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5. Spontaneous hematoma of the breast: What can we learn about the management of blunt force trauma of the female breast and spontaneous rectus sheath hematoma?

Author

Louise Alder, Alexandra Kenchington, and Avi Agrawal

Subjects
Hematoma, medicine.medical_specialty, business.industry, Rectus Abdominis, Breast Neoplasms, Wounds, Nonpenetrating, medicine.disease, Surgery, Blunt, Muscular Diseases, Oncology, Internal Medicine, medicine, Humans, Female, Spontaneous hematoma, Rectus sheath hematoma, business
Published
2020
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6. Association between preadmission frailty and care level at discharge in older adults undergoing emergency laparotomy

Author

B Carter, J Law, J Hewitt, K L Parmar, J M Boyle, P Casey, I Maitra, L Pearce, S J Moug, Bryony Ross, Julia Oleksiewicz, Nicola Fearnhead, Christopher Jump, Jemma Boyle, Alex Shaw, Jonathan Barker, Jane Hughes, Jonathan Randall, Isileli Tonga, James Kynaston, Matthew Boal, Nicola Eardley, Elizabeth Kane, Harriet Reader, Sunanda Roy Mahapatra, Michael Garner-Jones, Jessica Juliana Tan, Said Mohamed, Rina George, Ed Whiteman, Kamran Malik, Christopher J Smart, Monica Bogdan, Madhu Parna Chaudhury, Videha Sharma, Daren Subar, Panna Patel, Sok-Moi Chok, Evelyn Lim, Vedamurthy Adhiyaman, Glesni Davies, Ellen Ross, Rudra Maitra, Colin W Steele, Campbell Roxburgh, Shelly Griffiths, Natalie S Blencowe, Emily N Kirkham, John S Abraham, Kirsty Griffiths, Yasser Abdulaal, Muhammad Rafaih Iqbal, Munir Tarazi, James Hill, Azam Khan, Ian Farrell, Gemma Conn, Jugal Patel, Hyder Reddy, Janahan Sarveswaran, Lakshmanan Arunachalam, Afaq Malik, Luca Ponchietti, Krystian Pawelec, Yan Mei Goh, Parveen Vitish-Sharma, Ahmed Saad, Edward Smyth, Amy Crees, Louise Merker, Nahida Bashir, Gethin Williams, Jennifer Hayes, Kelly Walters, Rhiannon Harries, Rahulpreet Singh, Nikola A Henderson, Francesco M Polignano, Ben Knight, Louise Alder, Alexandra Kenchington, Yan Li Goh, Ilaria Dicurzio, Ewen Griffiths, Ahmed Alani, Katrina Knight, Patrick MacGoey, Guat Shi Ng, Naomi Mackenzie, Ishaan Maitra, Susan Moug, Kelly Ong, Daniel McGrath, Emanuele Gammeri, Guillame Lafaurie, Gemma Faulkner, Gabriele Di Benedetto, Julia McGovern, Bharathi Subramanian, Sunil Kumar Narang, Jennifer Nowers, Neil J Smart, Ian R Daniels, Massimo Varcada, Tanzeela Gala, Julie Cornish, Zoe Barber, Stephen O'Neill, Richard McGregor, Andrew G Robertson, Simon Paterson-Brown, Thomas Raymond, Mohamed A Thaha, William J English, Cillian T Forde, Heidi Paine, Alpa Morawala, Ravindra Date, Patrick Casey, Thomas Bolton, Xuan Gleaves, Joshua Fasuyi, Sanja Durakovic, Matt Dunstan, Sophie Allen, Angela Riga, Jonathan Epstein, Lyndsay Pearce, Emily Gaines, Anthony Howe, Halima Choonara, Ffion Dewi, Joanne Bennett, Emile King, Kathryn McCarthy, Greg Taylor, Dean Harris, Hari Nageswaran, Amy Stimpson, Kamran Siddiqui, Lay In Lim, Christopher Ray, Laura Smith, Gillian McColl, Mohammed Rahman, Aaron Kler, Abhi Sharma, Kat Parmar, Neil Patel, Perry Crofts, Claudio Baldari, Rhys Thomas, Michael Stechman, Roland Aldridge, James O'Kelly, Graeme Wilson, Nicholas Gallegos, Ramya Kalaiselvan, Rajasundaram Rajaganeshan, Aliya Mackenzie, Prashant Naik, Kaushiki Singh, Harinath Gandraspulli, Jeremy Wilson, Kate Hancorn, Amir Khawaja, Felix Nicholas, Thomas Marks, Cameron Abbott, and Susan Chandler

