2,630 results on '"Mastectomy, Modified Radical"'
Search Results
2. Comparison Between Levobupivacaine and Levobupivacaine With Dexmedetomidine in Ultrasound Guided Pectoral Nerve Block
- Author
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Hilde Coppejans, data manager
- Published
- 2019
3. Guideline-Concordant Surgical Care for Lobular Versus Ductal Inflammatory Breast Cancer.
- Author
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Iwai Y, Perez-Rojas S, Thomas SM, Tadros AB, Woodward SG, Zhang JQ, Elmore LC, Freedman GM, Tchou JC, Bleznak AD, and Fayanju OM
- Subjects
- Humans, Female, Middle Aged, Aged, Follow-Up Studies, Prognosis, Guideline Adherence statistics & numerical data, Lymph Node Excision, Mastectomy, Modified Radical, Breast Neoplasms surgery, Breast Neoplasms pathology, Adult, Carcinoma, Lobular surgery, Carcinoma, Lobular pathology, Inflammatory Breast Neoplasms surgery, Inflammatory Breast Neoplasms pathology, Carcinoma, Ductal, Breast surgery, Carcinoma, Ductal, Breast pathology, Practice Guidelines as Topic standards
- Abstract
Introduction: Quality of surgical care is understudied for lobular inflammatory breast cancer (IBC), which is less common, more chemotherapy-resistant, and more mammographically occult than ductal IBC. We compared guideline-concordant surgery (modified radical mastectomy [MRM] without immediate reconstruction following chemotherapy) for lobular versus ductal IBC., Methods: Female individuals with cT4dM0 lobular and ductal IBC were identified in the National Cancer Database (NCDB) from 2010-2019. Modified radical mastectomy receipt was identified via codes for "modified radical mastectomy" or "mastectomy" and "≥10 lymph nodes removed" (proxy for axillary lymph node dissection). Descriptive statistics, chi-square tests, and t-tests were used., Results: A total of 1456 lobular and 10,445 ductal IBC patients were identified; 599 (41.1%) with lobular and 4859 (46.5%) with ductal IBC underwent MRMs (p = 0.001). Patients with lobular IBC included a higher proportion of individuals with cN0 disease (20.5% lobular vs. 13.7% ductal) and no lymph nodes examined at surgery (31.2% vs. 24.5%) but were less likely to be node-negative at surgery (12.7% vs. 17.1%, all p < 0.001). Among those who had lymph nodes removed at surgery, patients with lobular IBC also had fewer lymph nodes excised versus patients with ductal IBC (median [interquartile range], 7 (0-15) vs. 9 (0-17), p = 0.001)., Conclusions: Lobular IBC patients were more likely to present with node-negative disease and less likely to be node-negative at surgery, despite having fewer, and more frequently no, lymph nodes examined versus ductal IBC patients. Future studies should investigate whether these treatment disparities are because of surgical approach, pathologic assessment, and/or data quality as captured in the NCDB., (© 2024. The Author(s).)
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- 2024
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4. Assessment of ultrasound guided erector spinae plane block for early post-operative analgesia for modified radical mastectomy: a prospective, randomized, controlled study.
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Kumar P, Singh A, Sharma J, Parshad S, Johar S, and Kaur K
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- Humans, Female, Middle Aged, Prospective Studies, Adult, Analgesia methods, Aged, Bupivacaine administration & dosage, Nerve Block methods, Pain, Postoperative drug therapy, Mastectomy, Modified Radical, Ultrasonography, Interventional
- Abstract
Erector spinae plane block is a recently introduced block with a wide range of indications. The aim of the present study was to assess the efficacy and safety of ultrasound-guided erector spinae plane block on early post-operative pain relief in patients undergoing modified radical mastectomy. We conducted a prospective, randomized, controlled study in a tertiary care institute. Sixty-five patients were enrolled. Final analysis was performed on 58 patients randomized into two groups. Ultrasound-guided erector spinae plane block with 25 mL of 0.25% bupivacaine was given using a 18 gauge needle. No block was given in the other group. All patients received general anesthesia. Primary outcome measure was 24-hour analgesic consumption. Secondary outcome measures included intra-operative fentanyl consumption, time to first analgesic request, Visual Analog Scale score, nausea score, sedation score, wound quality and patient satisfaction score. Post-operative additional analgesics and intra-operative fentanyl were significantly reduced in patients receiving erector spinae plane block. Time to rescue analgesia was significantly delayed. Visual Analog Scale score was significantly lower at all time intervals. Post-operative nausea at various time intervals was also less. Patient satisfaction score was also noted on a 5-point scale and there was a statistical significant difference. We concluded that erector spinae plane block is a safe technique and provides good analgesia in breast surgery., (Copyright © 2024 Copyright: © 2024 Medical Gas Research.)
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- 2024
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5. Rare Occurrence of the Miller Fisher Variant of Guillain-Barré Syndrome Following Modified Radical Mastectomy in a Patient with Breast Cancer.
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Bhowmik S, Gupta K, Halder A, and Kannaujiya V
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- Humans, Female, Middle Aged, Breast Neoplasms surgery, Mastectomy, Modified Radical, Miller Fisher Syndrome
- Published
- 2024
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6. Effects of a single subanesthetic dose of esketamine on postoperative subthreshold depressive symptoms in patients undergoing unilateral modified radical mastectomy: a randomised, controlled, double-blind trial.
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Wang H, Te R, Zhang J, Su Y, Zhou H, Guo N, Chi D, and Huang W
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- Humans, Female, Middle Aged, Double-Blind Method, Adult, Postoperative Complications prevention & control, Antidepressive Agents therapeutic use, Antidepressive Agents administration & dosage, Ketamine administration & dosage, Ketamine therapeutic use, Breast Neoplasms surgery, Depression, Mastectomy, Modified Radical
- Abstract
Background: Breast cancer is the most common malignant tumor in females worldwide. During disease development, breast cancer patients suffer anxious and depressed, which may lead to worse quality of life or even higher mortality. Esketamine has been regarded as an antidepressant in breast cancer patients with mild or moderate depression. Here, we wonder whether the administration of esketamine could reduce the postoperative depressive symptom score of breast cancer patients who have no preoperative depression., Methods: A total of 64 patients treated with unilateral modified radical mastectomy were randomly divided into an experimental group (esketamine group, Group E) and a control group (Group C), with 32 cases in each one. After anesthesia induction, Group C received 0.2 ml/kg of normal saline intravenously and Group E was administered 0.2 mg/kg intravenous esketamine. The primary outcome was the Patient Health Questionnaire-9 (PHQ-9) scores. The secondary outcomes included the Visual Analogue Scale (VAS) scores for pain, inflammatory markers, perioperative-related indicators, and the incidence of postoperative delirium, nausea and vomiting., Results: The PHQ-9 score on postoperative day (POD) 1 in Group E declined from the preoperative level, while the score in Group C was higher than before, and the former was far lower than the latter (P = 0.047). There is no statistically significant difference in PHQ-9 scores between Group E and Group C on POD 3, 7, and 30. Moreover, the postoperative leukocyte level of Group E was higher than that of Group C, and the difference was statistically significant (P = 0.030)., Conclusions: A single subanesthetic dose of esketamine can result in lower postoperative score on subthreshold depressive symptoms compared to the Group C on POD 1, without increasing the occurrence of postoperative adverse reactions., Trial Registration: Registration number: Chinese Clinical Trial Registry ChiCTR2200057028. Date of registration: 26/02/2022., (© 2024. The Author(s).)
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- 2024
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7. The impact of ultrasound-guided erector spinae plane block on hemodynamic stability and postoperative pain in patients undergoing modified radical mastectomy for breast cancer.
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Nikolić A, Stošić M, Živadinović J, Gmijović M, ĐorĐević M, Janković R, Karanikolić A, and Stošić B
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- Humans, Female, Middle Aged, Adult, Anesthesia, General, Aged, Pain, Postoperative prevention & control, Pain, Postoperative etiology, Breast Neoplasms surgery, Nerve Block methods, Hemodynamics drug effects, Mastectomy, Modified Radical, Ultrasonography, Interventional
- Abstract
Objective: Breast cancer, a prevalent global malignancy in women, necessitates a comprehensive treatment approach, with surgery playing a crucial role. Severe acute pain is common post-radical breast cancer surgery, emphasizing the significance of hemodynamic stability and postoperative pain control for optimal outcomes. This study evaluates the impact of ultrasound-guided erector spinae plane block (ESPB) on these parameters in ASA scores 1-2 patients undergoing modified radical breast cancer surgery with general anesthesia., Patients and Methods: Forty-eight patients were divided into two groups: a general anesthesia group, with erector spinae plane block (GA+ESPB), and a control group receiving only general anesthesia (GA). Hemodynamic parameters were continuously monitored, and postoperative pain was assessed using the visual analog scale (VAS) at various time points., Results: Ultrasound-guided ESPB effectively maintained hemodynamic stability and reduced postoperative pain in breast cancer surgery patients. Statistically significant differences were observed in heart rate, systolic and diastolic blood pressure, and mean arterial pressure between the GA and GA+ESPB groups at multiple time points (p < 0.05). VAS scores showed a significant interaction time*group (p < 0.001), with consistent differences between the groups at all time points (p ≤ 0.001)., Conclusions: Ultrasound-guided ESPB application proved effective in preserving hemodynamic stability and managing postoperative pain in modified radical breast cancer surgery. The technique demonstrates promise in minimizing complications related to hemodynamic variations and postoperative pain, contributing to a comprehensive approach to breast cancer surgical treatment.
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- 2024
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8. Prospective Study on Avoiding Seroma Formation by Flap Fixation After Modified Radical Mastectomy.
