Luciano Ipólito Branquinho

Although standard chemotherapy for three to four cycles followed by surgery is considered safe and effective in the management of advanced ovarian cancer, the impact of extending treatment beyond this period remains uncertain. Some authors suggest that the number of neoadjuvant chemotherapy cycles does not directly affect prognosis and may reflect a confounding bias. Others, however, indicate that a prolonged exposure to chemotherapy can promote the selection of resistant tumor clones, negatively influencing patient survival and disease progression. This review aims to summarize the current evidence on the topic, evaluating the effect of prolonged chemotherapy on surgical cytoreduction and survival. To achieve this, we conducted an analysis of the English-language literature available in PubMed, focusing on treatment duration, achievement of complete surgical resection, survival outcomes, and prognostic factors.

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).

The authors presented a case of a patient with locally advanced breast cancer, with mammary and axillary localization, initially considered non-resectable, with good response after neoadjuvant chemotherapy. Due to the location of the lesion and the need for extensive resection, radical mastectomy was performed, associated with reconstruction with myocutaneous flap of the vertical rectus abdominis muscle. Different therapeutic options, the reasons that determine this choice, and local long-term control were discussed.

Revista Online - Surgical & Cosmetic Dermatology | Publicação oficial da Sociedade Brasileira de Dermatologia, a segunda maior sociedade dermatológica do mundo com mais de 5.000 associados, o periódico Surgical & Cosmetic Dermatology, editada em 2009, constitui publicação médica destinada a difundir a experiência brasileira nas áreas de Cirurgia Dermatológica e Cosmiatria. É uma publicação trimestral das Sociedades Brasileiras de Dermatologia e de Cirurgia Dermatológica.

Revista Online - Surgical & Cosmetic Dermatology | Publicação oficial da Sociedade Brasileira de Dermatologia, a segunda maior sociedade dermatológica do mundo com mais de 5.000 associados, o periódico Surgical & Cosmetic Dermatology, editada em 2009, constitui publicação médica destinada a difundir a experiência brasileira nas áreas de Cirurgia Dermatológica e Cosmiatria. É uma publicação trimestral das Sociedades Brasileiras de Dermatologia e de Cirurgia Dermatológica.