Subjects
Male, medicine.medical_specialty, Frail Elderly, medicine.medical_treatment, Decision Making, MEDLINE, Comorbidity, 030230 surgery, Risk Assessment, Preoperative care, 03 medical and health sciences, Patient Admission, 0302 clinical medicine, Risk Factors, Laparotomy, medicine, Humans, Prospective Studies, 030212 general & internal medicine, Prospective cohort study, Geriatric Assessment, Aged, Aged, 80 and over, Frailty, business.industry, Odds ratio, Length of Stay, medicine.disease, Patient Discharge, Emergency medicine, Care level, Female, Surgery, Emergencies, business, Follow-Up Studies, Abdominal surgery
Abstract

Older adults undergoing emergency abdominal surgery have significantly poorer outcomes than younger adults. For those who survive, the level of care required on discharge from hospital is unknown and such information could guide decision-making. The ELF (Emergency Laparotomy and Frailty) study aimed to determine whether preoperative frailty in older adults was associated with increased dependence at the time of discharge.The ELF study was a UK-wide multicentre prospective cohort study of older patients (65 years or more) undergoing emergency laparotomy during March and June 2017. The objective was to establish whether preoperative frailty was associated with increased care level at discharge compared with preoperative care level. The analysis used a multilevel logistic regression adjusted for preadmission frailty, patient age, sex and care level.A total of 934 patients were included from 49 hospitals. Mean(s.d.) age was 76·2(6·8) years, with 57·6 per cent women; 20·2 per cent were frail. Some 37·4 per cent of older adults had an increased care level at discharge. Increasing frailty was associated with increased discharge care level, with greater predictive power than age. The adjusted odds ratio for an increase in care level was 4·48 (95 per cent c.i. 2·03 to 9·91) for apparently vulnerable patients (Clinical Frailty Score (CFS) 4), 5·94 (2·54 to 13·90) for those mildly frail (CFS 5) and 7·88 (2·97 to 20·79) for those moderately or severely frail (CFS 6 or 7), compared with patients who were fit.Over 37 per cent of older adults undergoing emergency laparotomy required increased care at discharge. Frailty scoring was a significant predictor, and should be integrated into all acute surgical units to aid shared decision-making and discharge planning.Los adultos mayores sometidos a cirugía abdominal de urgencia tienen resultados significativamente peores que los adultos jóvenes. Para aquellos pacientes que sobreviven, el nivel de atención que requieren tras el alta hospitalaria se desconoce y esta información podría servir de guía en la toma de decisiones. El estudio ELF (Emergency Laparotomy and Frailty) tenía como objetivo determinar si la fragilidad preoperatoria en adultos mayores se asociaba con un aumento de la dependencia en el momento del alta. MÉTODOS: El estudio ELF era un estudio multicéntrico extenso efectuado en el Reino Unido (n = 49) que incluyó una cohorte prospectiva de 934 pacientes mayores ( 65 años) sometidos a laparotomía de urgencia durante marzo-junio de 2017. El objetivo fue establecer si la fragilidad preoperatoria aumentaba el nivel de asistencia en el momento del alta en comparación con el nivel de asistencia preoperatorio. Para el análisis se utilizó una regresión logística multinivel ajustada a características previas al ingreso: fragilidad, edad del paciente, género, y nivel de asistencia.La edad media de los pacientes fue 76,2 años (DE = 6,83), con un 57% de mujeres, un 20,2% de pacientes frágiles y un 37,4% de adultos mayores que presentaron un aumento en el nivel de asistencia en el momento del alta. Un aumento de la fragilidad se asoció con un incremento en el nivel de asistencia en el momento del alta (y mayor poder predictivo que la edad). La razón de oportunidades (odds ratio, OR) ajustada por el aumento del nivel de asistencia fue 4,48 (i.c. del 95% 2,03-9,91) para pacientes aparentemente vulnerables (Clinical Frailty Scale, CFS 4); 5,94 (i.c. del 95% 2,54-13,90) para aquellos ligeramente frágiles (CFS 5); y 7,88 (i.c. del 95% 2,97-20,79) para aquellos con fragilidad moderada o grave (CFS 6 and 7) en comparación con pacientes en buenas condiciones. CONCLUSIÓN: Este es el primer estudio que documenta que más del 37% de adultos mayores sometidos a laparotomía de urgencia precisaron un aumento en el nivel de asistencia en el momento del alta. La evaluación de la fragilidad debería integrarse en todas las unidades quirúrgicas de agudos para ayudar a compartir la toma de decisiones y los planes de tratamiento.

