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P77 Synchronous bilateral breast cancer: comparison of modified radical mastectomy performed with ultrasound scalpel and electrocautery
S34
Poster Session I. Surgery/Sentinels/DCIS
for lymph node metastasis. Tamoxifen has been administered for those positive for eestrogen receptor. Results: The age of the patients ranged from 23 to 94 years, with a mean age of 55.3 years. The tumor diameter ranged from 0 to 4.5 cm (mean: 1.8 cm). For histological type, the patients were classified into 271 with invasive ductal carcinoma, 19 with intraductal carcinoma, and 20 with other types of carcinoma. For lymph node metastasis, they were classified into 237 at pN0, 49 at pN1, 22 at pN2 and 2 at pN3. For clinical staging, they were classified into 8 in Stage 0, 132 in Stage I, 159 in Stage II, and 11 in Stage III. There was no safety margin at the cut end in 12 patients. Breast cancer recurred in 6 patients (1.9%), and the first recurrence sites included bone in 3 patients, lung in 1, and local site of the cancer in 2. One case canceled radiotherapy because of a side effect in two cases that caused a local recurrence. The relapse-free rate of the patients was 98.1%, and overall survival rate 98.7% at the median follow up period of 5 years. Conclusions: The present examination showed that the breast conserving surgery provided satisfactory results when the tumor was excised with a sufficient safety margin and adjuvant chemotherapy was combined with radiotherapy.
P76 Improving cosmetic outcome in central breast cancer: The use of oncoplastic techniques F. Fitzal1 , G. Nehrer2 , O. Riedl1 , P. Dubsky1 , T. Bachleitner1 , E. Sporn1 , M. Mittlboeck3 , R. Jakesz1 , M. Gnant. 1 University Vienna Medical School, Surgery, Vienna, Austria, 2 Top Med, Vienna, Austria, 3 University Vienna Medical School, Statistic, Vienna, Austria Oncoplastic breast conserving techniques (oBCT) have been increasingly used for about 10% of breast cancer patients to improve cosmetic outcome and to increase resection margins [1]. Centrally located breast cancer usually requires mastectomy due to unfavourable cosmetic results. More over the oncologic safety of BCT for central breast cancer is still disputed. We retrospectively evaluated patients with and without centrally located breast cancer and compared between BCT and mastectomy. Additionally we used three new oBCT to improve cosmetic outcome in patients with central breast cancer. Kapplan Meier curves demonstrate no significant difference between mastectomy and BCT in central breast cancer patients for recurrence-free and overall survival. There was also no significant difference between BCT of central and non-central located breast cancer regarding oncologic outcome. The three techniques, the button close technique, the modified batwing technique and the Hall Findlay technique, will be demonstrated. All these techniques achieved excellent results. We conclude that by using oncoplastic surgery the breast of patients with central breast cancer may be conserved. References [1] 1. Clough KB: Oncoplastic surgery allows extensive resections for conservative treatment of breast cancer. In: 5th European Breast Cancer Conference 2006, Nice. Eur J Cancer 2006: 119.
P77 Synchronous bilateral breast cancer: comparison of modified radical mastectomy performed with ultrasound scalpel and electrocautery R. Matkowski1,2 , B. Szynglarewicz2 , U. Ochenduszkiewicz1,2 , P. Kasprzak3 , J. Forgacz2 , M. Pudelko2 , J. Kornafel1 . 1 Wroclaw Medical University, Department of Oncology, Wroclaw, Poland, 2 Lower Silesian Oncology Center, 2nd Department of Surgical Oncology, Wroclaw, Poland, 3 Lower Silesian Oncology Center, Department of Radiology, Wroclaw, Poland Goals: To compare the early functional results following modified radical mastectomy performed with electrocautery and ultrasound scalpel due to synchronous bilateral breast cancer. Methods: Sixty-nine years old woman was operated on due to synchronous bilateral breast cancer: II B lesion (T2N1M0) of the right breast and II A tumour (T2N0M0) of the left one. The patient underwent modified radical mastectomy performed with the ultrasound scalpel on the right side and with traditional unipolar electrocautery on the left side by the same surgical team. Therefore, patient- and surgeon-related differences between the procedures were eliminated. Results: Skin flaps preparation, breast dissection and axillary clearance were carefully done with the lack of any intraoperative complications. Perforators of the internal mammary artery were ligated. Low-suction drains were
Thursday, 15 March 2007 placed before skin closure. Operating time differed very slightly between 108 minutes with ultrasound scalpel and 103 minutes with electrocautery. The wounds were healed by primary adhesion. Neither flap necrosis nor wound infection was noticed. Drains were removed when their output was equal or less than 30 mL per day. On the right side the total amount of drainage was 265 mL and the drain was removed on the third postoperative day. Palpable seroma formation did not occur. On the left side the total amount of drainage was 680 mL while the drain had to be remained to the fifth postoperative day. Symptomatic seroma requiring aspiration developed and four punctures had to be done with the total 270 mL volume of evacuated fluid. Conclusions: The use of ultrasound scalpel can reduce the time and the total amount of drainage after modified radical mastectomy with the similar operating time when compared to electrocautery. It may be helpful for seroma prevention, probably because of less tissue damage. Its potential clinical advantages should be assessed in further studies and the costeffectiveness analysis is needed.
