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29. Oncoplastic lumpectomy with LICAP perforator flap reconstruction + SLNB
ABSTRACTS
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14 September 2016 14:00e15:30 Abstract Video Session 2 9 . O n c o p l a s t i c l u mp e c t o m y wi t h L I C A P p e r fo r a t o r fl a p reconstruction + SLNB A. Zhygulin LISOD Israeli Cancer Care Hospital, Breast Unit, Kiev, Ukraine The 44 years old female with B-cup breasts applied to our hospital for examination with complaints for a tumor about 3 cm in the left breast. Mammography, US with core biopsy, chest and abdomen CT and bone scintigraphy were performed. Metastases were not found. Pathology report: Poorly differentiated invasive ductal carcinoma of the left breast with strong estrogen and progesterone receptor expression and absence of Her2/neu, Ki67-40%. Presurgery diagnosis: Invasive ductal carcinoma of the left breast cT2(3sn)N0M0G3, Ki67-40%, ER+++, PR+++, Her2/neu e negative, 2A stage. After discussion the type of surgery with patient, she chose breast conservation. Due to the tumor and breast size ratio and young age of the patient, we offered the neoadjuvant chemotherapy. Treatment plan: 1. Neoadjuvant chemotherapy: AC (4 cycles) + Taxol-weekly (12 cycles). 2. Oncoplastic lumpectomy with SLNB. 3. External beam radiotherapy to the left breast at a total dose of 50 Gy. 4. Tamoxifen for 5 years During neoadjuvant chemotherapy we performed intraparenchymal marking of the tumor by titanium clip. We received partial response for the treatment. Before the surgery MRI of the breast was performed. We decided to do oncoplastic lumpectomy with LICAP-flap reconstruction + SLNB. We also used US for the measuring the tumor borders and for the marking of perforator vessels in the axillary region before the surgery. The surgery was performed according to the plan. Lateral contour approach for the breast was used. After subdermal tumor removing we had made X-ray control of the specimen and made sure that titanium clip was removed. Weight of specimen was 48 grams. We also colored and checked the surgical margins histopathologically during the surgery and made sure that margins were clear. We used LICAP flap from the axillary region with addition of the thoracica lateralis branch. The flap was mobilized, deepidermized and moved to the defect. Wound margins in the axillary region were widely mobilized, modified and closed. Postsurgery diagnosis: Invasive ductal carcinoma of the left breast cT2(3sn)/ypTis(2,5sn)G2N0(0/3sn)M0G3, Ki67-40%, R0, ER+++, PR+++, Her2/neu e negative, 2A stage. We present photo of all stages of the treatment e initial view of the patient in standard positions with the borders of the tumor, presurgery markings and view in 1 month after surgery. Conflict of interest: No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2016.06.035
30. Complete diaphragmatic peritonectomy in the treatment of advanced ovarian cancer A.L. Komorowski1, P. Blecharz2, W. Szatkowski2, M. Jasiowka2 1 Maria Curie Sklodowska Institute, Department of Surgical Oncology Cancer Centre, Krakow, Poland 2 Maria Curie Sklodowska Institute, Department of Gynecology Oncology Cancer Centre, Krakow, Poland
Background: Complete peritonectomy in advanced ovarian cancer is currently the treatment of choice for chemotherapy naive, selected patients. However, due to the circulation pattern of peritoneal fluid the majority of patients require extensive right diaphragmatic peritonectomy with partial diaphragmatic resection. Although the technique itself is relatively easy, it is not well known to the majority of surgical oncologists, who are usually called for this part of operation by the gynecology oncology team. Methods: In our institution we have started an advanced ovarian cancer team comprising both gyneco-oncologists and surgical oncologists. All patients are qualified for surgery and operated upon by the same team. The pelvic part of peritonectomy is done by gynecologists whit surgical assistance and diaphragmatic part by a surgeon with gynecologist assistance. Results: Complete or near complete (R0 or R1) peritonectomy have been performed in 7 patients. Intraoperative complications included small bowel injury, bleeding from liver parenchyma, uretheral and vesical injury. No injury to hepatic veins, IVC nor hilar structures occurred. In the postoperative period we have seen one intestinal leak requiring reoperation, one evisceration requiring two reoperations and one case of incarcerated diaphragmatic hernia requiring surgery. All patients experienced right pleural effusion managed conservatively. No bile leaks nor late bleedings were seen. Conclusion: Complete diaphragmatic peritonectomy is a relatively safe and simple procedure and could be performed by a mixed gyneco-surgical team. Conflict of interest: No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2016.06.036