Published
2020
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7. Sarcopenia and Myosteatosis Predict Adverse Outcomes After Emergency Laparotomy: A Multi-center Observational Cohort Study

Author

Katherine Pearson, Denny Z. H. Levett, Thakshyanee Bhuvanakrishna, David P. Berry, Rachel Carten, Timothy J. Underwood, Simon Toh, Jenny McLachlan, Zeeshan Khawaja, Frances Howse, Kate Nicholls, John N. Primrose, Gui Han Lee, Richard Booth, Anastasia Benjafield, Marjolein A P Ligthart, Brendan Moran, Peter May-Miller, Duncan Chambler, Nicholas Baylem, Heather Davis, Eva Sorensen, James Ward, Michael Terry, Victoria Morrison Jones, James P. Byrne, Samantha Body, Paul Robinson, Camilla Hickish, Stuart Mercer, Noori Suhail, Jack Broadhurst, Mark R Edwards, Philip H. Pucher, Amanda Bond, Benjamin M Stubbs, Louise Alder, Saqib Rahman, Michael P.W. Grocott, Alex H. Mirnezami, Steven W.M. Olde Damink, Nathan Curtis, Malcolm A. West, Nader K. Francis, Paul Froggatt, Alexios Tzivanakis, Prashan Kangesu, Clizia Airofarulla, Chui Lee, Jieyun Lee, RS: NUTRIM - R2 - Liver and digestive health, Surgery, and MUMC+: MA Heelkunde (9)

Subjects
Male, medicine.medical_specialty, Sarcopenia, Adverse outcomes, medicine.medical_treatment, Lumbar vertebrae, MUSCLE RADIATION ATTENUATION, Cohort Studies, MORBIDITY, myosteatosis, Internal medicine, Laparotomy, ABDOMINAL-SURGERY, Medicine, Humans, COMPUTED-TOMOGRAPHY, Multi centre, Muscle, Skeletal, ELDERLY-PATIENTS, FRAILTY, emergency, business.industry, MORTALITY, Mortality rate, Cancer, medicine.disease, SOLID TUMORS, PREVALENCE, medicine.anatomical_structure, Surgery, Female, DEPLETION, business, Tomography, X-Ray Computed, Cohort study
Abstract

Objective: To determine the relationship between body composition (BC), specifically low skeletal muscle mass (sarcopenia) and poor muscle quality (myosteatosis) and outcomes in emergency laparotomy patients. Background: Emergency laparotomy has one of the highest morbidity and mortality rates of all surgical interventions. BC objectively identifies patients at risk of adverse outcomes in elective cancer cohorts, however evidence is lacking in emergency surgery. Methods: An observational cohort study of patients undergoing emergency laparotomy at ten English hospitals was performed. BC analyses were performed at the third lumbar vertebrae level using pre-operative CT images to quantify skeletal muscle index (SMI) and skeletal muscle radiation attenuation (SM-RA). Sex-specific SMI and SM-RA were determined, with the lower tertile splits defining sarcopenia (low SMI) and myosteatosis (low SM-RA). Accuracy of mortality risk prediction, incorporating SMI and SM-RA variables into risk models was assessed with regression modelling. Results: Six hundred and ten patients were included. Sarcopenia and myosteatosis were both associated with increased risk of morbidity (52.1% vs. 45.1%, p = 0.028; 57.5% vs. 42.6%, p = 0.014), 30-day (9.5% vs. 3.6%, p = 0.010; 14.9% vs. 3.4%, p < 0.001), and 1-year mortality (27.4% vs. 11.5%, p < 0.001; 29.7% vs.12.5%, p < 0.001). Risk-adjusted 30-day mortality was significantly increased by sarcopenia (OR 2.56 (95%CI 1.12-5.84), p = 0.026) and myosteatosis (OR 4.26 (2.01-9.06), p < 0.001), similarly at 1-year (OR 2.66 (95%CI 1.57-4.52), p < 0.001; OR 2.08 (95%CI 1.26-3.41), p = 0.004). BC data increased discrimination of an existing mortality risk-prediction model (AUC 0.838, 95%CI 0.835-0.84). Conclusion: Sarcopenia and myosteatosis are associated with increased adverse outcomes in emergency laparotomy patients.

