- Email: [email protected]
238. Risk reducing surgery in BRCA positive population – A single-center experience
ABSTRACTS Results: Mean age at diagnosis 44 years, 25% achieved complete pathological response in the axilla [CPR], No lymphovascular invasion found in CPR cases. Conclusion: High histological grade and absence of LVI were associated with CPR. Conflict of interest: No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2016.06.167
236. Does the presence of sentinel lymph node macrometastases among breast cancer patients require adjuvant axillary lymphadenectomy e A single center study T. Nowikiewicz1,2, M. Nowacki2, W. Zegarski1,2 1 Oncology Centre Bydgoszcz, Clinical Department of Breast Cancer and Reconstruction Surgery, Bydgoszcz, Poland 2 the Ludwik Rydygier Collegium Medicum in Bydgoszcz- Nicolaus Copernicus University in Torun, Surgical Oncology Clinic, Bydgoszcz, Poland Background: According to the current guidelines on treatment of breast cancer patients, identification of metastases in the sentinel lymph node (SLN (+)) is not an absolute indication for axillary lymph node dissection (ALND). In our publication we present long-term outcomes of treatment among SLN (+) patients referred for conservative treatment. Material and methods: 3145 breast cancer patients subjected to sentinel lymph node biopsy (SLNB) between 11.2008 and 6.2015. Presence of SLN metastases were identified in 719 patients (22.9%) e macrometastases in 83.2% of cases, micrometastases in 16.3% of patients, isolated tumor cells (ITC) in 0.6% of subjects. Cases of disease recurrence were taken into consideration e local recurrences (surgical scar, axillary fossa) and distant metastases. In the course of patient qualification to adjuvant treatment (chemo-, radio-, immuno-, and hormonal-therapy) we conformed to the generally accepted therapeutic standards in breast cancer management. Mean follow-up time for patients after ALND was 36.2 months (6e74 months), for patients without ALND e 34 months (6e74 months). Results: Adjuvant ALND was performed in 626 of SLN (+) patients. Conservative treatment was applied in the remaining 93 cases (37 patients with macrometastases, 54 patients with micrometastases, 2 e ITC). In 221 patients (39.4%) subjected to ALND due to the presence of SLN macrometastases we found metastatic lesions in the non-sentinel lymph nodes (the proportion was 7.7 for micrometastases/ITC; p < 0.0001). Among SLN (+) patients without adjuvant ALND there was 1 case of disease recurrence (local recurrence in the post-mastectomy scar in a patient with an SLN micrometastasis). We did not identify any cases of recurrence involving axillary lymph node or dissemination of metastatic disease (general proportion of cases of recurrence in the SLN (+) group without ALND e 1.07%). In a group of patients without SLN metastases disease recurrence was noted in 32 patients (1.32%). Among SLN (+) patients diagnosed with macrometastases it concerned 2.01% of analyzed cases (all subject to ALND). There were no recurrences among SLN (+) patients with micrometastasis/ITC (patients after ALND). All identified differences failed to demonstrate statistical significance (p > 0.05). Conclusions: Lack of radicalization of surgical treatment in breast cancer patients in the presence of metastatic lesions identified in sentinel lymph nodes (regardless of their size) did not lead to worsening of longterm therapeutic outcomes (local remissions, distant metastases). Incase of macrometastases to the sentinel lymph node relinquishing adjuvant axillary lymphadenectomy might constitute an alternative to current management. However, it would require continuation of current research studies, preferably involving a clinical trial. Conflict of interest: No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2016.06.168