- Author
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Hakseven M, Avşar G, Çetindağ Ö, Deryol R, Benk MS, Sırgancı G, Culcu S, Ünal AE, and Bayar S
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- Humans, Female, Mastectomy, Modified Radical, Prospective Studies, Mastectomy, Retrospective Studies, Seroma etiology, Seroma prevention & control, Breast Neoplasms surgery, Surgeons
- Abstract
Introduction: Seroma development after mastectomy is a common complication. Continued seroma causes increased outpatient visits, repeated aspirations, infection, delayed healing, delayed adjuvant therapy, and increased cost. Various treatments are being attempted to prevent and reduce seroma development. We examined the effects of flap fixation on seroma using absorbable sutures after modified radical mastectomy (MRM)., Methods: The prospectively recorded data of patients who underwent surgery for breast cancer were analyzed retrospectively. 72 consecutive patients who underwent MRM were included in the study. Patients who underwent MRM in the same way by the same surgeon were divided into two groups: the group whose wound was closed by fixing the flap to the chest wall with an absorbable suture (group A), and the group whose wound was closed with the classical method (group B). The groups were compared in terms of seroma development, clinicopathological data, and early complications., Results: Drain removal time and the total amount of drained fluid in group A patients were significantly lower than drain removal time and the total amount of drained fluid in group B patients ( P < .001). Similarly, the amount of aspirated seroma in the control examinations of group A patients was significantly lower than that in group B ( P < .05). Group B needed re-aspiration significantly more than group A ( P < .05)., Conclusions: Flap fixation with suture after MRM is a method that reduces seroma formation and the amount of drained fluid, enables early removal of the drain, prevents delay in starting adjuvant treatment, is more comfortable for the patient and physician, and is also inexpensive., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
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- 2024
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9. Paravertebral Block (PVB) Combined Pectoral Musculature Blocks for Modified Radical Mastectomy (MRM)
- Author
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Nai Liang Li, Dr
- Published
- 2016
10. Comparison of Dexamethasone Doses on Persistent Postmastectomy Pain
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Onur Koyuncu, Assist.Prof
- Published
- 2015
11. Clinical value of KiSS-1 and MMP-2 expression levels in breast cancer tissue in evaluating prognosis of elderly breast cancer patients after modified radical mastectomy.
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Lv J, Zhang J, and Wu F
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- Humans, Female, Aged, Prognosis, ROC Curve, Biomarkers, Tumor metabolism, Biomarkers, Tumor blood, Aged, 80 and over, Matrix Metalloproteinase 2 metabolism, Matrix Metalloproteinase 2 blood, Breast Neoplasms surgery, Breast Neoplasms pathology, Breast Neoplasms metabolism, Breast Neoplasms mortality, Kisspeptins metabolism, Mastectomy, Modified Radical
- Abstract
We attempted to clarify clinical value of KiSS-1 and MMP-2 levels in breast cancer (BC) tissue in evaluating prognosis of elderly BC patients after modified radical mastectomy (MCM). The data of 192 elderly female BC patients receiving MCM in our hospital from January 2018 to December 2022 were collected. According to prognosis, patients received division into poor prognosis group (n = 43) and good prognosis group (n = 149). The serum CEA level and KiSS-1 and MMP-2 levels in BC tissue received measurement in both groups. The predictive value of KiSS-1 and MMP-2 alone and jointly in adverse prognosis of elderly BC patients after MCM received assessment. Results showed that No statistical significance was exhibited between both groups in general data (P > 0.05). The serum CEA level and MMP-2 expression in BC tissue in poor prognosis group exhibited elevation relative to those in good prognosis group, and KiSS-1 expression in BC tissue in poor prognosis group exhibited depletion relative to that in good prognosis group, indicating statistical significance (P < 0.05). The high-level KiSS-1 might be a protective element for adverse prognosis of elderly BC patients after MCM, and high-level CEA and MMP-2 might be an independent risk element for adverse prognosis of elderly BC patients after MCM (P < 0.05). KiSS-1 and MMP-2 alone and jointly predicted AUC of adverse prognosis in elderly BC patients after MCM were 0.93, 0.802 and 0.958, with certain predictive values; when cutoff values of KiSS-1 and MMP-2 were 6.15 and 2.26, the predictive value was the best. In conclusion, KiSS-1 and MMP-2 levels in BC tissue possess relation to adverse prognosis of MCM. KiSS-1 and MMP-2 levels in elderly BC patients before surgery may be detected in the future to assist in prognosis evaluation of elderly BC patients after MCM.
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- 2024
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12. Application of rapid rehabilitation surgical concepts in the care of patients with modified radical breast cancer in the perioperative period.
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Ma Y, Wei Y, Li H, Lv N, Ban Y, Zhang Y, Wang Y, Wu Y, Xu Y, and DU H
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- Humans, Female, Mastectomy, Modified Radical, Perioperative Period, Breast Neoplasms surgery, Medicine
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- 2024
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13. Clinical Efficacy of Neoadjuvant Chemotherapy plus Modified Radical Mastectomy for Stage II-III Breast Cancer Patients and Its Influence on Serum Tumor Markers.
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Yan S, Li J, Chen J, Zhou Y, Qiu Y, Chen Y, and Wu W
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- Humans, Female, Mastectomy, Modified Radical, Neoadjuvant Therapy, Quality of Life, Biomarkers, Tumor therapeutic use, Mastectomy, Retrospective Studies, Treatment Outcome, Breast Neoplasms drug therapy, Breast Neoplasms surgery
- Abstract
Objective: This research aims to assess the clinical efficacy of neoadjuvant chemotherapy (NACT) in combination with modified radical mastectomy (MRM) for stage II-III breast cancer (BC) patients and its impact on serum tumor markers (STMs)., Methods: The study included 119 stage II-III BC patients treated between June 2018 and June 2021. Among them, 55 cases underwent MRM (reference group), while 64 cases received NACT followed by MRM (research group). We compared intraoperative parameters (blood loss, operation time, hospital stay), clinical outcomes, the incidence of postoperative adverse events (AEs), changes in STMs (CA125, CA153, CEA), and one-year postoperative quality of life (QOL)., Results: In comparison to the reference group, the research group exhibited significantly lower intraoperative blood loss, shorter operation times, reduced hospital stays, and higher rates of disease remission. Notably, the research group experienced a lower overall incidence of AEs, including skin flap necrosis, subscalp effusion, infection, and upper limb lymphedema. Postoperatively, all STMs in the research group exhibited statistically significant reductions and were lower than those in the reference group. Additionally, all QOL subscales demonstrated improvements and higher scores in the research group., Conclusions: NACT followed by MRM represents an effective approach for enhancing surgical outcomes and clinical efficacy in stage II-III BC patients. This combination therapy also reduces the risk of postoperative AEs and leads to favorable changes in STMs and postoperative QOL levels.
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- 2024
14. The incision can't be sutured after modified radical mastectomy: What else can we do?
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Guo H, Wang X, Gao Z, and Feng L
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- Humans, Female, Mastectomy, Modified Radical, Mastectomy, Intubation, Intratracheal, Breast Neoplasms surgery, Surgical Wound
- Abstract
Competing Interests: Declaration of competing interest None of the Authors declare any conflicts of interest in regard to this study.
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- 2024
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15. Comparison of Efficacy and Psychology of Breast-Conserving Surgery and Modified Radical Mastectomy on Patients with Early Breast Cancer under Graded Nursing
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Tiantian Ren, Jianli Wu, Lu Qian, Jing Liu, and Kan Ni
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Mastectomy, Modified Radical ,Article Subject ,General Immunology and Microbiology ,Applied Mathematics ,Modeling and Simulation ,Quality of Life ,Humans ,Breast Neoplasms ,Female ,General Medicine ,Mastectomy, Segmental ,Mastectomy ,General Biochemistry, Genetics and Molecular Biology - Abstract
Objective. To compare the efficacy and psychology of breast-conserving surgery and modified radical mastectomy in patients with early breast cancer (BC) under graded nursing. Methods. Forty-one early breast-conserving surgery BC patients admitted to our hospital from April 2020 to March 2022 were regarded as group A, and 52 with modified radical surgery were seen as group B. The operating time, intraoperative bleeding, postoperative drainage, and hospital stay were compared, and the postoperative adverse effects were counted. In addition, patients’ psychology and quality of life were assessed using the HAMD, HAMA, and QLSBC rating scales. At the time of discharge, a treatment satisfaction survey was conducted. Results. The operative time, intraoperative bleeding, postoperative drainage, and hospital stay of patients in group A were lower than those in group B ( P < 0.05 ). After treatment, the HAMD and HAMA scores were lower in group A than in group B, while the QLSBC scores and treatment satisfaction were higher ( P < 0.05 ). Conclusion. Breast-conserving surgery under graded nursing is less damaging to early BC patients. It can effectively shorten the postoperative recovery process and improve the psychology and quality of life, so it has higher clinical applicability.
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- 2022
16. Innovation in Breast Surgery: Practical and Ethical Considerations
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Paige Teller, Toan T. Nguyen, Jennifer Tseng, Lisa Allen, Cindy B. Matsen, Emily Bellavance, David Kaufman, Tina Hieken, Steven Nagel, Caitlin Patten, Laura Pomerenke, Sarah E. Tevis, and Terry Sarantou
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Mastectomy, Modified Radical ,Surgical Oncology ,Oncology ,Sentinel Lymph Node Biopsy ,Humans ,Breast Neoplasms ,Female ,Surgery ,Mastectomy, Segmental ,Mastectomy - Abstract
The adoption of innovation is essential to the evolution of patient care. Breast surgical oncology advances through incorporating new techniques, devices, and procedures. Historical changes in practice standards from radical to modified radical mastectomy or axillary node dissection to sentinel node biopsy reduced morbidity without sacrifice in oncologic outcome. Contemporary oncoplastic techniques afford broader consideration for breast conservation and the potential for improved cosmetic outcomes. At present, many breast surgeons face the decision of which wireless device to use for localization of nonpalpable lesions. Consideration for future changes, such as robotic mastectomy, are on the horizon. No guideline exists to assist breast surgeons in the adoption of innovation into practice. The Ethics Committee of the American Society of Breast Surgeons acknowledges that breast surgeons confront many questions associated with onboarding innovation. This paper aims to provide a framework for asking relevant questions along with the ethical principles to consider when integrating an innovation into practice.
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- 2022
17. Value Analysis of Neoadjuvant Radiotherapy for Breast Cancer after Modified Radical Mastectomy Based on Data Mining
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Bo Liu, Haiyun Huang, Lijuan Pan, and Yufeng Ma
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Mastectomy, Modified Radical ,Article Subject ,General Computer Science ,General Mathematics ,General Neuroscience ,Quality of Life ,Data Mining ,Humans ,Breast Neoplasms ,Female ,General Medicine ,Mastectomy ,Neoadjuvant Therapy - Abstract
Over the last two generations, there has been a surge of interest in nonmutilating treatment for women with early breast cancer. Neoadjuvant radiation therapy, which is progressively being provided to breast cancer patients, could be used to decrease tumor burden while also providing an ability to examine treatment response. This paper aims to explore the effects of the initiation time of radiotherapy after modified adjuvant radical mastectomy on the prognosis of breast cancer. The EMR data can be used to mine hidden rules, which are of great significance for treatment and prognosis analysis. In collaboration with breast cancer, the appropriate prediction model and visualization method are selected and a visual analysis system for breast cancer group and treatment plan based on electronic medical record is constructed. Patients with multiple dimensions are reduced and clustered to form patient groups. The differences of characteristics among patient groups are intuitively displayed by using Nightingale diagram, word cloud, and time axis visualization methods. The support vector machine (SVM) model is used to predict the treatment scheme. The radiotherapy time after modified radical surgery in the two groups was within 15 weeks (observation group) and 15 weeks (routine group), respectively. The incidence of complications, local recurrence rate, progression-free survival, and quality of life scores of patients in the routine group and observation group were compared. The total incidence of complications differed significantly between the observation and routine groups. The physical function, material function, psychological function, and social function of the observation group were significantly higher than the routine group P < 0.05 . Radiotherapy within 15 weeks after modified radical mastectomy for breast cancer can not only reduce the local recurrence rate but also prolong the progression-free survival of patients, and the incidence of complications will not increase, which will greatly help improve the quality of life of patients.