Published
2021

10. Therapeutic mammaplasty is a safe and effective alternative to mastectomy with or without immediate breast reconstruction

Author

S Potter, A Trickey, T Rattay, R L O'Connell, R Dave, E Baker, L Whisker, J Skillman, M D Gardiner, R D Macmillan, C Holcombe, Nicola L P Barnes, Jane Blazeby, Elizabeth Conroy, Rajiv V Dave, Matthew D Gardiner, Adrian Harnett, Chris Holcombe, Shelley Potter, Tim Rattay, Joanna Skillman, Paula Williamson, Rajgopal Achuthan, Shweta Aggarwal, Elizabeth Baker, Naren Basu, Lisa Brock, Patricia Fairbrother, Charlotte Ives, Abhilash Jain, Baek Kim, R Douglas Macmillan, John Murphy, Dennis Remoundos, Richard Sutton, Adam Trickey, Philip Turton, Kathryn Williams, Alain Curnier, Amir Tadros, Ivan Depasquale, Mairi Fuller, Roger Bourne, Steven Heys, Ishrak Hamo, Fatima Aloraifi, Laura Fopp, Radhika Bali, Sarah Bache, Sarah L Benyon, Michael S Irwin, Amit Agrawal, Charles M Malata, Claire Murphy, Adam Misky, Dennis Wayne Chicken, Nassreen Abdullah, Arnold D K Hill, Carolyn Cullinane, Gareth Irwin, Stuart A McIntosh, Sigi Refsum, Samantha Sloan, Peter Mallon, Chiara Sirianni, Ilyas Khattak, Geerthan Nagachandra, Pasupathy Kiruparan, Debasish Debanth, Simon Davey, Terry-Ann Curran, Matilda Svenning, Sasirekha Govindarajulu, Zenon Rayter, Rachel Ainsworth, Simon Cawthorn, Ajay Sahu, Sherif Wilson, Elena Prousskaia, Antonello Accurso, Nicola Rocco, Rosa Di Micco, Gennaro Limite, Raffaele Ceccarino, Raffaele Liccardo, Guido Coco, Metin Nizamoglu, Mary Morgan, Venkat Ramakrishnan, Giuseppe Catanuto, Alex Wilkins, Penelope McManus, Peter Kneeshaw, Kartikae Grover, Tapan Mahapatra, Brendan Wooler, Bilal Elahi, Naila Ihsan, Alexandra Bucknor, Dimitris Reissis, Judith Hunter, Simon Wood, Navid Jallali, Francis P Henry, Liaquat S Verjee, Jason Lee, Shazia M Khan, Iman Azmy, Julia Massey, Ciaran Hollywood, Michael Oluwajana, Sonia Bathla, Joanna Seward, Claudia Harding-MacKean, Risha Lane, Kothandaraman Murali, Bashishta Biswas, Pawel Trapszo, Seema Seetharam, Katy Kennedy, Louise Alder, Tomasz Graja, Khalid Amin, Jalal Kokan, Chandeena Roshanlall, Emma Gill, Dhananjay Kulkarni, J M Dixon, Oliver Young, Talha Saleem, M Biddle, Marie Kearns, Eva Weiler-Mithoff, Ben Chew, Andy Malyon, John Scott, David McGill, Iain Mackay, Salena Bains, Sara Barrows, Simon Pilgrim, Sheila Shokuhi, Kelly Lambert, Frances Kenny, Kalliope Valassiadou, Monika Kaushik, Jaroslaw Krupa, Dimitris Dragoumis, Pavlos Lampropoulos, Sarah Moss, Haitham Khalil, Anwar Haq, Balapathiran Balasubramanian, Petros Charalampoudis, Hisham Hamed, Ashutosh Kothari, Tibor Kovacs, Michael Douek, Iftikhar Mehmood, Biswajit Ray, Matthew Adelekan, Laura Humphreys, Salim Tayeh, Christina Choy, Laila Parvanta, Silvia Michieletto, Tania Saibene, James O'Brien, Sue Down, Sarah