P78 Y-shaped incision for modified radical mastectomy with level III axillary dissection in obese woman B. Szynglarewicz1 , R. Matkowski1,2 , Z. Smorag1 , P. Kasprzak3 , J. Forgacz1 , M. Pudelko1 , J. Kornafel2 . 1 Lower Silesian Oncology Center, 2nd Department of Surgical Oncology, Wroclaw, Poland, 2 Wroclaw Medical University, Department of Oncology, Wroclaw, Poland, 3 Lower Silesian Oncology Center, Department of Radiology, Wroclaw, Poland Goals: To assess the cosmetic result and the access to axilla in obese female patient. Methods: Fifty-eight years old obese woman with body mass index above 35 underwent modified radical mastectomy due to stage II B (T2N1M0) histologically confirmed ductal breast cancer presented as a palpable mass with clinically and radiologically suspected axillary lymph nodes. Traditional transverse Stewart’s incision was modified by the adding of the Y-shaped incision at the lateral part. It resulted in construction of the triangular axillary skin flap with the apex sited near the edge of the pectoral muscles and the basis located along the posterior axillary line. Dissection was performed with electrocautery with ligation of the perforators of the internal mammary artery. Results: Preparation was performed with electrocautery. Triangular axillary flap was formed with the 12 cm-long basis and 8 cm-long limbs. When it was raised and rectracted laterally the edge of latissimus dorsi muscle was uncovered. Dissection was led carefully up to the axillary vein, which was easily seen. Complete all-level lymphatic axillary clearance was done because of the enlarged and palpable nodes at the level III. Lowsuction drains were placed. Before the wound closing the triangular flap was advanced medially whereas superior and inferior areas of redundant skin overlying the latissimus dorsi muscle were excised. The wound was healed by primary adhesion with the excellent cosmetic result. No skin flap necrosis, inflammation and wound infection were found. Neither necrosis of the apex of axillary triangle nor dog-ear deformity was noticed. Conclusions: Y-shaped incision for modified radical mastectomy gives the wide access to the axilla and can improve the cosmetic results in female patients with obesity.