- Published
- 2022
18. Dosimetry of intensity-modulated radiation therapy and volumetric-modulated arc therapy techniques after modified radical mastectomy for breast cancer and hypofractionated intensity-modulated radiotherapy.
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Lin H, Sheng X, Liu H, Zhang P, Liu Y, and Zang C
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- Humans, Female, Mastectomy, Modified Radical, Radiotherapy Dosage, Radiotherapy Planning, Computer-Assisted methods, Mastectomy, Organs at Risk, Breast Neoplasms radiotherapy, Breast Neoplasms surgery, Radiotherapy, Intensity-Modulated methods
- Abstract
Objective: The aim of this study was to compare the advantages and disadvantages of intensity-modulated radiation therapy (IMRT) and volumetric-modulated arc therapy (VMAT) in patients with left-sided breast cancer who underwent hypofractionated IMRT after a modified radical mastectomy., Materials and Methods: Twenty patients who required adjuvant radiotherapy after modified radical mastectomy were randomly selected, and a specified dose of 43.5 Gy/15 F was used to plan for IMRT or VMAT. Dose-volume histograms (DVHs) were utilized to evaluate the dose distribution of the planning target volumes (PTVs) and organs at risk (OARs)., Results: VMAT demonstrated a greater and more uniform dose distribution of PTVs and lower number of monitor units. No significant differences were found in V5 of the affected lung and heart between the two techniques (P > 0.05). The V10, V20, V30, and Dmean of the affected lung and V10, V20, V30, V40, Dmean, and Dmax of the whole heart were better in the VMAT than in the IMRT (P < 0.05). The Dmean and Dmax of the left anterior descending (LAD) branch of the coronary artery of the heart were better in the VMAT (P < 0.05), and the use of the VMAT effectively reduced the cardiopulmonary dose. A significant advantage of V30 and Dmean was also found in VMAT (P < 0.05)., Conclusion: These findings indicate that VMAT has higher clinical significance than IMRT, because it improved the dose distribution in the target area, reduced the cardiopulmonary dose, protected the OARs (e.g. thyroid), and shortened the treatment duration., (Copyright © 2023 Copyright: © 2023 Journal of Cancer Research and Therapeutics.)
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- 2023
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19. Quality of life of patients one year after breast-conserving surgery versus modified radical mastectomy for early breast cancer: a Kenyan tertiary hospital five-year review.
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Senoga A, Wasike R, Ali Mwanzi S, and Mutebi M
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- Female, Humans, Cross-Sectional Studies, Kenya, Mastectomy methods, Mastectomy, Segmental methods, Quality of Life, Tertiary Care Centers, Breast Neoplasms surgery, Breast Neoplasms radiotherapy, Mastectomy, Modified Radical
- Abstract
Introduction: Breast conserving surgery (BCS) followed by radiotherapy (BCT) and modified radical mastectomy (MRM) are the most common surgical techniques utilized in treatment of early breast cancer (EBC) with similar overall survival and recurrence rates. Western literature suggests that these treatments impact the quality of life (QOL) of patients variably. There are no comparison studies on these treatments as per patient's QOL in East Africa. The objectives were to compare the QOL of patients with EBC at least one year after BCT or MRM and assess the factors that affect this QOL., Methods: this was a cross-sectional study conducted at Aga Khan University Hospital-Nairobi (AKUHN). Eligible female patients with EBC who had undergone either BCT or MRM between January 2013 and December 2018 were invited to fill out European Organization for the Treatment and Research of Cancer Quality of Life Questionnaire (EORTC-QLQ-C30). Data on participant demographics and clinical information was also obtained. Average scores for each aspect of QOL were obtained and overall means for each surgical treatment were compared. Linear regression was done to assess the factors that affected this QOL., Results: forty-two patients had BCS/BCT and 39 had MRM. Patients who had undergone BCS/BCT had a better overall QOL than those who had undergone MRM (p=0.0149). Multivariate analysis revealed that five years from time of surgery, level of education and diabetes mellitus significantly (p<0.05) affected the QOL of these patients., Conclusion: after one year from surgery for EBC, patients who had undergone BCS/BCT had a better QOL as compared to MRM., Competing Interests: The authors declare no competing interests., (Copyright: Senoga Andrew et al.)
- Published
- 2023
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20. An Overview of Psychological Analysis of Breast Cancer Patients undergoing Modified Radical Mastectomy and Breast Conservation Surgery and its impact on Objectified Body Consciousness at a Tertiary Care Cancer Centre in South India.
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Shekhar N, Jaiswal R, Joseph L, Jain S, Jain S, Kr A, Yashas N, Fernandes A, G C, S V, Reddy T, Reddy L, and Kumar R
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- Humans, Female, Mastectomy, Modified Radical, Retrospective Studies, Consciousness, Tertiary Healthcare, India, Mastectomy, Segmental psychology, Mastectomy methods, Breast Neoplasms surgery, Breast Neoplasms psychology
- Abstract
Background: Breast cancer is the most common cancer among females, and surgery plays a central role in its treatment. Surgical treatments may have a negative psychological impact on women's mental health regarding their body image. The purpose of this study was to compare the psychological health insights pertaining to objectified body consciousness scores before and after the surgery and also to observe whether these scores were comparable across the surgery types., Materials and Methods: This retrospective analysis of prospectively maintained data included 706 breast carcinoma patients who underwent either Breast Conservation Surgery or Modified Radical Mastectomy at tertiary care Cancer Centre, between the years 2020 to 2021. A validated questionnaire of Objectified Body Consciousness was used to obtain responses at diagnosis and at 6 months postsurgery and final scores were calculated for both instances. Two sample t-tests/analysis of variance and Chi-square tests were used to compare continuous and categorical variables respectively., Results: Out of total 706 breast cancer patients, 402 patients underwent Breast Conservation Surgery and 304 underwent Modified radical mastectomy procedure. A statistically significant change was seen in the mean Objectified Body Consciousness Score (14.22 ± 15.44) for all patients when compared preoperatively(72.72 ± 11.38) and postoperatively(60.15 ± 17.58). This change was higher in the Modified Radical Mastectomy group(29.38 ± 11.53). Also, statistically significant rise in scores was seen with increasing age., Conclusion: We could affirmatively conclude in our study that younger breast cancer patients and all patients who underwent a Modified Radical Mastectomy, had more psychological apprehension with the body image postsurgery, signifying these groups should be encouraged by healthcare professionals to reach out for counselling at the earliest., (Copyright © 2023 Elsevier Inc. All rights reserved.)
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- 2023
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21. Letter to the Editor: Response to: Comment on: Application of a new serratus anterior plane block in modified radical mastectomy under ultrasound guidance: A prospective, randomized controlled trial.
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Li Y
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- Humans, Female, Mastectomy, Modified Radical, Mastectomy adverse effects, Prospective Studies, Pain, Postoperative etiology, Pain, Postoperative prevention & control, Breast Neoplasms surgery, Nerve Block
- Abstract
Competing Interests: Declaration of Competing Interest The authors declare that there is no conflict of interest.
- Published
- 2023
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22. Paravertebral block versus erector spinae plane block for analgesia in modified radical mastectomy: a randomized, prospective, double-blind study
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Nükhet SİVRİKOZ, Özlem TURHAN, Achmet ALİ, Demet ALTUN, Mustafa TÜKENMEZ, and Zerrin SUNGUR
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Pain, Postoperative ,Anesthesiology and Pain Medicine ,Mastectomy, Modified Radical ,Double-Blind Method ,Morphine ,Humans ,Female ,Breast Neoplasms ,Nerve Block ,Prospective Studies ,Analgesia ,Ultrasonography, Interventional ,Mastectomy - Abstract
Pain control after breast surgery is crucial and supported with regional techniques. Paravertebral block (TPVB) is shown to be effective in postoperative pain management. Erector spinae plane block (ESPB) is assumed to have a similar analgesic effect as an easier and safer block. Our aim was to compare TPVB and ESPB for modified radical mastectomy (MRM) in terms of analgesic efficiency and dermatomal spread.Patients were randomized into Group E (ESPB) and Group P (TPVB). Total 83 patients completed study 42 in Group E and 41 in Group P. Blocks were performed under ultrasonography with 20 mL 0.375% bupivacaine at T4 prior to surgery. T1-10 dermatomal block was examined via pin-prick sensation on the midaxillary and midclavicular lines. Primary outcome was 24-hour morphine consumption. Dermatomal coverage, postoperative 0Morphine consumption was lower in Group P (19.2±2.9 vs. 21±3.1, P=0.007; mean difference 1.8 mg, 95%CI=0.48-3.1 mg). The number of dermatomes with total loss of sensation was higher in Group P. Pain scores were significantly lower in Group P at all time points. The incidence of complications and adverse events was similar in both groups.Thoracal paravertebral block reduced morphine consumption compared to ESPB after MRM, albeit a small difference. A through coverage of TPVB may be preferred with experienced operators in MRM due to lower pain scores.
