breast con- serving surgery （MBCS）＋latissimus dorsi （LD） flap reconstruction, 41 to skin sparing mastectomy （SSM）＋implant＋LD flap reconstruction, 29 to MBCS＋distal transverse rectus abdominis myocutaneous （DTRAM） flap reconstruction, and 20 to SSM＋DTRAM flap reconstruction. The results showed that out of the 143 patients, there was no graft loss. Minor complications included 4 cases of fat liquefaction, and 6 cases of seratoma, which all resolved after conservative treatment. Five patients had visible protu- berance in the abdomen, but not leading to any gastrointestinal symptoms. The reconstructed breasts all presented good shape. 96.7% of the patients were satisfied with the outcome. The follow-up period var- ied from 6 months to 60 months, and only one patient died from tumor metastasis in the brain. No local recurrence occurred. It was concluded that these two modified pedicled-flap surgeries are readily practi- cal, and aesthetically satisfactory, with high applicability in China. They do not compromise the on- cological outcomes, but also are well-accepted by Chinese patients.

Evaluation of Inferior Pedicle Therapeutic Mammoplasty as a Primary Procedure for Upper Quadrants Early Breast Cancer

Background: The treatment of breast cancer in large breast patients represents a great challenge to both surgical oncologist and radiation oncologist. The aim of this study is to evaluate the outcome of inferior pedicle therapeutic mammoplasty in large-breasted patients with upper quadrants early breast cancer. Methods: Thirty five large-breasted patients with early breast cancer were included in this study. Simultaneous bilateral inferior pedicle therapeutic mammoplasty was performed. Results: The age of the patients is ranged from 36 to 61 (median 46) years and tumour size is ranged from one to three and half cm. The weight of tissue removed is ranged from 350 gm to 780 gm and the tumour safety margins are ranged from three to eight cm. Wound dehiscence was the commonest post operative complications and six patients were affected (17.6%). The cosmetic outcome was excellent in 22 patients (64.5%), nine patients (26.5%) showed good results, two patients (6%) were satisfactory and one patient (3%) showed poor result. The follow up period is ranged from 6 to 42 months with one case (3%) of systemic metastasis. Conclusion: Inferior pedicle therapeutic reduction mammoplasty for upper quadrants early breast cancer in large breasted women is a surgically and oncologically safe procedure, and it carries a satisfactory aesthetic outcome.

Significance of ipsilateral breast tumor recurrence after breast conserving treatment: role of surgical removal

Objective： To analyze the pattern over time （dynamics） of further recurrence and death after ipsilateral breast tumor recurrence （IBTR） in breast cancer patients undergoing breast conserving treatment （BCT）. Methods： A total of 338 evaluable patients experiencing IBTR were extracted from a database of 3,293 patients undergoing BCT. The hazard rates for recurrence and mortality throughout 10 years of follow-up after IBTR were assessed and were compared to the analogous estimates associated to the primary treatment. Results： In a time frame with the time origin at the surgical treatment for IBTR, the hazard rate for further recurrence displays a bimodal pattern （peaks at the second and at the sixth year）. Patients receiving mastectomy for IBTR reveal recurrence and mortality dynamics similar to that of node positive （N＋） patients receiving mastectomy as primary surgery, apart from the first two-three years, when IBTR patients do worse. If the patients with time to IBTR longer than 2.5 years are considered, differences disappear. Conclusions： The recurrence and mortality dynamics following IBTR surgical removal is similar to the corresponding dynamics following primary tumor removal. In particular, patients with time to IBTR in excess of 2.5 years behave like N＋ patients following primary tumor removal. Findings may be suitably explained by assuming that the surgical manoeuvre required by IBTR treatment is able to activate a sudden growing phase for tumor foci most of which, as suggested by the systemic model of breast cancer, would have reached the clinical level according to their own dynamics.