S131 237. How we can effectively implement the ‘scientific and practical know how’ from the ACOSOG Z0011 randomized trial of axillary node dissection into the clinic? A single-center analysis of 1349 patients diagnosed with breast cancer T. Nowikiewicz1,2, M. Nowacki2, W. Zegarski1,2 1 Oncology Centre Bydgoszcz, Clinical Department of Breast Cancer and Reconstruction Surgery, Bydgoszcz, Poland 2 Ludwik Rydygier Collegium Medicum in Bydgoszcz- Nicolaus Copernicus University in Torun, Surgical Oncology Clinic, Bydgoszcz, Poland Background: One of the still most interesting and still subjected for discussion topics related to the current breast cancer professional and evidenced treatment belongs the data published in ACOSOG Z0011 randomized trial of axillary node dissection. Some of authors directly suggest how to effectively use the selected conclusions and recommendations and other authors directly present how to professionally without any of misstatement use this knowledge in standard clinical procedures performed daily in several breast cancer units all across the world. Material and methods: In this work we have analyzed the 1349 cases of patients qualified for sentinel lymph node biopsy (SLNB) procedures performed in our center. The aim of this work was to present the potential consequences of withdrawal from intraoperative pathological verification of removed lymph nodes and evaluation of the “scientific and practical know how” influencing from the ACOSOG Z0011 randomized trial which could be used to improve the general therapeutic outcome. We have compared two groups of patients. First observed between July 2013 and June 2014 in which we performed intraoperative diagnostic SLN procedure in all cases, and second observed between July 2014 and June 2015 treated using breast conserving therapy (BCT) method in which final decision related to the intraoperative assessment of routinely performed SLN depend individually upon the surgeon during surgery. Results: In 71.5% of patients the BCT has been performed. The remaining group of patients undergone the total mastectomy. SLN metastasis was diagnosed in 318 (23.6%) patients (macro-metastases in 277 patients and micro-metastases in 41 patients). In second evaluated group treated using BCT method the intraoperative diagnostic analysis of SLN procedure has been performed in 20.2% of patients, in remaining group (388/486) the intraoperative SLN analysis was not performed. In 28% of patients with diagnosed (due to the SLN) metastases the radicalization of surgery was abandoned (vs 15.4% before the implementation of procedure modification). In the group treated using BCT method, were the metastases were confirmed due to the SLN the percentage of patients treated conservatively has considerably increased (from 5.3% to 23.1%) and was statistically significant. Conclusions: In our analysis we have proven that the proper selection of histological verification using SLN diagnostic tool, influence directly onto the decision making process related to the potential surgical radicalization. Following the resignation of routine intraoperative SLN we found a statistically significant increase of decisions related to the withdrawal of additional axillary dissection. Prospectively the creation of specific guidelines and recommendations for conservatively treatment options for patients with macro-metastases diagnosed in SLN is needed. Conflict of interest: No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2016.06.169
238. Risk reducing surgery in BRCA positive population e A singlecenter experience A. Perhavec1, M. Hocevar1, S. Novakovic2, J. Zgajnar1, B. Peric1, M. Krajc3 1 Institute of Oncology Ljubljana, Department of Surgical Oncology, Ljubljana, Slovenia 2 Institute of Oncology Ljubljana, Department of Molecular Diagnostics, Ljubljana, Slovenia
S132 3 Institute of Oncology Ljubljana, Cancer Genetic Clinic, Ljubljana, Slovenia
Introduction: BRCA 1 and BRCA 2 mutation carriers are at increased risk of developing breast and/or ovarian cancer compared with the general population. Options to reduce the incidence of cancer and/or subsequent mortality include regular surveillance with imaging studies, chemoprevention and risk reduction surgery (RRS), i. e. risk reduction mastectomy (RRM) and risk reduction salpingo-oophorectomy (RRSO). There is a great variation in uptake of RRS in different countries. The aim of our study was to evaluate the uptake of RRS in Slovenian BRCA 1 or 2 mutation carriers with and without breast cancer. Furthermore, among patients that chose RRM the proportion and type of breast reconstruction was analyzed. Patients and methods: Altogether 2877 individuals were counselled and 919 were tested for BRCA 1 and 2 and other high penetrance gene mutations at our institute until May 2015. 