- Published
- 2022
23. Effects of the Different Doses of Esketamine on Postoperative Quality of Recovery in Patients Undergoing Modified Radical Mastectomy: A Randomized, Double-Blind, Controlled Trial
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Min Zhu, Siqi Xu, Xia Ju, Shengbin Wang, and Xitong Yu
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Pharmacology ,Pain, Postoperative ,Drug Design, Development and Therapy ,Mastectomy, Modified Radical ,Double-Blind Method ,Drug Discovery ,Pharmaceutical Science ,Humans ,Female ,Breast Neoplasms ,Mastectomy - Abstract
Min Zhu, Siqi Xu, Xia Ju, Shengbin Wang, Xitong Yu Department of Anesthesiology, The Anqing Medical Center of Anhui Medical University, The Fifth Clinical Medical College of Anhui Medical University, Anqing, Peopleâs Republic of ChinaCorrespondence: Xia Ju, Department of Anesthesiology, The Anqing Medical Center of Anhui Medical University, The Fifth Clinical Medical College of Anhui Medical University, Anqing, 246003, Peopleâs Republic of China, Tel +86 13685563136, Email alcon2006@126.comPurpose: This study aims to investigate the effects of the different doses of esketamine on postoperative quality of recovery in patients undergoing modified radical mastectomy.Methods: Ninety-nine female patients were randomly allocated to three groups: the low-dose esketamine group (group E1) (0.5 mg/kg loading, 2 μg/kg/h infusion), the high-dose esketamine group (group E2) (0.5 mg/kg loading, 4 μg/kg/h infusion), the control group (group C) (received normal saline). The primary outcome was the quality of recovery-15 (QoR-15) scores on postoperative day 1 (POD1) and days 3 (POD3). The secondary outcomes were the sleep quality scores on POD1, bispectral index (BIS) value at 10, 30, and 60 min after operation, numeric rating scale (NRS) pain scores within 24 h after surgery, nausea, vomiting, drowsiness, nightmare, and intraoperative awareness.Results: The total QoR-15 scores were higher in group E1 and group E2 than in group C on POD1 and POD3 (P< 0.05). The sleep quality scores on POD1 and BIS value at 10, 30, and 60 min after operation were higher in group E1 and group E2 than in group C (P< 0.05). The NRS pain scores at 2, 4 and 6 h after surgery in group E1 and at 2, 4, 6, 12 and 24 h after surgery in group E2 were lower than in group C (P< 0.05). The NRS pain scores at 6, 12 and 24 h after surgery in group E2 were lower than in group E1 (P< 0.05). The incidence of drowsiness was higher in group E1 and group E2 than in group C (P< 0.05).Conclusion: Esketamine infusion improved to some extent the quality of recovery on POD1 and POD3 in patients undergoing modified radical mastectomy, especially 4 μg/kg/h esketamine was better, but the BIS value and incidence of drowsiness were significantly increased.Keywords: esketamine, postoperative quality of recovery, radical mastectomy
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- 2022
24. The Role of Preoperative Breast Reconstruction Information in Selection of Immediate Reconstruction After Modified Radical Mastectomy—A Randomized Study
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Xiaojie Wang, Fan Zhang, and Hailing Guo
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medicine.medical_specialty ,business.industry ,Mammaplasty ,General surgery ,Breast Neoplasms ,Evidence-based medicine ,Modified Radical Mastectomy ,law.invention ,Plastic surgery ,Mastectomy, Modified Radical ,Treatment Outcome ,Randomized controlled trial ,Otorhinolaryngology ,law ,Humans ,Medicine ,Marital status ,Female ,Surgery ,skin and connective tissue diseases ,business ,Breast carcinoma ,Breast reconstruction ,Mastectomy ,Retrospective Studies - Abstract
Immediate breast reconstruction has become an important supplement after modified radical mastectomy. The role of preoperative breast reconstruction information has not been widely popularized in China. It may play an important role in choosing immediate breast reconstruction. In this paper, we investigated whether there was an effect of the role of preoperative breast reconstruction information on the difference about choosing immediate breast reconstruction after modified radical mastectomy at signing the operation consent. From 2015 January to March 2018, newly admitted 100 patients with breast carcinoma must receive modified radical mastectomy. All these patients’ conditions met the requirements of immediate breast reconstruction. Patient age, breast reconstruction cognition, marital status, education, and family economics were recorded. They were randomly classified into two groups (A & B). Preoperative breast reconstruction information was designed and prepared. When it came to signing operation consent, Group A received preoperative breast reconstruction information and Group B did not receive it. We recorded whether they were willing to receive immediate breast reconstruction in different groups. There was no significant difference in patient age, breast reconstruction cognition, marital status, education, and family economics (P > 0.05). Thirty-two patients agreed to receive breast reconstruction and 18 patients did not agree to receive breast reconstruction in Group A when 24 patients agreed to receive breast reconstruction and 26 patients did not agree to receive breast reconstruction in Group B. There was a statistical significance (P
- Published
- 2021
25. Role of ultralow dose of naloxone as an adjuvant to fentanyl–bupivacaine in thoracic paravertebral block analgesia after modified radical mastectomy: Randomized controlled trial
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Motaz M. A. Abusabaa, Sameh Abdelkhalik Ahmed, and Amany Faheem Omara
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Visual analogue scale ,medicine.medical_treatment ,Breast Neoplasms ,Fentanyl ,law.invention ,Mastectomy, Modified Radical ,Double-Blind Method ,Randomized controlled trial ,law ,Naloxone ,medicine ,Humans ,Pharmacology (medical) ,Paravertebral Block ,Prospective Studies ,Anesthetics, Local ,Mastectomy ,Radical mastectomy ,Bupivacaine ,Pain, Postoperative ,business.industry ,General Medicine ,Analgesics, Opioid ,Anesthesiology and Pain Medicine ,Anesthesia ,Morphine ,Female ,Analgesia ,business ,medicine.drug - Abstract
Objective: We evaluated the effect of the addition of 100 ng of naloxone to fentanyl–bupivacaine mixture used in thoracic paravertebral block (PVB) on the duration and the quality of post-mastectomy analgesia. Design: A randomized double-blinded trial. Setting: Oncology surgery unit. Patients and participants: This study included 135 patients, aged 40-60 years of either sex presented for elective unilateral-modified radical mastectomy. Interventions: Patients were divided randomly into three groups: group I, received 0.3 mL/kg of 0.25 percent bupivacaine; group II, received 0.3 mL/kg of 0.25 percent bupivacaine, fentanyl 50 μg, and naloxone 100 ng; group III, received 0.3 mL/kg of 0.25 percent bupivacaine and fentanyl 50 μg. Main outcome measure(s): The visual analog scale was assessed immediately post-operative, every 2 hours till 12 hours, and then every 6 hours for 24 hours; the time of first and total amount of rescue analgesia and side effects during the first 24 hours were recorded. Results: Group II showed a significant prolonged analgesia with a delayed first request of rescue analgesia and lower amount of morphine (592.1 ± 14.9 minutes and 7.28 ± 7.81 mg, respectively) than groups I (127.7 ± 35.1 minutes and 19.84 ± 2.56 mg, respectively) and III (232.2 ± 9.27 minutes and 13.52 ± 1.74 mg, respectively) as p < 0.001. Conclusion: Using naloxone as additives in PVB has been promising and effective in controlling post-mastectomy pain.
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- 2021
26. Is really thoracic paravertebral block superior to erector spinae plane block for pain control after modified radical mastectomy?
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Li XT, Xue FS, and Tian T
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- Humans, Female, Mastectomy, Modified Radical, Mastectomy, Pain, Pain, Postoperative drug therapy, Pain, Postoperative prevention & control, Breast Neoplasms surgery, Nerve Block
- Published
- 2023
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27. Effect of Dexmedetomidine and Two Different Doses of Esketamine Combined Infusion on the Quality of Recovery in Patients Undergoing Modified Radical Mastectomy for Breast Cancer - A Randomised Controlled Study.
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Huang Z, Liu N, Hu S, Ju X, Xu S, and Wang S
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- Humans, Female, Mastectomy, Modified Radical, Bradycardia, Remifentanil, Mastectomy, Pain, Breast Neoplasms drug therapy, Breast Neoplasms surgery, Dexmedetomidine therapeutic use, Propofol
- Abstract
Purpose: This study evaluated the effect of a combined infusion of dexmedetomidine and esketamine on the quality of recovery in patients undergoing modified radical mastectomy., Methods: A total of 135 patients were randomly divided into three groups: dexmedetomidine group (group D) received dexmedetomidine (0.5 µg/kg loading, 0.4 µg/kg/h infusion), dexmedetomidine plus low-dose esketamine group (group DE
1 ) received dexmedetomidine (0.5 µg/kg loading, 0.4 µg/kg/h infusion) and esketamine (0.5 mg/kg loading, 2 µg/kg/min infusion), dexmedetomidine plus high-dose esketamine group (group DE2 ) received dexmedetomidine (0.5 µg/kg loading, 0.4 µg/kg/h infusion) and esketamine (0.5 mg/kg loading, 4 µg/kg/min infusion). The primary outcome was the overall quality of recovery-15 (QoR-15) scores at 1 day after surgery. The secondary endpoints were total QoR-15 scores at 3 days after surgery, propofol and remifentanil requirement, awaking and extubation time, postoperative visual analogue scale (VAS) pain scores, rescue analgesic, nausea and vomiting, bradycardia, excessive sedation, nightmares, and agitation., Results: The overall QoR-15 scores were much higher in groups DE1 and DE2 than in groups D 1 and D 3 days after surgery ( P < 0.05). VAS pain scores at 6, 12, 24 h postoperatively, propofol and remifentanil requirements were significantly lower in groups DE1 and DE2 than in group D ( P < 0.05). Compared with group D, awaking time, extubation time, and post-anesthesia care unit (PACU) stay were significantly prolonged in groups DE1 and DE2 ( P < 0.05) and were much longer in group DE2 than in group DE1 ( P < 0.05). The proportion of postoperative rescue analgesics and bradycardia was higher and the incidence of excessive sedation was lower in group D than in groups DE1 and DE2 ( P < 0.05)., Conclusion: Dexmedetomidine plus esketamine partly improved postoperative recovery quality and decreased the incidence of bradycardia but prolonged awaking time, extubation time, and PACU stay, especially dexmedetomidine plus 4 µg/kg/min esketamine., Competing Interests: The authors report no conflicts of interest in this work., (© 2023 Huang et al.)- Published
- 2023
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28. [Choice of immediate breast reconstructive methods after modified radical mastectomy].
