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Long-term results of physical and operative treatment of secondary arm lymphedema in patients with early breast cancer
15th St.Gallen International Breast Cancer Conference / The Breast 32S1 (2017) S78–S132
P302 Long-term results of physical and operative treatment of secondary arm lymphedema in patients with early breast cancer D. Sidorov1 *, T. Grushina2. 1Moscow Regional Oncology Center, Moscow, Russian Federation, 2Moscow Scientific-Practical Center of Medical Rehabilitation Rehabilitation and Sports Medicine, Moscow, Russian Federation Aims: Radical treatment of early breast cancer significantly prolongs life in patients, but reduces its quality due to the developing of postoperative arm lymphedema. Studying the long-term results of physical and operative treatment of secondary arm lymphedema in patients with early breast cancer. Methods: 50 early breast cancer patients with late secondary lymphedema of I–IV degrees, aged 30–69 years, firstly were receiving the local low-intensity and low-frequency electro- and magnetotherapy, pneumatic compression, manual lymphatic drainage, exercise programs during 15 days, then the subcutaneous surgical correction (hydroblasting-assisted liposuction) was conducted. Results: The evaluation of treatment results: arm volume measurement with simplified water displacement instrument and ultrasound of the soft tissues state, psychological lymphedema-related distress and quality of life – MOSSF-36. The immediate results of arm volume reduction: lymphedema of I degree–reduced by 92.0 ± 10.0%, II d. – 82.0 ± 5.6%, III d. 70.1 ± 6.8%, IV d.- 61.0 ± 6.6% ( p < 0.05) respectively. The long-term results of treatment (after 12–36 months): arm volume for all degrees of lymphedema reduced by 50–75% (good result) in 78%, by 25–50% (satisfactory result) in 22% patients. According to ultrasound, subcutaneous fat of entire upper extremity reduced from baseline on average by 29.5%, with the most expressed changes in forearm and hand (35.7%) ( p < 0.05), echogenicity of tissues decreased, improved theirs contrast and differentiation, reduced the number of interstices liquid structures. In accordance with the Clavien-Dindorating scale in 5 (10%) patients the complications of subcutaneous surgical correction of I degree were observed. Functional correlates of general quality of life: in patients with a good result the general quality of life pursuant to the all scales of MOS SF36 was 72.25 points, with a satisfactory result- 61.25 points, while in the normal population- 86.88 points. Monitoring of patients within 5 years showed that physical and operative treatment did not have a negative impact on course of early breast cancer. Conclusions: This preliminary research has allowed reducing the severity of late secondary arm lymphedema and improving the quality of life related to health inpatients with early breast cancer without worsening results of cancer treatment. The study will continue to a larger number of patients with long-term followcompliance with the requirements and standards of Good Clinical Practice (GCP). Disclosure of Interest: No significant relationships. P303 Remote pathological examination for confirming negative margin in breast conservation surgery M. Suzuki1 *, M. Nakai2, H. Takei2, H. Nanjo3, T. Sugiyama3. 1Breast Center, Kitamurayama Hospital, Higashine, Japan, 2Department of Breast Surgery, Nippon Medical School, Japan, 3AKH Research Center, Japan Aims: During breast conservation surgery, surgeons must confirm that surgical margins are pathologically negative for cancer cells. The margin status serves as a surrogate marker of residual disease in the breast and has an impact on patient risk of breast cancer recurrence. Therefore, surgeons should inspect the surgical margin during operation. However, some general hospitals have no pathologists to examine the surrounding rim of resected breast tissue, including our hospital (Kitamurayama Hospital). Recently, we have established an internet-based remote pathological examination system for inspection of surgical margin by cooperating with an off-site
S123
pathology laboratory (AKH Research Center). In this study, we analyzed the results of the remote examination and verified the usefulness of it. Methods: Breast conservation surgery was conducted in our hospital using the remote examination for analysis of surgical margins in 130 breast cancer cases. We counted the number of cases in which we performed additional resection due to margins found to be positive in order to achieve negative margins. We also tried to ensure that the results of remote examination conducted intraoperatively using the cryosection method matched the results of postoperative examination using the formalin fixation method. Results: In the first resected surgical margins, pathologically negative results were obtained in 93 of the 130 cases (71.5%), while 37 cases (28.5%) showed positive results. In those 37 positive cases, 33 cases underwent additional resection until negative margins were confirmed, but the remaining 4 cases (3.1%) were converted to mastectomy. As many as 126 cases (96.9%) with negative results in the first or final resected margins were able to avoid mastectomy. Only one case was postoperatively verified to be