586 individuals tested positive. Male patients, patients lost from follow up and patients with the malignancy other than breast were excluded from the current analysis. 383 patients were included in this study and were divided in two groups: women with and without breast cancer. Chi square test was used to compare the proportion of RRS, RRM and RRSO between groups. Results: Of 383 patients included, 213 (55.6%) had breast cancer and 170 (44.4%) didn’t have. 112 of 213 (52.6%) patients with and 38 of 170 (22.4%) patients without breast cancer underwent RRM (p < 0.0001). Of 213 patients with breast cancer, 129 (60.6%) chose RRSO, while in patients without breast cancer the proportion of RRSO was 64/170 (37.6%) (p < 0.0001). Uptake of any type of RRS was 157/213 (73.7%) and 75/ 170 (44.1%) in patients with and without breast cancer, respectively (p < 0.0001). Of 150 patients that underwent RRM, 121 (80.7%) had breast reconstruction. The majority (88/121, 72.7%) had implant based reconstruction. Autologous reconstruction was performed in 28/121 (23.1%), while 5 patients (4%) had combination of implant based and autologous reconstruction. Conclusions: Patients with breast cancer significantly more often choose to undergo RRS than patients without breast cancer. The uptake rate of RRS in both groups is comparable to the rate in developed countries. The majority of patients that undergo RRM also choose breast reconstruction. Conflict of interest: No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2016.06.170
239. Technical feasibility and validity of sentinel lymph node biopsy after ipsilateral breast tumor recurrence A. Matsumoto1, H. Jinno1, M. Takahashi2, T. Hayashida2, Y. Kitagawa2 1 Teikyo University School of Medicine, Department of Surgery, Tokyo, Japan 2 Keio University School of Medicine, Department of Surgery, Tokyo, Japan Background: Ipsilateral breast tumor recurrence (IBTR) after breast econserving surgery is reported approximately 10% of breast cancer patients. However, the role of sentinel lymph node biopsy (SLNB) in patients with IBTR still remains to be elucidated. The aim of this study was to evaluate feasibility and validity of sentinel lymph node biopsy for ipsilateral breast tumor recurrence (second SLNB). Material and methods: A prospective database of 1172 patients with clinically node-negative breast cancer who underwent SLNB from January 2005 to December 2013 was analyzed and 35 patients with IBTR underwent SLNB. Lymphatic mapping was performed using a combined method of blue dye and radioisotope. ICG fluorescence imaging was performed in cases with failure of identification by blue dye and radioisotope. Results: Twenty-two (62.9%) and eight (22.9%) patients had a history of previous SLNB and axillary lymph node dissection (ALND), respectively. Another five (14.3%) patients had no previous axillary surgery for
ABSTRACTS primary tumors. Preoperative lymphatic mapping by lymphoscintigraphy was successful in 15 of 25 patients (60.0%). The identification rate by lymphoscintigraphy among patients with previous SLNB, ALND, and no previous axillary surgery was 56.3% (9/16), 57.1% (4/7) and 100% (2/2), respectively (P ¼ 0.682). Overall, SLNs were successfully identified in 28 (80.0%) of 35 patients during surgery. The identification rate in patients with previous SLNB, ALND and no axillary surgery was 81.8% (18/22), 75% (6/8) and 80% (4/5), respectively (P ¼ 0.52). In each patient after previous SLNB and ALND, SLNs were identified only by ICG fluorescence. Aberrant drainage outside the ipsilateral axilla was found more frequently in patients with previous ALND compared with previous SLNB and no axillary treatment (37.5% vs 4.5% vs 0%, P ¼ 0.048). Among two (7.1%) patients with SLN metastases, one with previous SLNB had macrometastasis at the ipsilateral axilla and ALND found a positive non-SLN (1/ 21). The other with previous ALND had micrometastatic SLN at the contralateral axilla, identified by ICG fluorescence, and underwent no further axillary treatment. After second SLNB, systemic treatment including chemotherapy, endocrine therapy and trastuzumab was performed for 12 (34.3%), 27 (77.1%) and five (14.3%) patients, respectively. No axillary recurrence was observed after a median follow-up of 40.3 months from surgery for IBTR. Conclusions: Second SLNB is technically feasible and may avoid complications from unnecessary ALND for IBTR. Furthermore, it could improve risk prediction for IBTR and provide valid information for deciding adjuvant therapy. Conflict of interest: No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2016.06.171