Combined Patients and Medical Related Cosmetic Breast Cancer Outcomes—A Preferred Approach to Outcomes Assessment

Introduction: Reducing positive margins and need for re-excision yet maintaining cosmesis is key in breast cancer surgery. This study describes the evaluation of early outcomes of a combined cosmetic assessment programme following breast conservation surgery (BCS). Methods: An ethically approved prospective study was conducted at Letterkenny University Hospital and a 15-month timeframe was chosen. All consecutive patients undergoing conservative breast surgery with complete local excision, from July 2015 to October 2016, were entered into the study. Patients undergoing mastectomy and reconstruction with either implant or autologous tissue were not included. 41 patients undergoing BCS were analysed. Objective and subjective cosmetic evaluations were carried out. Assessments used were the Breast Cancer Conservative Treatment—cosmetic results [BCCT.core 2.0] Software, a panel of 4 experts in breast surgery and the Breast Cancer Treatment Outcome Scale (BCTOS). Demographic and pathological data, breast excision weight, % breast volume excised (BVE), margin positivity, complications and re-excision were documented. Data was expressed as mean and standard deviation for normally distributed data and medians and inter quartile range for non-normal data. Scores were also dichotomised to excellent/good and fair/poor and results were analysed. Results: 41 patients’ mean age is 55 ± 13 years. Mean breast volume was 768.3 cm3 ± 440;BVE weighed 78.6g ± 42.6 (18.9 - 214.4) and %BVE 11.3% ± 5.2% (5.1 - 23.3). Re-excision rate was 2/41 (4.9%) all for positive margins. 0/41 infections or haematomas occurred. Cosmetic status of 10 - 14 days post surgery was excellent or good by BCCT.core Software 78%, Expert panel 82.9%, BCTOS scale (92.7%), and fair or poor in 22%, 17.1% and 7.3% respectively. Conclusion: This study successfully evaluated objective and subjective cosmetic related outcomes following breast conserving surgery, incorporating both patient and surgeon in these assessments. The encouraging results show that despite low re-excision rates, acceptable cosmetic outcomes were achieved.

Comparison of breast-conserving surgery and mastectomy in early breast cancer using observational data revisited:a propensity score-matched analysis

Recent observational studies showed that breast-conserving surgery(BCS) resulted in superior survival compared to mastectomy in breast cancer patients. This study compared the clinical outcomes of BCS and mastectomy using propensity score(PS)matching analysis, which had advantages over conventional methods in reducing bias. Nonmetastatic breast cancer patients who underwent BCS and mastectomy were matched 1:1 based on their PS. We used the Kaplan-Meier method and Cox-regression model to estimate the treatment effects. A total of 2,866 patients with a median follow-up time of 67 months were included in the original study population. Although the mastectomy cohort(N=1,219) had more advanced disease compared to the BCS cohort(N=1,647), LRFS was similar between the two groups(93.8% vs. 92.4%, P>0.05). BCS(vs. mastectomy) was associated with improved DFS(73.8% vs. 58.7%, P<0.01) and CSS(91% vs. 78.2%, P<0.01) in the original population. In the PS-matched population(N=1,668), clinicopathological features were equally distributed between the two cohorts. BCS(vs. mastectomy) was not associated with improved DFS(70.7% vs. 66.9%, P>0.05) or CSS(87.5% vs. 84.9%, P>0.05). We found that PS methods reduce bias when estimating treatment effects using observational data. BCS and mastectomy show equivalent outcomes in nonmetastatic breast cancer patients.

Multicenter prospective study of magnetic resonance imaging prior to breast-conserving surgery for breast cancer

Background This multicenter prospective study aimed to assess the utility of dynamic enhanced magnetic resonance imaging （MRI） prior to breast-conserving surgery for breast cancer.Methods The research subjects were drawn from patients with primary early resectable breast cancer treated in the breast disease centers of six three-level hospitals in Beijing from 1 January 2010 to 31 December 2012.The participants were allocated to a breast-conserving surgery group （breast-conserving group） or a total mastectomy group （total mastectomy group）.Enhanced MRI was used to measure breast volume,longest diameter of tumor and tumor volume.The correlations between these measurements and those derived from histopathologic findings were assessed.The relationships between the success rate of breast-conserving surgery and MRI-and pathology-based measurement results were statistically analyzed in the breast-conserving group.Results The study included 461 cases in the total mastectomy group and 195 in the breast-conserving group.Allocation to these groups was based on clinical indications and patient preferences.The cut-off for concurrence between MRI-and pathology-based measurements of the longest diameter of tumor was set at 0.3 cm.In the total mastectomy group,the confidence interval for 95％ concurrence of these measurements was 35.41％-44.63％.Correlation coefficients for MRI and histopathology-based measurements of breast volume,tumor volume and tumor volume/breast volume ratio were r=0.861,0.569,and 0.600,respectively （all P ＜0.001）.In the breast-conserving group,with 0.30 cm taken as the cut-off for concurrence,the 95％ confidence interval for MRI and pathology-based measurements of the longest diameter of tumor was 29.98％-44.01％.The subjective and objective success rates for breast-conserving surgery were 100％ and 88.54％,respectively.Conclusions There were significant correlations between dynamic enhanced MRI-and histopathology-based measurements of the longest diameter of breast lesions,breast and tumor volumes,and breast volume/tumor volume ratios.Preoperative MRI examination improves the success rate of breast-conserving surgery.

