Loco-regional recurrence after skin and nipple-sparing mastectomy and immediate breast reconstruction using free flap autologous tissue in a single institution

BackgroundImmediate autologous tissue breast reconstruction after skin- and nipple-sparing mastectomy, is becoming increasingly popular, while the benefits are evident, the concern is in leaving breast tissue under the skin envelope, which could potentially lead to a higher chance of recurrence. We aim to determine the incidence and study the management of loco-regional recurrence (LR) of breast cancer following immediate autologous free flap reconstruction (AFFR) from a 10-year database at a single tertiary breast unit.MethodsThis is a retrospective analysis of a prospectively maintained database of consecutive patients who underwent AFFR between July 2008 and December 2018. All patients undergoing delayed reconstruction and risk-reducing surgery were excluded, leaving a total of 216 patients. Statistical analysis was performed to determine significance in the prediction of LR. Management and outcome of the LR was also studied.ResultsLR was found in 7/216 cases (3.25%). The median age at surgery for patients with LR, was 45 (range 31–54). Median time to recurrence was 54 months (7–79 months). Three patients presented with self-detected lesions. In all, 6/7 patients were ER/PR positive, 2/7 were HER2 + at recurrence, and 1/7 was triple negative.All patients underwent surgical excision for the LR followed by radiotherapy, either chemotherapy (n-5) and/or hormone therapy (n-2). No patients have developed further LR.Because of low numbers of recurrences, no statistical significance was observed for factors causing recurrence.ConclusionThe low LR we report demonstrates that immediate AFFR is oncologically safe. Timely recognition through post-reconstruction patient education and appropriate management results in good outcomes.     

Management of the axilla following neoadjuvant chemotherapy for breast cancer- A change in practice

ObjectivesChemotherapy in the neo adjuvant setting has allowed downsizing of breast tumours thus allowing patients to benefit from breast conservation surgery. The effect of neoadjuvant chemotherapy (NAC) has also been observed in the axilla but most units are still treating the axilla with axillary lymph node dissection (ALND).Materials and methodsA prospective database of breast cancer patients receiving NAC between 2007 and 2016 at a single breast unit was reviewed. The management of the axilla and outcomes was studied.Results165 patients received NAC, 123 (74.5%) were clinically/radiologically node positive and 42 were negative. Median age was 50 years. 26.7% had triple negative disease and 34.5% were HER2 positive. 56/123 (45.5%) patients with positive nodes at the outset responded completely to NAC. 40 patients with positive nodes pre-NAC had post NAC SLNB with 37 requiring adjuvant radiotherapy only. 83/123 went directly to ALND post NAC and of these 27 were node negative and therefore may be considered to have had an unnecessary ALND. Overall mortality was 20.6% (34), local recurrence in the breast or mastectomy scar was 3.6% (6) but there was no recurrence in the axilla (0/165) with a median follow up of 67 months.ConclusionThere is no clear evidence for management of the axilla post NAC. We have used best available evidence to change our practice over the years and our results should encourage others to de-escalate treatment of the axilla in line with the recently published multidisciplinary guidance on axillary surgery following neoadjuvant chemotherapy.     

冠心病合并高血压患者冠脉病变特点分析

目的:探讨冠心病合并高血压冠脉病变的特点.方法:100例经冠状动脉造影确诊的冠心病患者,其中男性65例,女性35例,平均年龄58.1±10.1岁.外周肱动脉压力测定收缩压(SBP)和舒张压(DBP).冠状动脉病变的严重程度用冠状动脉病变的血管支数及冠状动脉病变积分(coronary artery score,CSS)表示.结果:冠心病合并高血压组单支冠状动脉病变发生率明显低于(28% vs 56%)未合并高血压组 (P＜0.001);冠状动脉2支和3支血管病变的患病率显著高于(72% vs 44%)未合并高血压组(P＜0.001);冠状动脉病变积分显著高于未合并高血压组(P＜0.05).结论:冠心病合并高血压患者冠脉病变以多支病变、c型病变居多,提示对这部分患者强化降压治疗对改善预后具有重要价值.