240. Short-term outcome and QoL in 108 patients after immediate breast reconstruction with implants and acellular dermis V. Bjelic-Radisic Medical University Graz, Gynecology- Breast Unit, Graz, Austria Background: In postmastectomy breast reconstruction acellular dermal matrices are used for tissue support, implant positioning, rapid revascularization and esthetic results. Material and methods: We assessed peri- and post-operative results and quality of life (QoL) in 108 breast cancer patients undergoing immediate postmastectomy breast reconstruction with implants and acellular dermal matrices between 2012 and 2015. The EORTC QLQ C30, EORTC QLQ BR23 and BRR31 QoL questionnaires were used. Results: The median follow-up of the 108 patients was 14 months. 7 patients had preoperative irradiation. 14 patients had a prophylactic skinsparing mastectomy. The median hospital stay/drainage was 5 days. Complications occurred in 9 cases: wound healing problems (4), implant dislocation (1), seroma (1), hematoma (4), infection (2). Three implants had to be removed (all in patients after radiation therapy). QoL and satisfaction data were similar to those in a healthy population (reference data). Conclusion: Our results are consistent with previously published data. Complications and reoperations were more common in patients after radiation therapy. Despite better materials and operative technique, prior radiation therapy is a risk factor at immediate breast reconstruction. Conflict of interest: No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2016.06.172
241. Electrochemotherapy as palliative treatment in patients with skin metastases M. Wichtowski1, D. Murawa1, R. Czarnecki2, W. Witkiewicz2 1 Oncological and General Surgery Ward I- the Greater Poland Cancer Center- Poznan- Poland, Oncological and General Surgery Ward I, Poznan, Poland
236. Does the presence of sentinel lymph node macrometastases among breast cancer patients require adjuvant axillary lymphadenectomy e A single center study T. Nowikiewicz1,2, M. Nowacki2, W. Zegarski1,2 1 Oncology Centre Bydgoszcz, Clinical Department of Breast Cancer and Reconstruction Surgery, Bydgoszcz, Poland 2 the Ludwik Rydygier Collegium Medicum in Bydgoszcz- Nicolaus Copernicus University in Torun, Surgical Oncology Clinic, Bydgoszcz, Poland Background: According to the current guidelines on treatment of breast cancer patients, identification of metastases in the sentinel lymph node (SLN (+)) is not an absolute indication for axillary lymph node dissection (ALND). In our publication we present long-term outcomes of treatment among SLN (+) patients referred for conservative treatment. Material and methods: 3145 breast cancer patients subjected to sentinel lymph node biopsy (SLNB) between 11.2008 and 6.2015. Presence of SLN metastases were identified in 719 patients (22.9%) e macrometastases in 83.2% of cases, micrometastases in 16.3% of patients, isolated tumor cells (ITC) in 0.6% of subjects. Cases of disease recurrence were taken into consideration e local recurrences (surgical scar, axillary fossa) and distant metastases. In the course of patient qualification to adjuvant treatment (chemo-, radio-, immuno-, and hormonal-therapy) we conformed to the generally accepted therapeutic standards in breast cancer management. Mean follow-up time for patients after ALND was 36.2 months (6e74 months), for patients without ALND e 34 months (6e74 months). Results: Adjuvant ALND was performed in 626 of SLN (+) patients. Conservative treatment was applied in the remaining 93 cases (37 patients with macrometastases, 54 patients with micrometastases, 2 e ITC). In 221 patients (39.4%) subjected to ALND due to the presence of SLN macrometastases we found metastatic lesions in the non-sentinel