31. The technique of en block resection of pelvic peritoneum, uterus, adnexa and rectum from the retroperitoneal approach is effective in pelvic complete cytoreduction in patients with advanced ovarian cancer P. Blecharz1, J.J. Sznurkowski2, A. Komorowski3, W. Lobaziewicz3, W. Szatkowski1, M. Jasiowka1 1 Cancer Center e M. Sklodowska-Curie Memorial Institute e Cracow Branch, Gynecologic Oncology, Krakow, Poland 2 Medical University of Gdansk, Surgical Oncology, Gdansk, Poland 3 Cancer Center e M. Sklodowska-Curie Memorial Institute e Cracow Branch, Surgical Oncology, Krakow, Poland Background: The goal of surgical treatment for advanced ovarian cancer (AOC) is so called “optimal cytoreduction”, defined as residual disease smaller than 1 cm (R1). However, no macroscopic residual disease (R0) yields superior results in terms of survival. The cytoreductive complex surgeries in AOC include pelvic, retroperitoneal, intestinal and upper abdomen procedures. The pelvic procedure, described as en block resection of pelvic peritoneum, uterus, adnexa and rectum form the retroperitoneal approach (“modified posterior exenteration”) allows to achieve pelvic R0 cytoreduction. Aim of the study: The aim of the study was to asses the feasibility and tolerance of the procedure in the AOC patients. Materials and methods: Thirty-six patients with AOC, FIGO stages IIIeIII were treated with modified posterior exenteration between 2013 and 2015. The protocol of the procedure was as follows: 1. Deperitonisation of the urinary bladder 2. Deperitonisation of the pelvic parietal peritoneum
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14 September 2016 14:00e15:30 Abstract Video Session 2 9 . O n c o p l a s t i c l u mp e c t o m y wi t h L I C A P p e r fo r a t o r fl a p reconstruction + SLNB A. Zhygulin LISOD Israeli Cancer Care Hospital, Breast Unit, Kiev, Ukraine The 44 years old female with B-cup breasts applied to our hospital for examination with complaints for a tumor about 3 cm in the left breast. Mammography, US with core biopsy, chest and abdomen CT and bone scintigraphy were performed. Metastases were not found. Pathology report: Poorly differentiated invasive ductal carcinoma of the left breast with strong estrogen and progesterone receptor expression and absence of Her2/neu, Ki67-40%. Presurgery diagnosis: Invasive ductal carcinoma of the left breast cT2(3sn)N0M0G3, Ki67-40%, ER+++, PR+++, Her2/neu e negative, 2A stage. After discussion the type of surgery with patient, she chose breast conservation. Due to the tumor and breast size ratio and young age of the patient, we offered the neoadjuvant chemotherapy. Treatment plan: 1. Neoadjuvant chemotherapy: AC (4 cycles) + Taxol-weekly (12 cycles). 2. Oncoplastic lumpectomy with SLNB. 3. External beam radiotherapy to the left breast at a total dose of 50 Gy. 4. Tamoxifen for 5 years During neoadjuvant chemotherapy we performed intraparenchymal marking of the tumor by titanium clip. We received partial response for the treatment. Before the surgery MRI of the breast was performed. We decided to do oncoplastic lumpectomy with LICAP-flap reconstruction + SLNB. We also used US for the measuring the tumor borders and for the marking of perforator vessels in the axillary region before the surgery. The surgery was performed according to the plan. Lateral contour approach for the breast was used. After subdermal tumor removing we had made X-ray control of the specimen and made sure that titanium clip was removed. Weight of specimen was 48 grams. We also colored and checked the surgical margins histopathologically during the surgery and made sure that margins were clear. We