positive, while other 125 cases were postoperatively negative. Hence, the diagnostic concordance rate was 99.2%. Conclusion: A remote pathological examination with the cooperation of a pathology laboratory proved very useful for our hospital in confirming pathologically negative margins during breast conservation surgery. The remote pathological examination system enables surgeons to perform smaller partial resections to avoid mastectomy, and the system gives patients better outcomes even in hospitals that have no pathologists. Furthermore, the system may help to correct operational disparities between hospitals, between regions, and even between countries. Disclosure of Interest: No significant relationships. P304 Present status and outcome of immediate breast reconstruction after mastectomy at single institution in Japan S. Takayama*, T. Kinoshita, S. Asaga, K. Jimbo, S. Shiino, E. Iwamoto, T. Kurihara, K. Ogisawa, M. Yoshikawa, S. Miyamoto. National Cancer Center Hospital, Tokyo, Japan Aims: Since the approval of insurance indication of tissue expander (TE) and silicone implant (SI) for breast reconstruction in July 2013, the number of cases who are performed mastectomy and immediate reconstruction at the same time are increasing in Japan. The aim was to retrospectively examine the present status and outcome such as complications of mastectomy and immediate breast reconstruction in our institution. Methods: Of the 626 primary breast cancers operated in National Cancer Center Hospital, Tokyo, Japan from January to December in 2015, 131 patients (20.8%) who underwent immediate breast reconstruction after mastectomy were reviewed. We retrospectively examine patient clinicopathological characteristic, surgical procedure and outcome such as complications from medical records, and statistically analyzed. Results: The number of cases of immediate reconstruction in our hospital was 65 cases in 2013, 75 cases in 2014, and it was nearly doubled in 2015. Among 131 cases, TE was 115 cases and autologous tissue reconstruction was 16 cases (Deep Inferior Epigastric Perforator flap (DIEP): 10 cases, Latisimus Dorsi muscle transfer flap (LD): 5 cases, Inferior Gluteal Artery Perforator flap (IGAP): 1 case). There was no difference in the patient characteristic between the group who underwent TE reconstruction and the group that underwent autologous tissue reconstruction at the immediate reconstruction. There were no serious complications in 16 cases of autologous tissue reconstruction. Of the 114 patients who underwent TE reconstruction, 35 cases (30.7%) had complications such as infection, ischemia, skin necrosis, and 8 cases (7.0%) required removal of TE. Risk factors for complications in TE reconstruction were body mass index (BMI), surgical procedure (NSM: nipple
P302 Long-term results of physical and operative treatment of secondary arm lymphedema in patients with early breast cancer D. Sidorov1 *, T. Grushina2. 1Moscow Regional Oncology Center, Moscow, Russian Federation, 2Moscow Scientific-Practical Center of Medical Rehabilitation Rehabilitation and Sports Medicine, Moscow, Russian Federation Aims: Radical treatment of early breast cancer significantly prolongs life in patients, but reduces its quality due to the developing of postoperative arm lymphedema. Studying the long-term results of physical and operative treatment of secondary arm lymphedema in patients with early breast cancer. Methods: 50 early breast cancer patients with late secondary lymphedema of I–IV degrees, aged 30–69 years, firstly were receiving the local low-intensity and low-frequency electro- and magnetotherapy, pneumatic compression, manual lymphatic drainage, exercise programs during 15 days, then the subcutaneous surgical correction (hydroblasting-assisted liposuction) was conducted. Results: The evaluation of treatment results: arm volume measurement with simplified water displacement instrument and ultrasound of the soft tissues state, psychological lymphedema-related distress and quality of life – MOSSF-36. The immediate results of arm volume reduction: lymphedema of I degree–reduced by 92.0 ± 10.0%, II d. – 82.0 ± 5.6%, III d. 70.1 ± 6.8%, IV d.- 61.0 ± 6.6% ( p < 0.05) respectively. The long-term results of treatment (after 12–36 months): arm volume for all degrees of lymphedema reduced by 50–75% (good result) in 78%, by 25–50% (satisfactory result) in 22% patients. According to ultrasound, subcutaneous fat of entire upper extremity reduced from baseline on average by 29.5%, with the most expressed changes in forearm and hand (35.7%) ( p < 0.05), echogenicity of tissues decreased, improved theirs contrast and differentiation, reduced the number of interstices liquid structures. In accordance with the Clavien-Dindorating scale in 5 (10%) patients the complications of subcutaneous surgical correction of I degree were observed. Functional correlates of general quality of life: in patients with a good result the general quality of life pursuant to the all scales of MOS SF36 was 72.25 points, with a satisfactory result- 61.25 points, while in the normal population- 86.88 points. Monitoring of patients within 5 years showed that physical and operative treatment did not have a negative impact on course of early breast cancer. Conclusions: This preliminary research has allowed reducing the severity of late secondary arm lymphedema and improving the quality of life related to health inpatients with early breast cancer without worsening results of cancer treatment. The study will continue to a larger number of patients with long-term followcompliance with the requirements and standards of Good Clinical Practice (GCP). Disclosure of Interest: No significant relationships. P303 Remote pathological examination for confirming negative margin in breast conservation surgery M. Suzuki1 *, M. Nakai2, H. Takei2, H. Nanjo3, T. Sugiyama3. 