P79 Five year results of Breast Conserving Surgery for early breast cancer patients V. Ostapenko1 , S. Bruzas1 , A. Mudenas1 , J. Sabonis1 , A. Jackevicius1 , P. Jelsakov1 , J. Kurtinaitis2 . 1 Vilnius University Institute of Oncology, Breast Surgery, Vilnius, Lithuania, 2 Vilnius University Institute of Oncology, Cancer register, Vilnius, Lithuania During 1999–2000 1086 pts with breast cancer underwent combined treatment at Vilnius University Institute of Oncology. The data on vital status of all pts was summarized by June, 2006. Non-systematic random sampling (each next or third pts file) was used to evaluate the treatment results of operated pts. The surgery treatment was used as primarily selection criteria. The aim of study was to evaluate the results of combined treatment of early breast cancer patients treated by breast conserving surgery and evaluate the results of multivariate analysis of local recurrences according to “pT”, “pN”, “G”, “Er”, “Pr” and primary tumour localisation in the breast. Methods and Materials: The 365 pts (33.6%) stage I−III were selected for further analysis. The median follow-up time was 74.4 month. 79.8% of pts
Poster Session I. Surgery/Sentinels/DCIS
for lymph node metastasis. Tamoxifen has been administered for those positive for eestrogen receptor. Results: The age of the patients ranged from 23 to 94 years, with a mean age of 55.3 years. The tumor diameter ranged from 0 to 4.5 cm (mean: 1.8 cm). For histological type, the patients were classified into 271 with invasive ductal carcinoma, 19 with intraductal carcinoma, and 20 with other types of carcinoma. For lymph node metastasis, they were classified into 237 at pN0, 49 at pN1, 22 at pN2 and 2 at pN3. For clinical staging, they were classified into 8 in Stage 0, 132 in Stage I, 159 in Stage II, and 11 in Stage III. There was no safety margin at the cut end in 12 patients. Breast cancer recurred in 6 patients (1.9%), and the first recurrence sites included bone in 3 patients, lung in 1, and local site of the cancer in 2. One case canceled radiotherapy because of a side effect in two cases that caused a local recurrence. The relapse-free rate of the patients was 98.1%, and overall survival rate 98.7% at the median follow up period of 5 years. Conclusions: The present examination showed that the breast conserving surgery provided satisfactory results when the tumor was excised with a sufficient safety margin and adjuvant chemotherapy was combined with radiotherapy.
P76 Improving cosmetic outcome in central breast cancer: The use of oncoplastic techniques F. Fitzal1 , G. Nehrer2 , O. Riedl1 , P. Dubsky1 , T. Bachleitner1 , E. Sporn1 , M. Mittlboeck3 , R. Jakesz1 , M. Gnant. 1 University Vienna Medical School, Surgery, Vienna, Austria, 2 Top Med, Vienna, Austria, 3 University Vienna Medical School, Statistic, Vienna, Austria Oncoplastic breast conserving techniques (oBCT) have been increasingly used for about 10% of breast cancer patients to improve cosmetic outcome and to increase resection margins [1]. Centrally located breast cancer usually requires mastectomy due to unfavourable cosmetic results. More over the oncologic safety of BCT for central breast cancer is still disputed. We retrospectively evaluated patients with and without centrally located breast cancer and compared between BCT and mastectomy. Additionally we used three new oBCT to improve cosmetic outcome in patients with central breast cancer. Kapplan Meier curves demonstrate no significant difference between mastectomy and BCT in central breast cancer patients for recurrence-free and overall survival. There was also no significant difference between BCT of central and non-central located breast cancer regarding oncologic outcome. The three techniques, the button close technique, the modified batwing technique and the Hall Findlay technique, will be demonstrated. All these techniques achieved excellent results. We conclude that by using oncoplastic surgery the breast of patients with central breast cancer may be conserved. References [1] 1. Clough KB: Oncoplastic surgery allows extensive resections for conservative treatment of breast cancer. In: 5th European Breast Cancer Conference 2006, Nice. Eur J Cancer 2006: 119.
P77 Synchronous bilateral breast cancer: comparison of modified radical mastectomy performed with ultrasound scalpel and electrocautery R. Matkowski1,2 , B. Szynglarewicz2 , U. Ochenduszkiewicz1,2 , P. Kasprzak3 , J. Forgacz2 , M. Pudelko2 , J. Kornafel1 . 1 Wroclaw Medical University, Department of Oncology, Wroclaw, Poland, 2 Lower Silesian Oncology Center, 2nd Department of Surgical Oncology, Wroclaw, Poland, 3 Lower Silesian Oncology Center, Department of Radiology, Wroclaw, Poland Goals: To compare the early functional results following modified radical mastectomy performed with electrocautery and ultrasound scalpel due to synchronous bilateral breast cancer. Methods: Sixty-nine years old woman was operated on due to synchronous bilateral breast cancer: II B lesion (T2N1M0) of the right breast and II A tumour (T2N0M0) of the left one. The patient underwent modified radical mastectomy performed with the ultrasound scalpel on the right side and with traditional unipolar electrocautery on the left side by the same surgical team. Therefore, patient- and surgeon-related differences between the procedures were eliminated. Results: Skin flaps preparation, breast dissection and axillary clearance were carefully done with the lack of any intraoperative complications. Perforators of the internal mammary artery were ligated. Low-suction drains were
Thursday, 15 March 2007 placed before skin closure. Operating time differed very slightly between 108 minutes with ultrasound scalpel and 103 minutes with electrocautery. The wounds were healed by primary adhesion. Neither flap necrosis nor wound infection was noticed. Drains were removed when their output was equal or less than 30 mL per day. On the right side the total amount of drainage was 265 mL and the drain was removed on the third postoperative day. Palpable seroma formation did not occur. On the left side the total amount of drainage was 680 mL while the drain had to be remained to the fifth postoperative day. Symptomatic seroma requiring aspiration developed and four punctures had to be done with the total 270 mL volume of evacuated fluid. Conclusions: The use of ultrasound scalpel can reduce the time and the total amount of drainage after modified radical mastectomy with the similar operating time when compared to electrocautery. It may be helpful for seroma prevention, probably because of less tissue damage. Its potential clinical advantages should be assessed in further studies and the costeffectiveness analysis is needed.