Downey, Jerome Pereira, A S Sami, Anzors Gvaramadze, Jibril A Jibril, Dinesh Thekkinkattil, S Udayasankar, Saira Khawaja, Yousef Shariaha, Simon Holt, Ruth James, Hirah Rizki, Katharine Kirkpatrick, Duraisamy Ravichandran, Deepak Shrestha, Ellora Barua, Deepika Akolekar, Ahmed Hamad, Eleftheria Kleidi, Susan Hignett, Vanessa Pope, Salma Naseem, Jennifer Isherwood, Rachel Soulsby, Amanda Taylor, Kian Chin, Dai Nguyen, Francesca Guest, Amanda Thorne, Valentina Lefemine, Chris Kirchhoff, Declan C Murphy, Michelle Lo, Ruth Harcourt, Simon J Pain, Maged I Hussien, Katalin Zechmeister, E M Sassoon, Andrea Figus, Richard M Haywood, Rozina Ali, Susanna Alexander, Konstantinos Geropantas, Daniel Epurescu, Rebecca Lewis, Oladapo Fafemi, Jasdeep Gahir, Tasha Gandamihardja, Jennett Kelsall, Nazli Muhibullah, Charlene Otieno, Fayyaz Mazari, Marta Dauria, Lisa Whisker, Douglas Macmillan, Eleanor Gutteridge, Tuabin Rasheed, Hazem Khout, Kristjan Asgeirsson, Stephen McCulley, Maria Donatella Mariniello, Manuela Roncella, Matteo Ghilli, Livio Colizzi, Elena Rossetti, Lo Russo Marzia, Loredana Fustaino, Alessandro Quattrini Li, Kate L Harvey, Rebecca Windle, Dionysios Dennis Remoundos, Pankaj Roy, Gael MacLean, Asha Adwani, Elena Popa, Steven Goh, Geeta Shetty, Sarah Clark, Lorenzo Bernaudo, Avi Agrawal, Lucy Mansfield, Sally Tebbal, Ashraf Patel, Veronica Grassi, Ojas Pujji, Kathryn Hamnett, Emily Granger, Michael Durbar, Panagiotis Pikoulas, Clare Garnsey, Philip Walker, Angela J Vollermere, Ioannis Michalakis, Robin Jones, Mina Youssef, Mohammad Masood, Julie Dunn, Sisse Olsen, Douglas Ferguson, Rachel Tillett, Anna Allan, Alex Woollard, Rebecca Canny, Alexander Woollard, Afshin Mosahebi, Stephen Hamilton, Jagdeep Chana, Nilesh Sojitra, Ibby Younis, Dick Rainsbury, Natalie Chand, Vasileios Kalles, Anne Stebbing, Kevin Harris, Siobhan Laws, Anne Tansley, Geraldine Mitchell, Emma de Sousa, Julia Henderson, Mysore Chandrashekar, Bernadette Pereira, Chloe Constantinou, Dalia Elfadl, Foivos Irakleidis, Izaro Hernan, Miriam Byrne, Rachel O'Connell, Jennifer Rusby, Peter Barry, Katerine Krupa, William Allum, Fiona MacNeill, Nicola Roche, Gerald Gui, Kelvin Ramsey, Paul Harris, Stuart James, Jamie McIntosh, Nicola Laurence, Louise MacLennan, Robert Milligan, Henry Cain, Adam Critchley, Joe O'Donoghue, Loraine Kalra, Nick Collis, Gina Weston-Petrides, Roanne Fiddes, Victoria Brown, Anna Aertssen, Diana Slade-Sharman, Mansoor Khan, Caroline McGuiness, Vittoria Amorosi, Santanelli di Pompeo Fabio, Georgios Exarchos, Natasha Jiwa, Jennifer Hu, Serena Ledwidge, Laura Johnson, Anthony Peel, Naseem Dhooma, Eric Farrell, Liam Devane, Ruth Tevlin, Enda McDermott, Ruth Prichard, Denis Evoy, Jane Rothwell, James Geraghty, Colin Morrison, Catriona Lawlor, Fiona Langlands, Lauren Taylor, Raj