1Breast Center, Kitamurayama Hospital, Higashine, Japan, 2Department of Breast Surgery, Nippon Medical School, Japan, 3AKH Research Center, Japan Aims: During breast conservation surgery, surgeons must confirm that surgical margins are pathologically negative for cancer cells. The margin status serves as a surrogate marker of residual disease in the breast and has an impact on patient risk of breast cancer recurrence. Therefore, surgeons should inspect the surgical margin during operation. However, some general hospitals have no pathologists to examine the surrounding rim of resected breast tissue, including our hospital (Kitamurayama Hospital). Recently, we have established an internet-based remote pathological examination system for inspection of surgical margin by cooperating with an off-site
S123
pathology laboratory (AKH Research Center). In this study, we analyzed the results of the remote examination and verified the usefulness of it. Methods: Breast conservation surgery was conducted in our hospital using the remote examination for analysis of surgical margins in 130 breast cancer cases. We counted the number of cases in which we performed additional resection due to margins found to be positive in order to achieve negative margins. We also tried to ensure that the results of remote examination conducted intraoperatively using the cryosection method matched the results of postoperative examination using the formalin fixation method. Results: In the first resected surgical margins, pathologically negative results were obtained in 93 of the 130 cases (71.5%), while 37 cases (28.5%) showed positive results. In those 37 positive cases, 33 cases underwent additional resection until negative margins were confirmed, but the remaining 4 cases (3.1%) were converted to mastectomy. As many as 126 cases (96.9%) with negative results in the first or final resected margins were able to avoid mastectomy. Only one case was postoperatively verified to be positive, while other 125 cases were postoperatively negative. Hence, the diagnostic concordance rate was 99.2%. Conclusion: A remote pathological examination with the cooperation of a pathology laboratory proved very useful for our hospital in confirming pathologically negative margins during breast conservation surgery. The remote pathological examination system enables surgeons to perform smaller partial resections to avoid mastectomy, and the system gives patients better outcomes even in hospitals that have no pathologists. Furthermore, the system may help to correct operational disparities between hospitals, between regions, and even between countries. Disclosure of Interest: No significant relationships. P304 Present status and outcome of immediate breast reconstruction after mastectomy at single institution in Japan S. Takayama*, T. Kinoshita, S. Asaga, K. Jimbo, S. Shiino, E. Iwamoto, T. Kurihara, K. Ogisawa, M. Yoshikawa, S. Miyamoto. National Cancer Center Hospital, Tokyo, Japan Aims: Since the approval of insurance indication of tissue expander (TE) and silicone implant (SI) for breast reconstruction in July 2013, the number of cases who are performed mastectomy and immediate reconstruction at the same time are increasing in Japan. The aim was to retrospectively examine the present status and outcome such as complications of mastectomy and immediate breast reconstruction in our institution. Methods: Of the 626 primary breast cancers operated in National Cancer Center Hospital, Tokyo, Japan from January to December in 2015, 131 patients (20.8%) who underwent immediate breast reconstruction after mastectomy were reviewed. We retrospectively examine patient clinicopathological characteristic, surgical procedure and outcome such as complications from medical records, and statistically analyzed. Results: The number of cases of immediate reconstruction in our hospital was 65 cases in 2013, 75 cases in 2014, and it was nearly doubled in 2015. Among 131 cases, TE was 115 cases and autologous tissue reconstruction was 16 cases (Deep Inferior Epigastric Perforator flap (DIEP): 10 cases, Latisimus Dorsi muscle transfer flap (LD): 5 cases, Inferior Gluteal Artery Perforator flap (IGAP): 1 case). There was no difference in the patient characteristic between the group who underwent TE reconstruction and the group that underwent autologous tissue reconstruction at the immediate reconstruction. There were no serious complications in 16 cases of autologous tissue reconstruction. Of the 114 patients who underwent TE reconstruction, 35 cases (30.7%) had complications such as infection, ischemia, skin necrosis, and 8 cases (7.0%) required removal of TE. Risk factors for complications in TE reconstruction were body mass index (BMI), surgical procedure (NSM: nipple