lymph nodes (the proportion was 7.7 for micrometastases/ITC; p < 0.0001). Among SLN (+) patients without adjuvant ALND there was 1 case of disease recurrence (local recurrence in the post-mastectomy scar in a patient with an SLN micrometastasis). We did not identify any cases of recurrence involving axillary lymph node or dissemination of metastatic disease (general proportion of cases of recurrence in the SLN (+) group without ALND e 1.07%). In a group of patients without SLN metastases disease recurrence was noted in 32 patients (1.32%). Among SLN (+) patients diagnosed with macrometastases it concerned 2.01% of analyzed cases (all subject to ALND). There were no recurrences among SLN (+) patients with micrometastasis/ITC (patients after ALND). All identified differences failed to demonstrate statistical significance (p > 0.05). Conclusions: Lack of radicalization of surgical treatment in breast cancer patients in the presence of metastatic lesions identified in sentinel lymph nodes (regardless of their size) did not lead to worsening of longterm therapeutic outcomes (local remissions, distant metastases). Incase of macrometastases to the sentinel lymph node relinquishing adjuvant axillary lymphadenectomy might constitute an alternative to current management. However, it would require continuation of current research studies, preferably involving a clinical trial. Conflict of interest: No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2016.06.168
S131 237. How we can effectively implement the ‘scientific and practical know how’ from the ACOSOG Z0011 randomized trial of axillary node dissection into the clinic? A single-center analysis of 1349 patients diagnosed with breast cancer T. Nowikiewicz1,2, M. Nowacki2, W. Zegarski1,2 1 Oncology Centre Bydgoszcz, Clinical Department of Breast Cancer and Reconstruction Surgery, Bydgoszcz, Poland 2 Ludwik Rydygier Collegium Medicum in Bydgoszcz- Nicolaus Copernicus University in Torun, Surgical Oncology Clinic, Bydgoszcz, Poland Background: One of the still most interesting and still subjected for discussion topics related to the current breast cancer professional and evidenced treatment belongs the data published in ACOSOG Z0011 randomized trial of axillary node dissection. Some of authors directly suggest how to effectively use the selected conclusions and recommendations and other authors directly present how to professionally without any of misstatement use this knowledge in standard clinical procedures performed daily in several breast cancer units all across the world. Material and methods: In this work we have analyzed the 1349 cases of patients qualified for sentinel lymph node biopsy (SLNB) procedures performed in our center. The aim of this work was to present the potential consequences of withdrawal from intraoperative pathological verification of removed lymph nodes and evaluation of the “scientific and practical know how” influencing from the ACOSOG Z0011 randomized trial which could be used to improve the general therapeutic outcome. We have compared two groups of patients. First observed between July 2013 and June 2014 in which we performed intraoperative diagnostic SLN procedure in all cases, and second observed between July 2014 and June 2015 treated using breast conserving therapy (BCT) method in which final decision related to the intraoperative assessment of routinely performed SLN depend individually upon the surgeon during surgery. Results: In 71.5% of patients the BCT has been performed. The remaining group of patients undergone the total mastectomy. SLN metastasis was diagnosed in 318 (23.6%) patients (macro-metastases in 277 patients and micro-metastases in 41 patients). In second evaluated group treated using BCT method the intraoperative diagnostic analysis of SLN procedure has been performed in 20.2% of patients, in remaining group (388/486) the intraoperative SLN analysis was not performed. In 28% of patients with diagnosed (due to the SLN) metastases the radicalization of surgery was abandoned (vs 15.4% before the implementation of procedure modification). In the group treated using BCT method, were the metastases were confirmed due to the SLN the percentage of patients treated conservatively has considerably