Achuthan, Kieran Horgan, Shireen Mckenzie, Brian Hogan, Mark Lansdown, Channegowda Navin, Liz Sherwin, Caroline Mortimer, Neeraj Garg, Rahma Adam, Tahera Arif, Zbigniew Kryjak, Deedar Ali, Ravi Sowdi, Elena Fage, Senthurun Mylvaganam, Pilar Matey, Raghavan Vidya, Tapan Sircar, Oubida Asaad, Pud Bhaskar, Matei Dordea, Ada Chrysafi, Damian McCartan, Rajiv Dave, Rachel Foster, Rebecca Wilson, Sylvia Okwemba, Yousef Majeed, Ciara O'Brien, Vinod Mathen, Nicola Barnes, Ashu Gandhi, James Harvey, Cliona C Kirwan, Richard Johnson, Krupali Patel, Maria Dalmau Ribas, Natali Vigneswaran, Tom Challoner, Alan Park, Maged Rizkalla, Abigail Tomlins, Kat McEvoy, Sadaf Jafferbhoy, Soni Soumian, Sankaran Narayanan, Robert Kirby, Sladana Bajrusevic, Joseph Maalo, Michalis Charalambous, Lee Min Lai, Kelvin Chong, Simon Thomson, Sherif Monib, Leena Chagla, Riccardo Audisio, Rieka Taghizadeh, Azhar Iqbal, Karen James, Maria Callaghan, Shabbir Poonawala, Jonathan Lund, Raman Vinayagam, Steven Thrush, Rachel Bright Thomas, Michelle Mullan, Jevan Taylor, Ryo Yoshimura, Tom Mathew, Ben Mancey Jones, Kailas Munot, Rana Nasr, Jenny Piper, Deena El-Sharief, Mohammed Mustafa, Caitlin MacLeod, Elizabeth Smyth, Nina Saeed, Yazan Masannat, Amir Tan Mohd-Amin, Sam Sloan, Stuart McIntosh, Abdulla Ibrahim, Rathi Rathinaezhil, Eiman Khalifa, Penny McManus, Alexander Leeper, Jennifer McIlhenny, James Mansell, Keith Ogsto, Laszlo Romics, Shelia Shokuhi, Xiang Wei Jonathan Lee, Asmaa Al-Allak, Clare Fowler, Eleanore Massey, Fiona Court, Richard Hunt, Sarah Vestey, Mohsen Elgammal, Arish Noshirwani, Tehera Arif, Farah H Syed, Gazalla Safdar, Mohammed El-Abbar, Fiona Hogg, Pauline McGee, Vassilis Pitsinis, Jenny Smith, Sundus Makkiyah, Syed Mustafa, Dana Photiou, Ellie Gutteridge, Georgette Oni, Kelly Hallam, Kristjan Asgeirron, Marta D'Auria, Samim Al-zubaidi, James Bailey, Alexandra Tenovici, Dionysios-Dennis Remoundos, Nikos Chaidos, Oana Predescu, Jan Rezulski, Tholkifl Abdullah, Sujatha Udayasankar, Adam Talbot, Jagdeep Singh, Amy Smith, Angela Volleamere, Sarah Dean, Lashan Peiris, Olivia Sjokvist, Emma De Sousa, Aikaterini Micha, Amy Godden, Katherine Krupa, John Henton, Ruth Bennett, Stewart Nicholson, Guido Paolini, Luca Francesco Renzi, Santanelli Di Pompeo, Vitto Ria, Rebecca S Lewis, Sirwan Hadad, Anup Sharma, Delia Toomey, Dibyesh Banerjee, Sarah Shuk Kay Tang, Shireen McKenzie, Tanvir Ahmad, Kate Williams, Mohammed Absar, Nabila Nasir, Igor Jerzy Rychlik, Lynn Darragh, Ruth Johnston, Stephen Kirk, Jacqueline Rees-Lee, Michael Green, Abhishek Sharma, Jia Choong, Zaker Ullah, Ommen Koshy, Tamara Kiernan, Ajay Ashok Bhojwani, Rachel Bright-Thomas, Ged Byrne, Ibrahim Ibrahim, Lyndsey Highton, Owen Morris, Sumohan Chatterjee, Cliona Kirwan, Ben Mancey-Jones, Denna El Sharief, and Richard Frame