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Ma JX, Xia YC, Li B, Zhao HM, Lei YT, and Bu X
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- Humans, Female, Mastectomy adverse effects, Mastectomy methods, Mastectomy, Modified Radical, Retrospective Studies, Neoplasm Recurrence, Local etiology, Breast Neoplasms surgery, Mammaplasty adverse effects, Mammaplasty methods
- Abstract
Objective: To investigate the choice of immediate breast reconstructive methods and asso-ciated outcomes after modified radical mastectomy., Methods: Retrospective analysis of patients undergoing immediate breast reconstruction after modified radical mastectomy in Peking University Third Hospital from January 2009 to May 2019. The reconstructive methods were summarized, and the clinical outcomes and the safety of immediate breast reconstruction were evaluated., Results: One hundred and twenty-three patients were enrolled in this study. Different reconstructive methods were applied according to the clinical stage, the amount of skin removal, the size of contralateral breasts, the physical condition and the preference of the patients. Seventy-nine cases were performed with tissue expander/implant two-stage reconstruction, twenty-three cases received direct breast implant insertion, seven cases were applied for latissimus dorsi (LD) myocutaneous flap transfer combined with implant insertion, five cases were provided transverse rectus abdominis myocutaneous (TRAM) flap transfer, six cases underwent tissue expander/implant combined with endoscopic LD muscle flap transfer, and three cases chose tissue expander/deep inferior epigastric artery perforator (DIEP) flap transfer. The average follow-up time was (12.3±9.0) months (3.5-41.0 months). One patient with direct implant insertion had partial blood supply distur-bance of the mastectomy flap. One case had necrosis of distal end of TRAM zone Ⅳ. One patient with expander/DIEP reconstruction had partial fat liquefaction. And two cases had expander leakage at the end of the expansion period. The tumor local recurrence occurred in one patient, and the implant was finally removed. The outcomes were evaluated by Harris method, and 90.2% patients were good or above in shape evaluation. Among the patients with implant based reconstruction, there was no obvious capsular contracture, and most of the implants had good or fair mobility., Conclusion: It is safe and feasible of immediate breast reconstruction after modified radical mastectomy for appropriate cases. The reconstructive methods can be individualized according to the individual's different conditions. The appropriate reconstructive methods could achieve satisfactory results.
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- 2023
29. Value of Ambulatory Modified Radical Mastectomy.
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Bryan AF, Castillo-Angeles M, Minami C, Laws A, Dominici L, Broyles J, Friedlander DF, Ortega G, Jarman MP, and Weiss A
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- Humans, Aged, United States, Female, Mastectomy adverse effects, Medicare, Hospitalization, Patient Readmission, Retrospective Studies, Ambulatory Surgical Procedures adverse effects, Mastectomy, Modified Radical, Breast Neoplasms surgery
- Abstract
Background: Modified radical mastectomy (MRM) still is largely performed in inpatient settings. This study sought to determine the value (expenditures and complications) of ambulatory MRM., Methods: Health Care Utilization Project (HCUP) state databases from 2016 were queried for patients who underwent MRM. The study examined rates of 30-day readmission for surgical-site infection (SSI) or hematoma, charges by index care setting, and predictors of 30-day readmission., Results: Overall, 8090 patients underwent MRM: 5113 (63 %) inpatient and 2977 (37 %) ambulatory patients. Compared with the patients who underwent inpatient MRM, those who underwent ambulatory MRM were older (61 vs. 59 years), more often white (66 % vs. 57 %), in the lowest income quartile (28 % vs. 21 %), insured by Medicare (43 % vs. 33 %) and residents in a small metro area (6 % vs. 4 %) (all p < 0.01). Of the 5113 patients treated as inpatients, 126 (2.5 %) were readmitted, whereas 50 (1.7 %) of the ambulatory patients were readmitted (p = 0.02). The adjusted charge for inpatient MRM without readmission was $113,878 (range, $107,355-120,402) compared with $94,463 (range, $86,021-102,907) for ambulatory MRM, and the charge for inpatient MRM requiring readmission was $159,355 (range, $147,142-171,568) compared with $139,940 (range, $125,808-154,073) for ambulatory MRM (all p < 0.01). This difference remained significant after adjustment for hospital length of stay. Adjusted logistic regression showed that the ambulatory setting was protective for readmission (odds ratio, 0.49; 95 % confidence interval, 0.35-0.70; p < 0.01)., Conclusions: The analyses suggest that ambulatory MRM is both safe and less expensive. The findings advocate that MRM, a last holdout of inpatient care within breast surgical oncology, can be transitioned to the ambulatory setting for appropriate patients., (© 2023. Society of Surgical Oncology.)
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- 2023
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30. Choice of Hospital Setting for Modified Radical Mastectomy: Difference in Value?
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Ludwig KK
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- Humans, Female, Mastectomy, Hospitals, Mastectomy, Modified Radical, Breast Neoplasms surgery
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- 2023
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31. Implementation of a Multidisciplinary Inflammatory Breast Cancer Program for Quality Improvement.
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Hussain MM, Ashley G, Daniel S, Sachin J, Amy K, Doreen A, Sasha B, Roman S, and Ko Un P
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- Humans, Female, Mastectomy, Quality Improvement, Retrospective Studies, Mastectomy, Modified Radical, Neoadjuvant Therapy, Inflammatory Breast Neoplasms therapy, Inflammatory Breast Neoplasms drug therapy, Breast Neoplasms therapy, Breast Neoplasms surgery
- Abstract
Background: Inflammatory Breast Cancer (IBC) is a rare but aggressive subtype of breast cancer accounting for only 1% to 5% of cases but comprising 7% to 10% of breast cancer deaths. Diagnosis of IBC can be challenging which can lead to delays in diagnosis and treatment. We formed a multidisciplinary IBC program to address the unique challenges of diagnosing and treating patients with IBC., Materials and Methods: We retrospectively identified patients with an IBC CPT code and collected data on the date of the first visit with medical oncology, surgical oncology, or radiation oncology, date of biopsy, and initiation of neoadjuvant chemotherapy. In 2020, as part of the IBC program at The Ohio State University, the decision tree (DT) was revised to help identify potential IBC patients. These patients were prioritized with a multidisciplinary appointment within 3 days., Results: After adjusting the call center DT, there was a significant decline in the median and mean time from initial contact to chemotherapy initiation and an insignificant decrease in the mean time from contact to biopsy (P = .71884). The median time of contact to chemotherapy was 10 days (range 9-14) in 2020, a decrease of 43% compared to 3 prior years (P = .0068). After initiation of the IBC program, 100% of patients underwent trimodality therapy-neoadjuvant systemic therapy, modified radical mastectomy, and post mastectomy radiation therapy., Conclusion: A multidisciplinary IBC program that included scheduling DT with specific questions about IBC symptoms helped identify potential patients and significantly decrease time to treatment and assured completion of trimodality therapy., Competing Interests: Disclosure These authors have the following conflict of interest: Park – Bayer, LLC consultant. No conflict of interest: Hussain, Grimes, Stover, Jhawar, Kerger, Agnese, Beyer, Skoracki., (Copyright © 2023 Elsevier Inc. All rights reserved.)
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- 2023
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32. Comparing analgesic efficacy of the regional block with different-volume ropivacaine after a modified radical mastectomy
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Yu‐Jing Yuan, Fu‐Shan Xue, and Tian Tian
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Pharmacology ,Analgesics ,Mastectomy, Modified Radical ,Humans ,Pharmacology (medical) ,Female ,Ropivacaine ,Breast Neoplasms ,Anesthetics, Local ,Mastectomy - Published
- 2022
33. ASO Visual Abstract: Modified Radical Mastectomy in De Novo Stage IV Inflammatory Breast Cancer
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J. C. Chen, Yaming Li, James L. Fisher, Oindrila Bhattacharyya, Allan Tsung, Jose G. Bazan, and Samilia Obeng-Gyasi
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Mastectomy, Modified Radical ,Oncology ,Humans ,Surgery ,Inflammatory Breast Neoplasms ,Disease-Free Survival ,Mastectomy ,Neoplasm Staging - Published
- 2022
34. Comparison of tumor-infiltrating lymphocytes of breast cancer in core needle biopsies and resected specimens: a retrospective analysis.
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Cha, Yoon Jin, Ahn, Sung Gwe, Bae, Soong June, Yoon, Chang Ik, Seo, Jayeong, Jung, Woo Hee, Son, Eun Ju, and Jeong, Joon
- Abstract
Purpose: Neoadjuvant chemotherapy (NAC) is being increasingly used to treat locally advanced breast cancer and to conserve the breast. In triple-negative breast cancer and HER2-positive breast cancer, a high density of tumor-infiltrating lymphocytes (TILs) is an important predictor of NAC response. Thus far, it remains unclear whether the TIL scores in core needle biopsies (CNBs) are closely representative of those in the whole tumor section in resected specimens. This study aimed to evaluate the concordance between the TIL scores of CNBs and resected specimens of breast cancer.Methods: A total of 220 matched pairs of CNBs and resected specimens of breast cancer were included. Stromal TILs were scored on slides stained with hematoxylin and eosin. Clinicopathologic parameters and the agreement of the TIL scores between CNBs and resected specimens were statistically analyzed.Results: The average TIL score was approximately 4.4% higher for the resected specimens than for the CNBs. When the tumors were divided into two groups according to a 60% TIL score cut-off (low and intermediate TIL vs. high TIL), 8.2% showed discordance between the CNB and resected specimen. The overall intraclass correlation coefficient (ICC) value of the TIL score was 0.895 (95% confidence interval, 0.864-0.920, P < 0.001), and all molecular subtypes showed ICC values over 0.8 (P < 0.001). The ICC values were > 0.9 when ≥ 5 cores were included in the CNBs. Tumors with discordant TILs were characterized by histologic grade III, ER negativity, high proliferative index, and HER2 and triple-negative subtypes. A high proliferative index was an independent risk factor for TIL discordance.Conclusions: The TIL score in CNB specimens is a reliable value that reflects the TIL status of the entire tumor in resected specimens of breast cancer. More than five CNB cores may accurately predict the TIL score of the entire tumor. [ABSTRACT FROM AUTHOR]
- Published
- 2018
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35. Tailoring PTV expansion to improve the dosimetry of post modified radical mastectomy intensity‐modulated radiotherapy for left‐sided breast cancer patients by using 4D CT combined with cone beam CT
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Dongsheng Li, Lili Wu, Fangcai Wu, Lei Huang, Bao-Tian Huang, Changchun Ma, J. Y. Zhang, Yan Lin, and Guoxi Wang
- Subjects
medicine.medical_treatment ,Breast Neoplasms ,Modified Radical Mastectomy ,Left sided ,left‐sided breast cancer ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Breast cancer ,Mastectomy, Modified Radical ,post modified radical mastectomy ,medicine ,Unilateral Breast Neoplasms ,Dosimetry ,Humans ,Radiology, Nuclear Medicine and imaging ,Displacement (orthopedic surgery) ,Four-Dimensional Computed Tomography ,Instrumentation ,intensity‐modulated radiotherapy ,Cone beam ct ,Mastectomy ,Radiation ,dosimetry ,inter‐fractional CTV displacement ,business.industry ,Radiotherapy Planning, Computer-Assisted ,Radiotherapy Dosage ,intra‐fractional CTV displacement ,Cone-Beam Computed Tomography ,medicine.disease ,Radiation Measurements ,Radiation therapy ,030220 oncology & carcinogenesis ,tailoring PTV expansion ,Female ,Intensity modulated radiotherapy ,Radiotherapy, Intensity-Modulated ,Nuclear medicine ,business - Abstract
Purpose Our study aimed to improve the dosimetry of post modified radical mastectomy intensity‐modulated radiotherapy (PMRM‐IMRT) for left‐sided breast cancer patients by tailoring and minimizing PTV expansion three‐dimensionally utilizing 4D CT combined with on‐board cone beam CT (CBCT). Methods We enrolled a total of 10 consecutive left‐sided breast cancer patients to undergo PMRM‐IMRT. We measured the intra‐fractional CTV displacement attributed to respiratory movement by defining 9 points on the left chest wall and quantifying their displacement by using the 4D CT, and measured the inter‐fractional CTV displacement resulting from the integrated effect of respiratory movement, thoracic deformation and set up errors by using CBCT. We created 3 different PMRM‐IMRT plans for each of the patients using PTVt (tailored PTV expansion three‐dimensionally), PTV0.5 and PTV0.7 (isotropic 0.5‐ cm and isotropic 0.7‐ cm expanding margin of CTV), respectively. We performed paired samples t test to establish a hierarchy in terms of plan quality and dosimetric benefits. P
- Published
- 2021
36. 'Combination of Thoracic Epidural Anesthesia, Supraclavicular Brachial Plexus Block and Supraclavicular Nerve Block as Surgical Anesthesia for Modified Radical Mastectomy-A Case Series'
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R. Surya, Jennifer Lydia Joseph Gunasingh, Raghuraman M. Sethuraman, Aswin Asokan, and M. Thilak
- Subjects
Anesthesia, Epidural ,Mastectomy, Modified Radical ,Humans ,Breast Neoplasms ,Female ,General Medicine ,Brachial Plexus Block ,Mastectomy - Abstract
Sensory innervation of the breast is complex, thereby making it difficult to perform any surgical procedure with a single regional anesthesia technique. Because of the involvement of pectoral muscles and extension of the incision into the axilla, a modified radical mastectomy makes it further challenging and requires multiple techniques. We have used a new combination of regional techniques in this case series and found that it provided complete surgical anesthesia with a smaller volume of local anesthetic.