乳腺癌新辅助化疗联合保乳术患者血清P-selectin与CA15-3、TPA水平的相关性及与预后的关系

目的:探讨乳腺癌新辅助化疗联合保乳手术患者血清可溶性P选择素(P-selectin)水平与糖类抗原15-3(CA15-3)、组织多肽抗原(TPA)水平的相关性,分析以上几种指标的水平与乳腺癌患者预后的关系。方法:选取我院2016年5月至2020年5月收治的97例临床资料齐全的乳腺癌患者进行回顾性队列研究。患者均行新辅助化疗+保乳手术治疗,术后随访2年,根据医嘱定期复查。于治疗前及术后1、6个月复查时采血,检测血清P-selectin、CA15-3、TPA水平。根据随访结果将患者分别纳入预后不良组(n=34)和预后良好组(n=63),比较两组患者血清P-selectin、CA15-3、TPA水平;经Pearson线性相关分析血清P-selectin水平与CA15-3、TPA水平的相关性。比较不同临床分期、分子分型患者的血清P-selectin、CA15-3、TPA水平。结果:预后不良组与预后良好组患者术后1、6个月的血清P-selectin、CA15-3、TPA水平均低于治疗前。预后良好组患者治疗前及术后1、6个月血清P-selectin、CA15-3、TPA水平均低于预后不良组(P<0.05)。Pearson线性相关分析显示,患者治疗前及术后1、6个月的血清P-selectin水平与CA15-3、TPA水平呈正相关(P<0.05)。ⅡA期、ⅡB期乳腺癌患者治疗前及术后1、6个月血清P-selectin、CA15-3、TPA水平低于ⅢA期乳腺癌患者(P<0.05);Luminal A+B型、Her-2过表达型乳腺癌患者术后1、6个月血清P-selectin、CA15-3、TPA水平低于三阴性型乳腺癌患者(P<0.05)。结论:乳腺癌新辅助化疗+保乳手术患者治疗前及术后1、6个月的血清P-selectin、CA15-3、TPA水平增高与远期预后密切相关,且不同临床分期与分子分型患者的血清P-selectin、CA15-3、TPA水平存在差异,临床需密切监测乳腺癌患者以上指标水平的变化,尽早预测预后。

保乳术联合前哨淋巴结活检术对乳腺癌患者生活质量、应激水平及血清肿瘤标志物的影响

目的:探究保乳术联合前哨淋巴结活检术对乳腺癌患者生活质量、应激水平及血清肿瘤标志物的影响。方法:回顾性研究常熟市第五人民医院2017年2月—2021年12月收治的102例乳腺癌患者的病例资料。根据治疗方案将其分为对照组和观察组,其中对照组51例接受保乳术治疗,观察组51例接受保乳术联合前哨淋巴结活检术治疗。比较两组手术指标,生活质量的情况、应激水平血管紧张素Ⅱ(AngⅡ)、肾上腺素(AD)、检测血清肿瘤标志物水平。结果:观察组手术时间短于对照组,术后引流量少于对照组(P<0.05)。两组1年后生活质量评分(总体健康、生理职能、生理功能、活力、躯体疼痛、社会功能、情感职能、精神健康)比较,差异均有统计学意义(P<0.05)。术前0.5 h,两组应激反应相关指标对比,差异均无统计学意义(P>0.05);术后1 d,两组AD、AngⅡ水平均升高(P>0.05),观察组AD、AngⅡ水平均低于对照组(P<0.05)。术前0.5 h,两组血清癌胚抗原(CEA)和糖类抗原153(CA153)水平比较,差异均无统计学意义(P>0.05);术后1 d,两组血清CA153、CEA水平均低于术前0.5 h(P<0.05),观察组CA153、CEA水平均低于对照组(P<0.05)。结论:保乳术联合前哨淋巴结活检术应用于乳腺癌患者治疗中,更有助于缩短手术时间等手术指标,提高患者的生活质量,调节应激反应,且术后短期肿瘤标志物调节水平较低。