used LICAP flap from the axillary region with addition of the thoracica lateralis branch. The flap was mobilized, deepidermized and moved to the defect. Wound margins in the axillary region were widely mobilized, modified and closed. Postsurgery diagnosis: Invasive ductal carcinoma of the left breast cT2(3sn)/ypTis(2,5sn)G2N0(0/3sn)M0G3, Ki67-40%, R0, ER+++, PR+++, Her2/neu e negative, 2A stage. We present photo of all stages of the treatment e initial view of the patient in standard positions with the borders of the tumor, presurgery markings and view in 1 month after surgery. Conflict of interest: No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2016.06.035
30. Complete diaphragmatic peritonectomy in the treatment of advanced ovarian cancer A.L. Komorowski1, P. Blecharz2, W. Szatkowski2, M. Jasiowka2 1 Maria Curie Sklodowska Institute, Department of Surgical Oncology Cancer Centre, Krakow, Poland 2 Maria Curie Sklodowska Institute, Department of Gynecology Oncology Cancer Centre, Krakow, Poland
Background: Complete peritonectomy in advanced ovarian cancer is currently the treatment of choice for chemotherapy naive, selected patients. However, due to the circulation pattern of peritoneal fluid the majority of patients require extensive right diaphragmatic peritonectomy with partial diaphragmatic resection. Although the technique itself is relatively easy, it is not well known to the majority of surgical oncologists, who are usually called for this part of operation by the gynecology oncology team. Methods: In our institution we have started an advanced ovarian cancer team comprising both gyneco-oncologists and surgical oncologists. All patients are qualified for surgery and operated upon by the same team. The pelvic part of peritonectomy is done by gynecologists whit surgical assistance and diaphragmatic part by a surgeon with gynecologist assistance. Results: Complete or near complete (R0 or R1) peritonectomy have been performed in 7 patients. Intraoperative complications included small bowel injury, bleeding from liver parenchyma, uretheral and vesical injury. No injury to hepatic veins, IVC nor hilar structures occurred. In the postoperative period we have seen one intestinal leak requiring reoperation, one evisceration requiring two reoperations and one case of incarcerated diaphragmatic hernia requiring surgery. All patients experienced right pleural effusion managed conservatively. No bile leaks nor late bleedings were seen. Conclusion: Complete diaphragmatic peritonectomy is a relatively safe and simple procedure and could be performed by a mixed gyneco-surgical team. Conflict of interest: No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2016.06.036
31. The technique of en block resection of pelvic peritoneum, uterus, adnexa and rectum from the retroperitoneal approach is effective in pelvic complete cytoreduction in patients with advanced ovarian cancer P. Blecharz1, J.J. Sznurkowski2, A. Komorowski3, W. Lobaziewicz3, W. Szatkowski1, M. Jasiowka1 1 Cancer Center e M. Sklodowska-Curie Memorial Institute e Cracow Branch, Gynecologic Oncology, Krakow, Poland 2 Medical University of Gdansk, Surgical Oncology, Gdansk, Poland 3 Cancer Center e M. Sklodowska-Curie Memorial Institute e Cracow Branch, Surgical Oncology, Krakow, Poland Background: The goal of surgical treatment for advanced ovarian cancer (AOC) is so called “optimal cytoreduction”, defined as residual disease smaller than 1 cm (R1). However, no macroscopic residual disease (R0) yields superior results in terms of survival. The cytoreductive complex surgeries in AOC include pelvic, retroperitoneal, intestinal and upper abdomen procedures. The pelvic procedure, described as en block resection of pelvic peritoneum, uterus, adnexa and rectum form the retroperitoneal approach (“modified posterior exenteration”) allows to achieve pelvic R0 cytoreduction. Aim of the study: The aim of the study was to asses the feasibility and tolerance of the procedure in the AOC patients. Materials and methods: Thirty-six patients with AOC, FIGO stages IIIeIII were treated with modified posterior exenteration between 2013 and 2015. The protocol of the procedure was as follows: 1. Deperitonisation of the urinary bladder 2. Deperitonisation of the pelvic parietal peritoneum