- Published
- 2022
37. Analgesia and stress attenuation of ultrasound-guided modified pectoral nerve block type-II with different volumes of 0.3% ropivacaine in patients undergoing modified radical mastectomy for breast cancer: A prospective parallel randomized double-blind controlled clinical trial
- Author
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Xinqiang, Lin, Yuping, Cai, Xiao, Chen, Jianxin, Lin, Yingxi, He, Lijin, Xie, Xiaoling, Jiang, and Yuren, Chen
- Subjects
Pain, Postoperative ,Thoracic Nerves ,Interleukin-6 ,Interleukin-1beta ,Breast Neoplasms ,Analgesics, Opioid ,Hypesthesia ,Mastectomy, Modified Radical ,Double-Blind Method ,Humans ,Female ,Ropivacaine ,Prospective Studies ,Analgesia ,Mastectomy ,Ultrasonography, Interventional - Abstract
A previous randomized clinical trial concluded that an optimal concentration of 0.3% ropivacaine could provide satisfactory analgesia for breast cancer patients undergoing modified radical mastectomy. We wondered if a smaller volume (30 ml vs. 40 ml) of 0.3% ropivacaine could still provide adequate analgesia in an ultrasound-guided PECS II block in modified radical mastectomy.We performed a prospective parallel randomized double-blind controlled clinical trial. Eligible patients were assigned to either the PA total of 40 patients completed the trials, with 20 patients in each group. Although the skin area of hypoesthesia and the anaesthetic planes were significantly larger in the PCompared with 40 ml, 30 ml of 0.3% ropivacaine could provide adequate analgesia and reduce surgical stress in patients undergoing modified radical mastectomy for breast cancer.
- Published
- 2022
38. A novel balanced anesthesia shortens time to emergence in patients undergoing modified radical mastectomy: a randomized prospective trial
- Author
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Xiu-Hong Jiang, Zhen-Feng Zhang, Si-Bi Zhang, Linjia Zhu, and Ni Yan
- Subjects
Methyl Ethers ,Nausea ,Breast Neoplasms ,Sevoflurane ,Pacu ,Hypoxemia ,03 medical and health sciences ,Mastectomy, Modified Radical ,0302 clinical medicine ,030202 anesthesiology ,medicine ,Humans ,Prospective Studies ,Mastectomy ,Advanced and Specialized Nursing ,Balanced Anesthesia ,biology ,business.industry ,biology.organism_classification ,Anesthesiology and Pain Medicine ,Intravenous anesthesia ,030220 oncology & carcinogenesis ,Anesthesia ,Anesthesia Recovery Period ,Anesthetics, Inhalation ,Vomiting ,Female ,medicine.symptom ,Anesthesia, Inhalation ,business ,Propofol ,Anesthetics, Intravenous ,medicine.drug - Abstract
BACKGROUND In balanced anesthesia, protocol during the last 30 min is very important to guarantee rapid emergence and smooth extubation. In clinical practice, sevoflurane and propofol are often used in combination to achieve a better anesthetic effect and less adverse reaction. Approximately 30 min before surgical completion, sevoflurane inhalation is often discontinued and propofol is adjusted to keep sufficient depth of anesthesia. However, propofol-based anesthesia may delay time to emergence due to its unpredictable interindividual variability. In contrast, sevoflurane can be rapidly excreted unchanged from the respiratory tract, and more importantly, with minimal variability. This study aimed to investigate the effect of a novel balanced anesthesia protocol, that is propofol-based intravenous induction, propofol-sevoflurane combined maintenance, and total sevoflurane inhalation during the last 30 min of the surgery, on the time to emergence/extubation. METHODS In our study, a total of 100 female patients undergoing modified radical mastectomy were enrolled. All patients received propofol-based intravenous anesthesia for induction followed by propofolsevoflurane combined maintenance. Approximately 30 min before the end of surgery, sevoflurane was continually inhaled without propofol infusion in group Sev (n=50), while propofol was only infused in group Pro (n=50). The primary outcome was the time to emergence/extubation. The second outcomes included time to respiratory recovery, and duration of post-anesthesia care unit (PACU) stay. The hemodynamic parameters and incidences of postoperative adverse events such as hypoxemia, nausea, vomiting, dizziness, and emergence agitation (EA) were also assessed. RESULTS The time to emergence/extubation in group Sev was shorter than that in group Pro (12.74±4.31 vs. 17.74±4.27 min, P
- Published
- 2021
39. Development and validation of a nomogram to predict drainage duration in patients with breast cancer treated with modified radical mastectomy
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Zhengli Ou, Zechang Xin, Shenzhen Zhu, Xueying Wang, Song Wu, Haotian Bai, Jiaxin Zhang, and Daxing Sui
- Subjects
Adult ,medicine.medical_specialty ,Axillary lymph nodes ,Concordance ,Science ,Clinical Decision-Making ,Breast Neoplasms ,Modified Radical Mastectomy ,Article ,03 medical and health sciences ,Mastectomy, Modified Radical ,Breast cancer ,0302 clinical medicine ,Humans ,Medicine ,030212 general & internal medicine ,Drainage ,Aged ,Aged, 80 and over ,Multidisciplinary ,business.industry ,Disease Management ,Retrospective cohort study ,Middle Aged ,Nomogram ,medicine.disease ,Surgery ,Nomograms ,Treatment Outcome ,medicine.anatomical_structure ,ROC Curve ,Risk factors ,030220 oncology & carcinogenesis ,Female ,business ,Body mass index - Abstract
Appropriate drainage duration is vital for the postoperative rehabilitation of patients with breast cancer (BC) undergoing modified radical mastectomy (MRM). To provide better and individualized postoperative management for these patients, this study explored independent predictors of postoperative drainage duration in patients with BC. This was a single-center retrospective cohort study. Patients diagnosed with BC and treated with MRM from May 2016 to April 2020 were randomly divided into training (n = 729) and validation (n = 243) cohorts. Univariate and multivariate Cox analyses revealed that the body mass index, serum albumin level, hypertension, number of total dissected axillary lymph nodes, and ratio of positive axillary lymph nodes were independent predictors of postoperative drainage duration in the training cohort. Based on independent predictors, a nomogram was constructed to predict the median postoperative drainage duration and the probability of retaining the suction drain during this period. This nomogram had good concordance and discrimination both in the training and validation cohorts and could effectively predict the probability of retaining the suction drain during drainage, thus assisting clinicians in predicting postoperative drainage duration and providing individualized postoperative management for patients with BC.
- Published
- 2021
40. Efficacy of ultrasound-stellate ganglion block in breast cancer with postoperative neuropathic pain
- Author
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Cheng-jun LIU, Hai-feng CAI, Dian-chen LIU, Yan-qing LIU, Zhi-guo SUN, Ning LI, Juan ZHANG, Yang ZHANG, and Hao DAI
- Subjects
Nerve block ,Stellate ganglion ,Mastectomy, modified radical ,Neuralgia ,Ultrasonography, Doppler, color ,Neurology. Diseases of the nervous system ,RC346-429 - Abstract
Objective To compare the efficacy of ultrasound-stellate ganglion block (US-SGB) with that of blind SGB (B-SGB) in the management of breast cancer patients with postoperative neuropathic pain (NP). Methods Forty-eight breast cancer patients with postoperative neuropathic pain were randomly assigned to either US-SGB group (N = 24) or B-SGB group (N = 24). The mean age of US-SGB and B-SGB groups were (51.35 ± 5.63) and (49.54 ± 4.77) years, respectively. Two blockade procedures with 8-day interval were performed on the affected side. Visual Analogue Scale (VAS) was assessed before treatment, and in the 4th and 8th week after treatment. Results In both groups, VAS scores were significantly decreased after 4 and 8 weeks. The VAS score in US-SGB group was decreased from 5.44 ± 1.52 before treatment to 2.68 ± 1.33 at 4th week and to 1.32 ± 0.85 at 8th week after treatment, while in B-SGB group decreased from 5.36 ± 1.21 before treatment to 3.31 ± 1.27 at 4th week and to 2.09 ± 1.02 at 8th week after treatment. The alleviation of pain in US-SGB group was more significant than that in B-SGB group (4th week: t = 2.251, P = 0.038; 8th week: t = 1.971, P = 0.029). Conclusion Both US-SGB and B-SGB techniques were effective in relieving pain in breast cancer patients with neuropathic pain. However, with postoperative favorable clinical efficacy, US-SGB was better in pain relief in comparison with B-SGB.