P78 Y-shaped incision for modified radical mastectomy with level III axillary dissection in obese woman B. Szynglarewicz1 , R. Matkowski1,2 , Z. Smorag1 , P. Kasprzak3 , J. Forgacz1 , M. Pudelko1 , J. Kornafel2 . 1 Lower Silesian Oncology Center, 2nd Department of Surgical Oncology, Wroclaw, Poland, 2 Wroclaw Medical University, Department of Oncology, Wroclaw, Poland, 3 Lower Silesian Oncology Center, Department of Radiology, Wroclaw, Poland Goals: To assess the cosmetic result and the access to axilla in obese female patient. Methods: Fifty-eight years old obese woman with body mass index above 35 underwent modified radical mastectomy due to stage II B (T2N1M0) histologically confirmed ductal breast cancer presented as a palpable mass with clinically and radiologically suspected axillary lymph nodes. Traditional transverse Stewart’s incision was modified by the adding of the Y-shaped incision at the lateral part. It resulted in construction of the triangular axillary skin flap with the apex sited near the edge of the pectoral muscles and the basis located along the posterior axillary line. Dissection was performed with electrocautery with ligation of the perforators of the internal mammary artery. Results: Preparation was performed with electrocautery. Triangular axillary flap was formed with the 12 cm-long basis and 8 cm-long limbs. When it was raised and rectracted laterally the edge of latissimus dorsi muscle was uncovered. Dissection was led carefully up to the axillary vein, which was easily seen. Complete all-level lymphatic axillary clearance was done because of the enlarged and palpable nodes at the level III. Lowsuction drains were placed. Before the wound closing the triangular flap was advanced medially whereas superior and inferior areas of redundant skin overlying the latissimus dorsi muscle were excised. The wound was healed by primary adhesion with the excellent cosmetic result. No skin flap necrosis, inflammation and wound infection were found. Neither necrosis of the apex of axillary triangle nor dog-ear deformity was noticed. Conclusions: Y-shaped incision for modified radical mastectomy gives the wide access to the axilla and can improve the cosmetic results in female patients with obesity.
P79 Five year results of Breast Conserving Surgery for early breast cancer patients V. Ostapenko1 , S. Bruzas1 , A. Mudenas1 , J. Sabonis1 , A. Jackevicius1 , P. Jelsakov1 , J. Kurtinaitis2 . 1 Vilnius University Institute of Oncology, Breast Surgery, Vilnius, Lithuania, 2 Vilnius University Institute of Oncology, Cancer register, Vilnius, Lithuania During 1999–2000 1086 pts with breast cancer underwent combined treatment at Vilnius University Institute of Oncology. The data on vital status of all pts was summarized by June, 2006. Non-systematic random sampling (each next or third pts file) was used to evaluate the treatment results of operated pts. The surgery treatment was used as primarily selection criteria. The aim of study was to evaluate the results of combined treatment of early breast cancer patients treated by breast conserving surgery and evaluate the results of multivariate analysis of local recurrences according to “pT”, “pN”, “G”, “Er”, “Pr” and primary tumour localisation in the breast. Methods and Materials: The 365 pts (33.6%) stage I−III were selected for further analysis. The median follow-up time was 74.4 month. 79.8% of pts