Recurrent ovarian endometrioma after conservative surgery:A retrospective study

Objective:To study the prevalence and associated factors of recurrent ovarian endometrioma after ovarian cystectomy.Methods:This retrospective study analyzed 303 patients who underwent cystectomy for ovarian endometrioma and had at least a 2-year follow-up at Srinagarind Hospital from January 2013 to December 2018.The patients were divided into the recurrent and nonrecurrent groups according to the findings from postoperative transvaginal ultrasonography 6 months after undergoing surgery.Nineteen factors were collected for risk evaluation.The prevalence of recurrent ovarian endometrioma and its 95%confident interval(CI)were calculated.Univariate and multivariable logistic regression analyses were performed to determine the association between factors and recurrence.Results:Recurrent ovarian endometrioma occurred in 33%(95%CI 27.7%-38.3%)patients.The median duration of followup was 36 months.during the median follow-up period of 36 months.Preoperative history of parity,preoperative infertility history,endometriosis surgery,moderate to severe dysmenorrhea,dyspareunia,intraoperative stage 4 according to revised American Society for Reproductive Medicine classification,presence of adenomyosis,and postoperative pain relief were associated factors based on univariate analysis.In contrast,infertility[odds ratio(OR)2.22,95%CI 1.14-4.33],moderate to severe dysmenorrhea(OR 2.13,95%CI 1.09-4.15),and postoperative pelvic pain relief(OR 0.22,95%CI 0.12-0.42)were independently associated factors based on multivariable logistic regression analysis.Conclusions:In our setting,preoperative infertility history and moderate to severe dysmenorrhea were associated with a higher recurrent ovarian endometrioma risk.In contrast,postoperative pain relief was significantly associated with lower recurrence risk.

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.

Conservative laparoscopic surgery of adnex torsion for fertility preservation

Objectives:To evaluate the safety and efficacy of conservative laparoscopic surgery for adnexal torsion and the feasibility of secondary operation.Methods:This is a retrospective study that consists of 17 patients with clinically diagnosed adnexal torsion who have a desire for pregnancy in the future.We performed conservative laparoscopic adnexal detorsion operations from January 2014 to June 2016 in Sir Run Run Shaw Hospital.The collected data,including age,onset time,maximum diameter of adnexal lesion,local blood flow signal,torsion degree,and recovery of local blood supply after detorsions,were analyzed.The blood flow of the lesion side,the antral follicles development,the basal endocrine hormone levels and the menstrual cycle were examined one-month and three-month post operation.Future fertility was investigated postoperatively.Results:All cases had no obvious clinical postoperative complications.There were no significant changes on menstrual cycle and ovarian function during the follow-up period.Conclusions:Adnexal torsion in young patients should be carefully treated and fertility reservation should be thoroughly considered.The decision to remove adnexa needs careful consideration.Conservative laparoscopic surgery is safe and does not increase the occurrence of serious complications.There is a higher possibility of a long delay between surgery and onset necrosis,but this is not always the case.Even if there is adnex thromboembolic infarction it does not result in serious complications such as pulmonary infarction.Conservative laparoscopic surgery can be performed first unless the clinician is certain it is already necrotic.We should do our best to reserve patients’fertility as much as possible.If necessary,a secondary surgery can be performed.

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.

Breast Conserving Surgery: Has the Standard of Care Enhanced Outcomes for Patients?

Breast Conserving Surgery (BCS) is a rapidly emerging field increasingly adopted to facilitate breast conservation and preserve breast aesthetics. Since the publication of the Randomized Controlled Trials (RCTs) of Breast Conserving Surgery versus mastectomy in early breast cancer, the adoption of BCS for breast cancer patients’ surgical management has been comprehensive. A computerized bibliographic search was performed on PubMed/MEDLINE, Embase, Google Scholar and Cochrane library databases. This article aims to perform a thorough review of new data regarding invasive cancer and margins while evaluating patient outcomes related to BCS after neoadjuvant chemotherapy focusing on margins, imaging evaluation, the extent of resection, and local regional recurrence outcomes. The growth pattern and biopsy of Ductal Carcinoma In Situ (DCIS) differ from invasive cancer, impacting margins. It is essential to understand how the Society of Surgical Oncology (SSO) DCIS margin guideline has influenced practice. Early breast cancer surgical management should be unique to each patient, driven by evidence-based medicine, and focused on specific clinical, histological, and molecular characteristics of the tumor. Conclusion: The current management for early breast cancer should be tailored and evidence-based to each patient based on the clinical, histological and molecular characteristics of the tumor. Presumably, the standard of care in BCS has enhanced the outcomes for this patient population. This review made by peers will help surgeons to stay up to date with the current literature and help them manage breast cancer while improving multiple clinical parameters such as Disease-Free Survival (DFS), Recurrence-Free Survival (RFS) and most importantly Overall Survival (OS).