- Published
- 2013
41. Evaluation of postoperative pain in patients undergoing modified radical mastectomy with pectoralis or serratus-intercostal fascial plane blocks
- Author
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Kaur, Ushkiran, Shamshery, Chetna, Agarwal, Anil, Prakash, Neel, Valiveru, Ramya Chakrapani, and Mishra, Prabhaker
- Subjects
Adult ,medicine.medical_specialty ,Nerve block ,Shoulder pain ,medicine.medical_treatment ,Modified radical mastectomy ,Analgesic ,Breast Neoplasms ,Intercostal Muscles ,Pectoralis muscle ,Intermediate Back Muscles ,Modified Radical Mastectomy ,Pectoralis Muscles ,lcsh:RD78.3-87.3 ,Postoperative pain ,Mastectomy, Modified Radical ,Diclofenac ,Double-Blind Method ,medicine ,Humans ,Prospective Studies ,Fascia ,Mastectomy ,Pain Measurement ,Clinical Research Article ,Pain, Postoperative ,business.industry ,Middle Aged ,Surgery ,Anesthesiology and Pain Medicine ,medicine.anatomical_structure ,lcsh:Anesthesiology ,Female ,Shoulder joint ,Tramadol ,business ,Surgical incision ,medicine.drug - Abstract
Background: Regional nerve blocks are an integral part of multimodal analgesia and should be chosen based on their efficacy, convenience, and minimal side effects. Here, we compare the use of pectoral (PEC II) and serratus-intercostal fascial plane (SIFP) blocks in breast carcinoma cases undergoing modified radical mastectomy (MRM) in terms of the postoperative analgesic efficacy and shoulder mobility.Methods: The primary outcome of this prospective controlled study was to compare the postoperative static and dynamic pain scores, and the secondary outcome was to assess the shoulder pain, range of shoulder joint motion, and hemodynamic parameters. Sixty patients were randomly allocated to three groups and given general anesthesia. All patients received paracetamol, diclofenac, and rescue doses of tramadol based on the Institute's Acute Pain Service (APS) policy. No block was performed in group C (control), whereas groups P and S received PEC II and SIFP blocks, respectively, before surgical incision.Results: The groups were comparable in terms of age, weight, height, and body mass index distribution (P > 0.05). Dynamic pain relief was significantly better 12 and 24 h postoperatively in groups P (P = 0.034 and P = 0.04, respectively) and S (P = 0.01 and P = 0.02, respectively) compared to group C. Shoulder pain relief and shoulder mobility were better in group S, while the hemodynamic parameters were more stable in group P.Conclusions: Both SIFP and PEC blocks have comparable dynamic and static pain relief with better shoulder pain scores in patients receiving SIFP.
- Published
- 2020
42. Modified Radical Mastectomy in De Novo Stage IV Inflammatory Breast Cancer
- Author
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J C, Chen, Yaming, Li, James L, Fisher, Oindrila, Bhattacharyya, Allan, Tsung, Jose G, Bazan, and Samilia, Obeng-Gyasi
- Subjects
Mastectomy, Modified Radical ,Adolescent ,Humans ,Inflammatory Breast Neoplasms ,Radiotherapy, Adjuvant ,Mastectomy ,Neoplasm Staging - Abstract
There are few studies on surgical management in patients with de novo metastatic inflammatory breast cancer (IBC). The objective of this study is to examine the association between modified radical mastectomy (MRM) and disease-specific survival (DSS) in patients with de novo stage IV IBC.The Surveillance, Epidemiology, and End Result Program was queried for patients ≥18 years old with cT4d/pT4d pathology, histology type 8530 and 8533 with distant disease between 2010 and 2016. The sample was divided into two groups: (1) the MRM group, defined as MRM or mastectomy with at least ten lymph nodes removed, and (2) the no-surgery group. Sociodemographic and clinical variables were compared between the groups on bivariable analysis. After propensity score matching, Kaplan-Meier curves and a Cox proportional-hazards model examined DSS.1293 patients were included in the study, of whom 240 underwent MRM. A higher percentage in the MRM group had only one metastatic site (69.8% versus 52.2%), received chemotherapy (88.3% versus 66.1%) and radiation (58.8% versus 26.0%) compared with the no-MRM group. MRM was associated with an increase in DSS compared with no MRM [HR 0.63 (95% CI 0.50-0.80), p0.001]. Patients with MRM had a 5-year DSS rate of 31.4% compared with 17.7% for patients not undergoing surgery (p = 0.001). Survival time was 38 months (range 27-45 months) for the MRM group versus 27 months (22-29 months) for the no-MRM group.MRM in patients with de novo metastatic IBC may improve DSS in a subset of patients.
- Published
- 2022
43. Efficacy of breast conservative surgery versus modified radical mastectomy for triple-negative breast cancer: A systematic review and meta-analysis
- Author
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Hong-xing Wu, Zi-wen Lin, Tian-ye Song, and Ying-shi Piao
- Subjects
Mastectomy, Modified Radical ,Lymphatic Metastasis ,Humans ,Surgery ,Breast Neoplasms ,Female ,Triple Negative Breast Neoplasms ,Neoplasm Recurrence, Local ,Mastectomy, Segmental ,Mastectomy ,Neoplasm Staging - Published
- 2022
44. The effect of ultrasound-guided serratus plane block on the quality of life in patients undergoing modified radical mastectomy and axillary lymph node dissection: A randomized controlled study
- Author
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Muhammet Sulak, Ali Ahiskalioglu, Ahmet Yayik, Erdem Karadeniz, Mine Celik, Ufuk Demir, Muhammet Ari, and Haci Alici
- Subjects
Adult ,Pain, Postoperative ,Adolescent ,Serratus Plan Block ,Breast Neoplasms ,General Medicine ,macromolecular substances ,Middle Aged ,Critical Care and Intensive Care Medicine ,Modified Radical Mastectomy ,Young Adult ,Mastectomy, Modified Radical ,Anesthesiology and Pain Medicine ,Quality of Life ,Humans ,Lymph Node Excision ,Female ,Prospective Studies ,Chronic Pain ,Mastectomy ,Ultrasonography, Interventional ,Pre-Emptive Analgesia ,Aged - Abstract
BACKGROUND: Modified radical mastectomy (MRM) and axillary lymph node dissection (AD) are the most commonly used surgical methods in breast cancer surgery, and they are characterized by moderate to severe pain. This study aimed to investigate the effect of ultrasound-guided serratus plane block (SPB) on postoperative acute and chronic pain in patients undergoing MRM and AD. METHODS: After ethical approval, 60 patients, aged between 18-65 years, ASA I-III, underwent unilateral MRM, and AD was assigned into 2 groups. The SPB group received ultrasound-guided SPB with 30 mL 0.25% bupivacaine, and the control group received 2 mL saline injection subcutaneously. Postoperative analgesia was performed with intravenous patient-controlled analgesia and dexketoprofen trometamol. Pain scores, opioid consumption, and rescue analgesic requirements were recorded. Chronic pain and quality of life were evaluated with the Numerical Rating Scale (NRS), short form-36 (SF-36), and painDETECT. RESULTS: Compared with the control group, the visual analogue scale scores were statistically lower in the SPB group during 4 postoperative hours in post-anaesthetic care unit PACU at 1st, 2nd (P < 0.001), and 4th hour (P = 0.014). Fentanyl consumption and rescue analgesics were lower in the SPB group than in the control group (0-4 h, P = 0.001; 4-8 h, 8-12 h, 24 h; total P < 0.001). The incidence of chronic pain was 11%, and there was no statistically significant difference between control and SPB groups in terms of SF-36, NRS, and painDETECT scores measured at the first and sixth months. CONCLUSIONS: SPB demonstrated superiority versus the control group concerning acute postoperative pain parameters. However, SPB had no influence on the quality of life and did not prevent chronic postmastectomy pain.
- Published
- 2022
45. General anesthesia with S-ketamine improves the early recovery and cognitive function in patients undergoing modified radical mastectomy: a prospective randomized controlled trial.
- Author
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Zhang J, Jia D, Li W, Li X, Ma Q, and Chen X
- Subjects
- Humans, Female, Remifentanil, Sufentanil therapeutic use, Mastectomy, Modified Radical, Prospective Studies, Mastectomy, Anesthesia, General adverse effects, Pain etiology, Cognition, Pain, Postoperative epidemiology, Analgesics, Opioid, Breast Neoplasms
- Abstract
Background: Postoperative cognitive dysfunction (POCD) is a common postoperative disorder that is frequently observed after general anesthesia, which seriously threatens the quality of patients' life. Existing studies have demonstrated that S-ketamine plays an important role in improving neuroinflammation. This trial aimed to explore the effects of S-ketamine on quality of recovery and cognitive function in patients following modified radical mastectomy (MRM)., Methods: Ninety patients aged 45 to 70 years with ASA grades of I or II, who underwent MRM, were selected. Patients were randomly assigned to the S-ketamine or control group. In the S-ketamine group, patients were induced with S-ketamine instead of sufentanil and maintained with S-ketamine and remifentanil. In the control group, patients were induced with sufentanil and maintained with remifentanil. The primary outcome was the Mini-Mental State Examination (MMSE) and Quality of Recovery-15 (QoR-15) score. Secondary outcomes including visual analog scale (VAS) score, cumulative propofol and opioids consumption, post anesthesia care unit (PACU) recovery time, occurrence of remedial analgesia, postoperative nausea and vomiting (PONV), other adverse events, as well as patient satisfaction., Results: The global QoR-15 scores at postoperative day 1 (POD1) were significantly higher in the S-ketamine group than in the control group (124 [119.5-128.0] vs. 119 [114.0-123.5], P = 0.002), with a median difference of 5 points (95% confidence interval [CI] [-8 to -2]). Similarly, the global QoR-15 scores at postoperative day 2 (POD2) in the S-ketamine group were significantly higher than in the control group (140.0 [133.0-145.0] vs. 132.0 [126.5-141.5], P = 0.004). In addition, among the five subcomponents of the 15-item scale, S-ketamine group had a higher score in terms of physical comfort, pain, and emotional state both at POD1 and POD2. In terms of MMSE score, S-ketamine could promote the recovery of postoperative cognitive function at POD1, but not at POD2. Furthermore, the consumption of opioids, VAS score, and remedial analgesia in the S-ketamine group decreased significantly., Conclusions: Collectively, our findings support that general anesthesia with S-ketamine as a potential strategy showed high safety and could not only improve the quality of recovery mainly through improving pain, physical comfort, and emotional state but also promote the recovery of cognitive function on POD1 in patients undergoing MRM., Trial Registration: The study was registered in the Chinese Clinical Trial Registry (registration No:ChiCTR2200057226, Date of registration: 04/03/2022)., (© 2023. The Author(s).)
