Idam de Oliveira-Junior

Introduction: Locally advanced breast cancer (LABC) often requires extensive surgical resection, resulting in large chest wall defects that necessitate flap reconstruction. In this context, the latissimus dorsi myocutaneous flap (LDMF) is a widely used reconstructive option; however, its association with local disease control remains unclear. Methods: This retrospective study included patients who underwent mastectomy followed by LDMF reconstruction for chest wall defect closure between 2010 and 2020. Data were analyzed descriptively. Actuarial survival was estimated using the Kaplan-Meier method, and comparisons between groups were performed using the log-rank test. Results: A total of 15 patients were included, with low rates of major postoperative complications. Cases of wound dehiscence and flap necrosis were successfully managed with debridement and resuturing. Mean recurrence-free survival was 13.3 months, while the actuarial survival rates were 46.7%, 26.7%, 17.8%, 8.9% and 8.9% at 12, 24, 36, 48 and 60 months respectively. Patients who achieved complete resection (R0) demonstrated improved overall survival compared with those who underwent incomplete resections (R1/R2). Conclusion: The LDMF proved to be a safe and effective option for chest wall defect closure in patients with LABC, with improved overall survival associated with complete (R0) resection.

RESUMO Introdução: O carcinoma mamário localmente avançado (CMLA) muitas vezes requer amplas ressecções cirúrgicas, necessitando de retalhos para o fechamento do defeito torácico. Nesse contexto, o retalho miocutâneo do latíssimo do dorso (RM-LD) é uma opção amplamente utilizada; entretanto, é desconhecida a sua associação com o controle local da doença. Metodologia: Estudo retrospectivo que incluiu pacientes submetidas à mastectomia com RM-LD para fechamento do defeito torácico, no período de 2010 a 2020. Os dados foram apresentados de maneira descritiva. A sobrevida atuarial foi estimada pelo método de Kaplan-Meier, e a comparação entre os grupos foi realizada pelo teste de log-rank. Resultados: Foram incluídas 15 pacientes, com baixas taxas de complicações; os casos de deiscência e necrose foram resolvidos por debridamento e ressutura. A sobrevida média livre de recorrência foi de 13,3 meses, e a sobrevida atuarial global foi de 46,7%, 26,7%, 17,8%, 8,9% e 8,9% aos 12, 24, 36, 48 e 60 meses, respectivamente. Pacientes com ressecção completa (R0) apresentaram melhor sobrevida global em comparação com aquelas com ressecções incompletas (R1/R2). Conclusão: O RM-LD mostrou-se seguro no fechamento do defeito torácico em pacientes com CMLA, com melhor sobrevida global quando obtida ressecção completa (R0).

Sentinel Lymph Node (SLN) mapping is a highly accurate method for assessing axillary status in breast cancer, using various tracers such as Patent Blue, Technetium-99 m, Indocyanine Green, and Superparamagnetic Iron Oxide Nanoparticles. Despite its efficacy, there is limited literature on the costs of these procedures, prompting this study. The objective was to conduct a micro-costing and cost-effectiveness analysis of Sentinel Lymph Node Biopsy (SLNB) using Patent Blue (BD), Technetium-99 m (99mTc), and Indocyanine Green (ICG), estimating costs for a nonprofit institution over time. An economic evaluation using microcosting, cost-effectiveness, and financial impact analysis calculated direct medical and non-medical costs for approximately 100 procedures. The sensitivity analysis varied costs by ± 20%. Results showed the cost per procedure as US$ 67.71 for BD, US$ 88.31 for 99mTc, and US$ 134.98 for ICG, leading to annual costs of US$ 6,771.50, US$ 8,831.09, and US$ 13,498.38, respectively. For institutions with a Nuclear Center, 99mTc is more cost-effective than ICG, which incurs an additional US$ 51.48 per extra unit of effect with similar migration rates (96.5% vs. 97.3%). For institutions without a Nuclear Center, ICG is recommended over BD, despite an additional US$ 58.34 per unit of effect, due to a higher tracer migration rate (97.3% vs. 87.5%). Technetium-99 m is the preferred tracer for institutions with a Nuclear Medicine center due to its cost-effectiveness, offering higher accuracy and lower costs compared to Indocyanine Green, while Patent Blue, though cheaper, may lead to additional treatment costs due to its lower accuracy.