Latissimus Dorsi Mini-Flap as a Volume Replacement Technique after Partial Mastectomy for Breast Cancer in the Upper and Central Breast Quadrants: A Single Center Experience

Background: The latissimus dorsi (LD) muscle flap plays an essential role in breast reconstruction after partial mastectomy for cancer because of its stability and versatility. We evaluated both oncologic and aesthetic outcomes in addition to the related complications of this flap as an adjunct to breast conserving surgery in the management of breast cancer patients. Methods: All patients underwent a one-stage procedure with immediate reconstruction through two-steps operation;wider local excision utilizing oncoplastic principles and mini flap harvest & volume replacement. Results: The study included 34 cases with early breast cancer;30 patients had partial breast resection and defect refilling by LD mini-flap, three patients underwent mastectomy and one patient underwent extended LDF. The mean defect volume was (212.63 cm3 ± 59.57) cm3, while the mean flap volume was (218.27 cm3 ± 53.64 cm3). Patient self-evaluation of the cosmetic outcome was excellent in 20%, good in 60% and satisfactory in 20% of patients. Panel evaluation according to Harvard scale showed excellent in 36.7%, good in 36.7%, fair in 26.7% of patients. The median hospital stay was 4 days. The postoperative complications included wound gap in 4 patients (13.3%), postoperative donor site seroma in 16 patients (53.3%). No flap loss or necrosis, no affection on arm or shoulder mobility occurred. Lastly, no tumor recurrence till now. Conclusion: Latissimus dorsi mini-flap can achieve adequate cosmetic and oncologic outcomes with a low incidence of complications in patients with early stage (I/II) breast cancer and small to medium sized breasts.

Current aspects of therapeutic reduction mammaplasty for immediate early breast cancer management: An update

Breast-conservation surgery(BCS) is established as a safe surgical treatment for most patients with early breast cancer. Recently, advances in oncoplastic techniques are capable of preserving the breast form and quality of life. Although most BCS defects can be managed with primary closure, the aesthetic outcome may be unpredictable. Among technical options, therapeutic reduction mammaplasty(TRM) remains a useful procedure since the BCS defect can be repaired and the preoperative appearance can be improved, resulting in more proportional breasts. As a consequence of rich breast tissue vascularization, the greater part of reduction techniques have based their planning on preserving the pedicle of the nipple-areola complex after tumor removal. Reliable circulation and improvement of a conical shape to the breast are commonly described in TRM reconstructions. With an immediate approach, the surgical process is smooth since both procedures can be carried out in one operative setting. Additionally,it permits wider excision of the tumor, with a superior mean volume of the specimen and potentially reduces the incidence of margin involvement. Regardless of the fact that there is no consensus concerning the best TRM technique, the criteria is determined by the surgeon's experience, the extent/location of glandular tissue resection and the size of the defect in relation to the size of the remaining breast. The main advantages of the technique utilized should include reproducibility, low interference with the oncological treatment and long-term results. The success of the procedure depends on patient selection, coordinated planning and careful intra-operative management.

Accelerated partial breast irradiation:Current evidence and future developments

Whole breast irradiation after breast-conserving surgery for early breast cancer has become one of the standard treatment modes for breast cancer and yields the same effect as radical surgery.Accelerated partial breast irradiation(APBI)as a substitute for whole breast irradiation for patients with early breast cancer is a hot spot in clinical research.APBI is characterised by simple high-dose local irradiation of the tumour bed in a short time,thus improving convenience for patients and saving costs.The implementation methods of APBI mainly include brachytherapy,external beam radiation therapy,and intraoperative radiotherapy.This review provides an overview of the clinical effects and adverse reactions of the main technologies of APBI and discusses the prospects for the future development of APBI.

Surgical management of the diabetic foot:The current evidence

The prevalence of diabetes mellitus and its associated complications,particularly diabetic foot pathologies,poses significant healthcare challenges and economic burdens globally.This review synthesises current evidence on the surgical management of the diabetic foot,focusing on the interplay between neuropathy,ischemia,and infection that commonly culminates in ulcers,infections,and,in severe cases,amputations.The escalating incidence of diabetes mellitus underscores the urgency for effective management strategies,as diabetic foot complications are a leading cause of hospital admissions among diabetic patients,significantly impacting morbidity and mortality rates.This review explores the pathophysiological mechanisms underlying diabetic foot complications and further examines diabetic foot ulcers,infections,and skeletal pathologies such as Charcot arthropathy,emphasising the critical role of early diagnosis,comprehensive management strategies,and interdisciplinary care in mitigating adverse outcomes.In addressing surgical interventions,this review evaluates conservative surgeries,amputations,and reconstructive procedures,highlighting the importance of tailored approaches based on individual patient profiles and the specific characteristics of foot pathologies.The integration of advanced diagnostic tools,novel surgical techniques,and postoperative care,including offloading and infection control,are discussed in the context of optimising healing and preserving limb function.

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.