- Published
- 2023
- Full Text
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46. Efficacy of bi-level erector spinae plane block versus bi-level thoracic paravertebral block for postoperative analgesia in modified radical mastectomy: a prospective randomized comparative study.
- Author
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Santonastaso DP, de Chiara A, Righetti R, Marandola D, Sica A, Bagaphou CT, Rosato C, Tognù A, Curcio A, Lucchi L, Russo E, and Agnoletti V
- Subjects
- Adult, Female, Humans, Mastectomy, Modified Radical, Mastectomy, Analgesics, Opioid, Prospective Studies, Postoperative Nausea and Vomiting epidemiology, Postoperative Nausea and Vomiting prevention & control, Pain, Postoperative prevention & control, Ultrasonography, Interventional, Breast Neoplasms, Chronic Pain, Nerve Block, Analgesia
- Abstract
Background: Postoperative analgesia in breast surgery is difficult due to the extensive nature of the surgery and the complex innervation of the breast; general anesthesia can be associated with regional anesthesia techniques to control intra- and post-postoperative pain. This randomized comparative study aimed to compare the efficacy of the erector spinae plane block and the thoracic paravertebral block in radical mastectomy procedures with or without axillary emptying., Methods: This prospective randomized comparative study included 82 adult females who were randomly divided into two groups using a computer-generated random number. Both groups, Thoracic Paraverterbal block group and Erector Spinae Plane Block group (41 patients each), received general anesthesia associated with a multilevel single-shot thoracic paravertebral block and a multilevel single-shot erector spinae plane block, respectively. Postoperative pain intensity (expressed as Numeric Rating Scale), patients who needed rescue analgesic, intra- and post-operative opioid consumption, post-operative nausea and vomiting, length of stay, adverse events, chronic pain at 6 months, and the patient's satisfaction were recorded., Results: At 2 h (p < 0.001) and 6 h (p = 0.012) the Numeric Rating Scale was significantly lower in Thoracic Paraverterbal block group. The Numeric Rating Scale at 12, 24, and 36 postoperative hours did not show significant differences. There were no significant differences also in the number of patients requiring rescue doses of NSAIDs, in intra- and post-operative opioid consumption, in post-operative nausea and vomiting episodes and in the length of stay. No failures or complications occurred in the execution of techniques and none of the patients reported any chronic pain at six months from the surgery., Conclusions: Both thoracic paravertebral block and erector spinae plane block can be effectively used in controlling post-mastectomy pain with no significant differences between the two blocks., Trial Registration: The study was prospectively registered on Clinicaltrials.gov (trial identifier NCT04457115) (first registration 27/04/2020)., (© 2023. The Author(s).)
- Published
- 2023
- Full Text
- View/download PDF
47. Breast Conserving Surgery is Better for Sexual Satisfaction Compared to a Modified Radical Mastectomy for Breast Cancer.
- Author
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Salafuddin MF, Yarso KY, Nugroho HA, and Renardi AS
- Subjects
- Female, Humans, Middle Aged, Mastectomy, Segmental, Orgasm, Mastectomy, Cross-Sectional Studies, Mastectomy, Modified Radical, Breast Neoplasms surgery, Breast Neoplasms radiotherapy
- Abstract
Purpose: This study aimed to determine the difference between the level of sexual satisfaction in breast cancer patients with Modified Radical Mastectomy (MRM) and Breast Conserving Surgery (BCS)., Methods: This study used a cross-sectional study using a validated Female Sexual Function Index questionnaire. This study was conducted from 2020 until 2021. Data were collected and analyzed using the chi-square test for bivariate variables and logistic regression for multivariate variables., Results: Patients with BCS were more satisfied with their sexual activity than patients undergoing modified radical mastectomy (p = 0.0001, OR 6.25, CI = 2.78 - 14.01). Other factors having effect on sexual satisfactions were: age that showed a statistically effect on sexual satisfaction (patients <55 years were more satisfied than patients ≥55 years ( p = 0.004, OR = 3.23, CI 1.44 - 7.22), the period after operation (<5 years vs >5 years) showed a statistically significant difference in sexual satisfaction ( p = 0.087, OR=0.53, CI = 0.25-1.10), Having chemotherapy treatment showed statistically significant risk for sexual satisfaction (p = 0.003, OR=7.39, CI= 1.62-33.83). Factors having no statistically significant effect on sexual satisfactions were: Radiotherapy treatment (p = 0.133, OR=1.75 and CI = 0.84 -3.64), length of marriage as defined with <10 years and > 10 years (p = 0.616, OR=1.39 and CI = 0.38-5.09), marital status (p = 0.082, OR =0.39, CI=0,13 - 1.16), educational status (p = 0.778, OR = 1.18, CI = 0.37 - 3.75), and work at home vs outside home (p = 0.117, OR=1.8, and CI = 0.86 - 3.78)., Conclusion: BCS as surgical therapy option is the most dominant factor related to sexual satisfaction followed by age group, and chemotherapy group.
- Published
- 2023
- Full Text
- View/download PDF
48. Effectiveness of Scapular Strengthening Exercises on Shoulder Dysfunction for Pain and Functional Disability after Modified Radical Mastectomy: A Controlled Clinical Trial.
- Author
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Mohite PP and Kanase SB
- Subjects
- Humans, Female, Shoulder Pain etiology, Shoulder Pain therapy, Mastectomy, Modified Radical, Mastectomy adverse effects, Exercise Therapy, Shoulder, Breast Neoplasms surgery
- Abstract
Background: Breast cancer is the most prevalent from of cancer among women worldwide and leading cause of death. Breast cancer can be treated surgically, systemically (with hormonal therapy, chemotherapy) or with radiotherapy. Through the years, breast cancers management evolved towards conservation surgery. A surgical remove of partial or complete breast tissue, surrounding tissues, and nearby lymph nodes is called mastectomy. In Modified Radical Mastectomy, there is removal of entire breast tissue and lymph nodes. Treatment of modified radical mastectomy may lead to side effects such as shoulder pain, restricted shoulder mobility and anatomical and biomechanical changes of the shoulder, and also reduce functional disability., Method: Eighty six participants were included in this study. Two groups, each of 43 were made, Group A (control group) was given conventional exercises and Group B (study group) was given scapular strengthening exercises with conventional exercises. Outcome measures - Shoulder Pain And Functional Disability, Shoulder range of motion were assessed both pre and post-test., Result: Group B had lower pain intensity (77.116 ± 5.798vs 82.837 ± 3.860) and functional disability (70.326 ± 5.281 vs 77.791± 5.102) and higher shoulder flexion (167.98 ± 8.230 vs 107.05 ±8.018), abduction (156.91 ± 8.230 vs 107.63 ±8.230) and external rotation (62.372 ± 7.007 vs 41.907 ±6.771) range of motion than Group A., Conclusion: The current study concluded that, scapular strengthening exercises along with conventional treatment proved beneficial and effective rather than only conventional treatment on shoulder dysfunction for pain and functional disability after modified radical mastectomy.
- Published
- 2023
- Full Text
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49. Response on U S Seth, et al. (J Pak Med Assoc. 73: 69 -73, 2022) Effect of preoperative intravenous steroids on seroma formation after modified radical mastectomy.
- Author
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Seth US, Perveen S, Khan I, Ahmed T, Kamal MT, and Khomusi MM
- Subjects
- Humans, Female, Seroma etiology, Mastectomy adverse effects, Steroids, Mastectomy, Modified Radical, Breast Neoplasms surgery
- Published
- 2023
50. Effect of Erector Spinae Block and Pectoralis Block on Quality of Recovery and Analgesia After Modified Radical Mastectomy: A randomised controlled study.
- Author
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Mohsin MH, Verma R, Hemlata, Singh D, Singh S, and Singh K
- Subjects
- Humans, Female, Mastectomy, Modified Radical, Anesthetics, Local, Analgesics, Opioid, Mastectomy, Pain, Postoperative drug therapy, Pain, Postoperative prevention & control, Nerve Block, Breast Neoplasms surgery, Analgesia
- Abstract
Objectives: Post-operative pain after a modified radical mastectomy ranges from moderate to severe. Pectoralis (PECS) block has been found to be more effective than erector spinae block in reducing pain and the consumption of rescue analgesia in the post-operative period. This study aimed to compare the effect of erector spinae block and PECS block on the quality of recovery after modified radical mastectomy using the quality of recovery (QoR-40) score., Methods: This randomised controlled study was conducted at King George's Medical University, Lucknow, India, from 9
th October 2020 to 9th October 2021. After general anaesthesia, patients were given blocks according to computer-generated randomisation: Group I: PEC I and PEC II (PECS) blocks; Group II: erector spinae plane (ESP) block; and Group III: control group (no intervention). The QoR-40 score was observed on the morning of the surgery and after 24 hours. Time to rescue analgesia and the total consumption of rescue analgesia in the first 24 hours were also observed., Results: A total of 90 patients were included (30 in each group). In the post-operative period after 24 hours, global QoR-40 scores were 183.64 ± 6.36, 179.68 ± 6.38 and 171.37 ± 6.88 in the PECS, ESP and control groups ( P <0.0001). But there was no statistically significant difference between the QoR scores of PECS and ESP group patients ( P = 0.0551). The total requirement of rescue analgesic was significantly lower in the PECS group (137.28 ± 31.46 mg) than in the ESP (189.46 ± 42.98 mg) and control (229.57 ± 46.80 mg) groups ( P <0.0001). Time to first rescue analgesia was significantly higher in the PECS group (6.53 ± 2.78 hours) than in the ESP (4.05 ± 2.91 hours) and control (2.15 ± 1.51 hours) groups ( P <0.0001)., Conclusion: Both ESP and PECS blocks were effective in improving the QoR score and in reducing the consumption of rescue analgesia after modified radical mastectomy., Competing Interests: CONFLICTS OF INTEREST The authors declare no conflict of interests., (© Copyright 2023, Sultan Qaboos University Medical Journal, All Rights Reserved.)- Published
- 2023
- Full Text
- View/download PDF
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