Introduction: Compared to mastectomy, breast-conserving surgery (BCS) guarantees equivalent local control and survival, with lower morbidity and better quality of life (QOL), even in the long term. However, some BCS patients consider the cosmetic result to be unsatisfactory, which may affect QOL.Material and methods: This prospective, cross-sectional study included patients who underwent BCS. The patients answered the European Organization for Research and Treatment of Cancer Quality of Life questionnaire (EORTC QLQ) - C30, EORTC QLQ-BR23 and Breast Cancer Treatment Outcome Scale (BCTOS) questionnaires, underwent cosmetic breast self-assessment and had their breasts photographed. The photographs were analyzed using Breast Cancer Conservative Treatment. Cosmetic results (BCCT.core). For the categorical variables, the frequencies were calculated; for the numerical variables, the mean and standard deviation. The BCCT.core results were compared with the cosmetic results of the patients, which yielded four possible results: concordant satisfaction, discordant satisfaction, concordant dissatisfaction and discordant dissatisfaction (satisfactory BCCT.core evaluation but patient dissatisfaction). The kappa test was used for agreement between categorical variables. Student’s t test and Mann-Whitney were used to assess the relationship between QOL and cosmetic results. The ANOVA were performed with the adjusted Bonferroni correction to compare the four groups.Results: A total of 300 patients were evaluated, 298 underwent self-assessment of the breasts (76.8% satisfactory results and 23.2% unsatisfactory) and 297 underwent BCCT.core evaluation (29.9% satisfactory results and 79.1% unsatisfactory), which had a kappa of 0.095 (p = 0.01). In the self-assessment, patients with unsatisfactory cosmetic results had worse overall health, physical, functional, emotional, cognitive, and social capacity, fatigue, pain, dyspnea, financial difficulties, body image; future prospects, side effects, breast symptoms, functional aspects, cosmetics and edema. When we used software evaluation, these relationships did not have the same proportions. In patients with “discordant dissatisfaction”, higher pain scores and worse functionality on the treated side were found.Conclusion: An unsatisfactory cosmetic result was associated with worse QOL, which may be associated with other factors, such as breast pain and functionality.

Introduction: Oncoplastic surgery (OS) has expanded the indications for breast-conserving surgery associated with an adequate aesthetic result. However, few studies have described the factors associated with unsatisfactory cosmetic outcomes from this surgical modality.Materials and methods: This is a cross-sectional prospective study that included patients undergoing breast-conserving surgery (BCS) with or without OS. The patients self-evaluated the cosmetic results of the breasts posttreatment and had them photographed. The photos were analyzed by BCCT.core. Individual and treatment factors (local and systemic) for all patients were evaluated. These factors were dichotomized according to the use of OS and to the cosmetic result (satisfactory and unsatisfactory). Categorical variables were tested for association with surgical outcome using the chi-square test while numerical variables using the Mann−Whitney U test. Variables with p <0,2 were selected for multivariate analysis.Results: Of the 300 patients evaluated, 72 (24,0%) underwent OS. According to the patient self-evaluations, an unsatisfactory cosmetic result from OS was significantly associated with younger age at diagnosis, higher body mass index (BMI) at the time of evaluation, larger tumor size and greater weight of the surgical specimen. According to the BCCT.core, only the laterality of the tumor (left) was significantly associated with an unsatisfactory cosmetic result. In logistic regression, considering OS as a control variable, the risk of an unsatisfactory outcome according to patient self-evaluation was related to the tumor ≥ T2 odds ratio (OR) 1,85 (1,027-3,34) and age at diagnosis < 40 [OR 5,0 (1,84-13,95)]. However, according to the software, the variables were associated with an increased risk of an unsatisfactory outcome were the time interval between surgery and evaluation [OR 1,27 (1,16-1,39)], the presence of lymphedema [OR 2,97 (1,36-6,46)], surgical wound infection [OR 3,6 (1,22-11,16)], tumor location on the left side [OR 3,06 (1,69-5,53)], overweight [OR 2,93 (1,48-5,8)] and obesity [OR 2,52 (1,2-5,31)].Conclusion: There is no standard methodology for breast cosmesis evaluation, which influences the factors associated with unsatisfactory results. Younger patients and those with increased BMI, left breast cancer and extensive resections tend to present with unsatisfactory cosmetic results when OS is performed.