Subjects
Adult, therapeutic mammaplasty, medicine.medical_specialty, Mammaplasty, medicine.medical_treatment, Kaplan-Meier Estimate, 030230 surgery, Young Adult, 03 medical and health sciences, Postoperative Complications, breast cancer, 0302 clinical medicine, Breast cancer, cohort study, medicine, Adjuvant therapy, Humans, breast reconstruction, Young adult, Mastectomy, collaborative, Aged, Proportional Hazards Models, Aged, 80 and over, Proportional hazards model, business.industry, Immediate breast reconstruction, oncological safety, conservative treatment, mastectomy, Middle Aged, medicine.disease, Surgery, Logistic Models, Treatment Outcome, 030220 oncology & carcinogenesis, Female, Breast reconstruction, business, Cohort study
Abstract

Therapeutic mammaplasty (TM) may be an alternative to mastectomy, but few well designed studies have evaluated the success of this approach or compared the short-term outcomes of TM with mastectomy with or without immediate breast reconstruction (IBR). Data from the national iBRA-2 and TeaM studies were combined to compare the safety and short-term outcomes of TM and mastectomy with or without IBR.The subgroup of patients in the TeaM study who underwent TM to avoid mastectomy were identified, and data on demographics, complications, oncology and adjuvant treatment were compared with those of patients undergoing mastectomy with or without IBR in the iBRA-2 study. The primary outcome was the percentage of successful breast-conserving procedures in the TM group. Secondary outcomes included postoperative complications and time to adjuvant therapy.A total of 2916 patients (TM 376; mastectomy 1532; mastectomy and IBR 1008) were included in the analysis. Patients undergoing TM were more likely to be obese and to have undergone bilateral surgery than those having IBR. However, patients undergoing mastectomy with or without IBR were more likely to experience complications than the TM group (TM: 79, 21·0 per cent; mastectomy: 570, 37·2 per cent; mastectomy and IBR: 359, 35·6 per cent; P 0·001). Breast conservation was possible in 87·0 per cent of patients who had TM, and TM did not delay adjuvant treatment.TM may allow high-risk patients who would not be candidates for IBR to avoid mastectomy safely. Further work is needed to explore the comparative patient-reported and cosmetic outcomes of the different approaches, and to establish long-term oncological safety.La mamoplastia terapéutica (therapeutic mammaplasty, TM) puede ser una alternativa a la mastectomía, pero hay pocos estudios bien diseñados que hayan evaluado el éxito de esta estrategia o hayan comparado los resultados a corto plazo de la TM con la mastectomía con o sin (+/-) reconstrucción mamaria inmediata (immediate breast reconstruction, IBR). Para comparar la seguridad y los resultados a corto plazo de la TM y la mastectomía +/- IBR se combinaron los datos de los estudios nacionales iBRA-2 y TeaM. MÉTODOS: En el estudio TeaM se identificó el subgrupo de pacientes al que se realizó una TM para evitar la mastectomía y se compararon los datos demográficos, las complicaciones, los resultados oncológicos y el tratamiento adyuvante con las pacientes sometidas a mastectomía +/- IBR del estudio iBRA-2. La variable principal fue el porcentaje de éxito de la cirugía conservadora de mama en el grupo TM. Las variables secundarias fueron las complicaciones postoperatorias y el intervalo de tiempo hasta el inicio del tratamiento adyuvante.Se incluyeron en el análisis 2.916 pacientes (TM n = 376; mastectomía n = 1.532; IBR n = 1.008). La TM era más frecuente en pacientes obesas o en las sometidas a cirugía bilateral en comparación con las pacientes con IBR. Sin embargo, las pacientes sometidas a una mastectomía +/- IBR tenían más probabilidades de desarrollar complicaciones que las del grupo TM (TM n = 79, 21,0%; mastectomía n = 570, 37,2%; mastectomía y IBR n = 359, 35,6%; P 0,001). La conservación de la mama fue posible en el 87% de las pacientes con TM y el procedimiento no retrasó el inicio del tratamiento adyuvante. CONCLUSIÓN: La TM puede permitir que pacientes de alto riesgo que no serían candidatas a IBR eviten la mastectomía de una forma segura. Se necesitan más trabajos para comparar los resultados percibidos por las pacientes y los estéticos de las diferentes estrategias terapéuticas y establecer la seguridad oncológica a largo plazo.

Published
2020
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12. How to Publish in Biomedicine : 500 Tips for Success, Third Edition

Author

John Dixon, Louise Alder, Jane Fraser, John Dixon, Louise Alder, and Jane Fraser

Subjects
Publishers and publishing, Editing, Medical writing
Abstract

Getting published is crucial for success in biomedicine. Whether you are a beginner or an experienced writer, you will find this book has fresh, practical tips on everyday issues. Based on the authors'successful training courses and extensive experience of healthcare communications, this book will answer your questions and help you to avoid the most frequent problems and pitfalls. The book is designed to be very practical, and to be used when you are actually writing. It does not need to be read straight through from beginning to end before you get started. Instead, just dip into any chapter and you will find a range of tips relevant to the material you are working on right now.

Published
2017

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