increased (from 5.3% to 23.1%) and was statistically significant. Conclusions: In our analysis we have proven that the proper selection of histological verification using SLN diagnostic tool, influence directly onto the decision making process related to the potential surgical radicalization. Following the resignation of routine intraoperative SLN we found a statistically significant increase of decisions related to the withdrawal of additional axillary dissection. Prospectively the creation of specific guidelines and recommendations for conservatively treatment options for patients with macro-metastases diagnosed in SLN is needed. Conflict of interest: No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2016.06.169
238. Risk reducing surgery in BRCA positive population e A singlecenter experience A. Perhavec1, M. Hocevar1, S. Novakovic2, J. Zgajnar1, B. Peric1, M. Krajc3 1 Institute of Oncology Ljubljana, Department of Surgical Oncology, Ljubljana, Slovenia 2 Institute of Oncology Ljubljana, Department of Molecular Diagnostics, Ljubljana, Slovenia
S132 3 Institute of Oncology Ljubljana, Cancer Genetic Clinic, Ljubljana, Slovenia
Introduction: BRCA 1 and BRCA 2 mutation carriers are at increased risk of developing breast and/or ovarian cancer compared with the general population. Options to reduce the incidence of cancer and/or subsequent mortality include regular surveillance with imaging studies, chemoprevention and risk reduction surgery (RRS), i. e. risk reduction mastectomy (RRM) and risk reduction salpingo-oophorectomy (RRSO). There is a great variation in uptake of RRS in different countries. The aim of our study was to evaluate the uptake of RRS in Slovenian BRCA 1 or 2 mutation carriers with and without breast cancer. Furthermore, among patients that chose RRM the proportion and type of breast reconstruction was analyzed. Patients and methods: Altogether 2877 individuals were counselled and 919 were tested for BRCA 1 and 2 and other high penetrance gene mutations at our institute until May 2015. 586 individuals tested positive. Male patients, patients lost from follow up and patients with the malignancy other than breast were excluded from the current analysis. 383 patients were included in this study and were divided in two groups: women with and without breast cancer. Chi square test was used to compare the proportion of RRS, RRM and RRSO between groups. Results: Of 383 patients included, 213 (55.6%) had breast cancer and 170 (44.4%) didn’t have. 112 of 213 (52.6%) patients with and 38 of 170 (22.4%) patients without breast cancer underwent RRM (p < 0.0001). Of 213 patients with breast cancer, 129 (60.6%) chose RRSO, while in patients without breast cancer the proportion of RRSO was 64/170 (37.6%) (p < 0.0001). Uptake of any type of RRS was 157/213 (73.7%) and 75/ 170 (44.1%) in patients with and without breast cancer, respectively (p < 0.0001). Of 150 patients that underwent RRM, 121 (80.7%) had breast reconstruction. The majority (88/121, 72.7%) had implant based reconstruction. Autologous reconstruction was performed in 28/121 (23.1%), while 5 patients (4%) had combination of implant based and autologous reconstruction. Conclusions: Patients with breast cancer significantly more often choose to undergo RRS than patients without breast cancer. The uptake rate of RRS in both groups is comparable to the rate in developed countries. The majority of patients that undergo RRM also choose breast reconstruction. Conflict of interest: No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2016.06.170
239. Technical feasibility and validity of sentinel lymph node biopsy after ipsilateral breast tumor recurrence A. Matsumoto1, H. Jinno1, M. Takahashi2, T. Hayashida2, Y. Kitagawa2 1 Teikyo University School of Medicine, Department of Surgery, Tokyo, Japan 2 Keio University School of Medicine, Department of Surgery, Tokyo, Japan Background: Ipsilateral breast tumor recurrence (IBTR) after breast econserving surgery is reported approximately 10% of breast cancer patients. However, the role of sentinel lymph node biopsy (SLNB) in patients with IBTR still remains to be elucidated. The aim of this study was to evaluate feasibility and validity of sentinel lymph node biopsy for ipsilateral