乳腺肿瘤整形保乳手术治疗乳腺癌的临床效果研究

目的探究在乳腺癌患者的治疗中乳腺肿瘤整形保乳手术的临床应用效果。方法106例乳腺癌患者,按入院顺序编号分组,奇数者划至对照组,偶数者划至研究组,各53例。对照组以改良根治术治疗,研究组以整形保乳手术治疗。比较两组临床手术指标、术后并发症发生情况、手术前后血清肿瘤标志物水平、乳房美观满意度。结果研究组患者手术时间(129.74±10.65)min、术中失血量(64.29±9.31)ml、切口长度(4.64±1.19)cm、住院时间(4.88±1.10)d均优于对照组的(150.07±10.53)min、(86.71±10.29)ml、(10.48±3.74)cm、(5.92±1.21)d,组间比较统计学差异明显(P<0.05)。研究组并发症发生率5.66%低于对照组的22.64%,组间比较统计学差异明显(P<0.05)。两组术后癌抗原153(CA153)和癌胚抗原(CEA)均低于术前,统计学差异明显(P<0.05)。研究组患者对乳房美观的总满意度为96.23%,高于对照组的81.13%,组间比较统计学差异明显(P<0.05)。结论对于乳腺癌患者的手术治疗来说,乳腺肿瘤整形保乳手术的实施,可以在保证原有治疗效果的基础上,改善临床手术指标,减少术后并发症风险,同时满足患者在乳房美观度方面的要求,由此可见其良好的临床应用价值,因此可以于临床展开大力推广。

前哨淋巴结活检联合保乳术对早期乳腺癌的血清肿瘤标志物水平及创伤后应激障碍的影响

目的探讨前哨淋巴结活检联合保乳术对早期乳腺癌的血清肿瘤标志物水平及创伤后应激障碍(PTSD)的影响。方法选取2023年1月至10月于萍乡市人民医院就诊的80例早期乳腺癌患者作为研究对象,按照随机数字表法将其分为研究组与对照组,每组各40例。对照组患者行乳腺癌改良根治术,研究组患者采用前哨淋巴结活检联合保乳术。比较两组的围手术期指标、血清肿瘤标志物水平、PTSD评分、并发症总发生率,观察并统计观察组的前哨淋巴结活检情况。结果研究组的手术时间长于对照组,术中出血量、术后引流量均少于对照组,住院时间短于对照组,差异有统计学意义(P<0.05)。术后1周,研究组的癌胚抗原(CEA)、糖类抗原125(CA125)、糖类抗原15-3(CA15-3)水平均低于对照组,差异有统计学意义(P<0.05)。术后1周,研究组的各项PTSD评分均低于对照组,差异有统计学意义(P<0.05)。研究组的并发症总发生率低于对照组,差异有统计学意义(P<0.05)。观察组行前哨淋巴结活检,检出率为97.50%(39/40),每例患者中发现1~3枚前哨淋巴结,共检出前哨淋巴结46枚,经HE染色和连续切片可见前哨淋巴结阳性率为42.50%(17/40),伴有微转移3例。结论前哨淋巴结活检术联合保乳术在早期乳腺癌患者治疗中获得显著效果,有助于评估腋窝淋巴结情况,利于准确判断患者是否需要开展腋窝淋巴结清扫术,降低血清肿瘤标志物水平,且术后PTSD水平较轻,安全可靠,值得推广应用。

保乳术联合乳腔镜腋窝淋巴结清扫术治疗早期乳腺癌的效果

目的探讨保乳术联合乳腔镜腋窝淋巴结清扫术治疗早期乳腺癌的效果。方法选取2021年9月至2022年12月淄博市妇幼保健院乳腺甲状腺外科收治的66例早期乳腺癌患者作为研究对象,按照单双号分组法分为对照组和观察组,每组各33例。对照组行保乳术联合常规腋窝淋巴结清扫术,观察组行保乳术联合乳腔镜腋窝淋巴结清扫术。比较两组肩关节活动度、并发症总发生率、引流管留置时间及术后引流量。结果术后3个月,两组肩关节活动度均小于术前,但观察组大于对照组(P<0.05)。观察组并发症总发生率低于对照组(P<0.05)。观察组引流管留置时间短于对照组,术后引流量少于对照组(P<0.05)。结论保乳术联合乳腔镜腋窝淋巴结清扫术治疗早期乳腺癌,可减少对肩关节活动度的影响,降低并发症发生率,缩短引流管留置时间,减少术后引流量,值得临床推广。