breast tumor recurrence (second SLNB). Material and methods: A prospective database of 1172 patients with clinically node-negative breast cancer who underwent SLNB from January 2005 to December 2013 was analyzed and 35 patients with IBTR underwent SLNB. Lymphatic mapping was performed using a combined method of blue dye and radioisotope. ICG fluorescence imaging was performed in cases with failure of identification by blue dye and radioisotope. Results: Twenty-two (62.9%) and eight (22.9%) patients had a history of previous SLNB and axillary lymph node dissection (ALND), respectively. Another five (14.3%) patients had no previous axillary surgery for
ABSTRACTS primary tumors. Preoperative lymphatic mapping by lymphoscintigraphy was successful in 15 of 25 patients (60.0%). The identification rate by lymphoscintigraphy among patients with previous SLNB, ALND, and no previous axillary surgery was 56.3% (9/16), 57.1% (4/7) and 100% (2/2), respectively (P ¼ 0.682). Overall, SLNs were successfully identified in 28 (80.0%) of 35 patients during surgery. The identification rate in patients with previous SLNB, ALND and no axillary surgery was 81.8% (18/22), 75% (6/8) and 80% (4/5), respectively (P ¼ 0.52). In each patient after previous SLNB and ALND, SLNs were identified only by ICG fluorescence. Aberrant drainage outside the ipsilateral axilla was found more frequently in patients with previous ALND compared with previous SLNB and no axillary treatment (37.5% vs 4.5% vs 0%, P ¼ 0.048). Among two (7.1%) patients with SLN metastases, one with previous SLNB had macrometastasis at the ipsilateral axilla and ALND found a positive non-SLN (1/ 21). The other with previous ALND had micrometastatic SLN at the contralateral axilla, identified by ICG fluorescence, and underwent no further axillary treatment. After second SLNB, systemic treatment including chemotherapy, endocrine therapy and trastuzumab was performed for 12 (34.3%), 27 (77.1%) and five (14.3%) patients, respectively. No axillary recurrence was observed after a median follow-up of 40.3 months from surgery for IBTR. Conclusions: Second SLNB is technically feasible and may avoid complications from unnecessary ALND for IBTR. Furthermore, it could improve risk prediction for IBTR and provide valid information for deciding adjuvant therapy. Conflict of interest: No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2016.06.171
240. Short-term outcome and QoL in 108 patients after immediate breast reconstruction with implants and acellular dermis V. Bjelic-Radisic Medical University Graz, Gynecology- Breast Unit, Graz, Austria Background: In postmastectomy breast reconstruction acellular dermal matrices are used for tissue support, implant positioning, rapid revascularization and esthetic results. Material and methods: We assessed peri- and post-operative results and quality of life (QoL) in 108 breast cancer patients undergoing immediate postmastectomy breast reconstruction with implants and acellular dermal matrices between 2012 and 2015. The EORTC QLQ C30, EORTC QLQ BR23 and BRR31 QoL questionnaires were used. Results: The median follow-up of the 108 patients was 14 months. 7 patients had preoperative irradiation. 14 patients had a prophylactic skinsparing mastectomy. The median hospital stay/drainage was 5 days. Complications occurred in 9 cases: wound healing problems (4), implant dislocation (1), seroma (1), hematoma (4), infection (2). Three implants had to be removed (all in patients after radiation therapy). QoL and satisfaction data were similar to those in a healthy population (reference data). Conclusion: Our results are consistent with previously published data. Complications and reoperations were more common in patients after radiation therapy. Despite better materials and operative technique, prior radiation therapy is a risk factor at immediate breast reconstruction. Conflict of interest: No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2016.06.172
241. Electrochemotherapy as palliative treatment in patients with skin metastases M. Wichtowski1, D. Murawa1, R. Czarnecki2, W. Witkiewicz2 1 Oncological and General Surgery Ward I- the Greater Poland Cancer Center- Poznan- Poland, Oncological and General Surgery Ward I, Poznan, Poland