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Objetivo: el cáncer de seno en hombres es un diagnóstico subestimado y el tratamiento de elección es la mastectomía. Se han descrito diferentes técnicas quirúrgicas, entre ellas: la cirugía conservadora de mama en comparación con mastectomía simple, sin embargo, aún se desconoce la efectividad real de estas técnicas frente a la menor cantidad de complicaciones. Así que se pretendió evaluar sistemáticamente la literatura científica sobre la efectividad de estas 2 técnicas. Metodología: revisión sistemática de la literatura hasta noviembre del 2022, donde se siguió la metodología Prisma de Cochrane. Se evaluó la mejor evidencia disponible sobre la efectividad de la cirugía conservadora de mama al compararla con la mastectomía tradicional. Otros desenlaces evaluados fueron la sobrevida global y sobrevida libre de enfermedad. Resultados: de 1054 estudios iniciales, 7 cumplieron criterios para su selección y análisis. Ambas técnicas mostraron efectividad adecuada. En cuanto supervivencia libre de enfermedad, tanto a 5 como a 10 años, y supervivencia global no hubo significancia estadística entre las 2 técnicas quirúrgicas. Se evidenciaron más desenlaces negativos cosméticos y funcionales en la mastectomía. Conclusiones: la cirugía conservadora de mama es una opción que se debe considerar en hombres con cáncer de mama, ya que (respecto a supervivencia libre de enfermedad y supervivencia global) no hay diferencia estadística frente a la mastectomía y puede tener mejores desenlaces cosméticos. El papel de la radioterapia adyuvante es tema de nuevos estudios adicionales.

Purpose: The use of advanced energy devices for mastectomy and axillary lymph node dissection can reduce perioperative blood loss, seroma formation, and drainage duration/volume. Retraction using fiberoptic retractors can help visualize deep and narrow surgical fields. We aimed to compare the postoperative outcomes between single-incision breast-conserving surgery (SIBCS) and conventional breast-conserving surgery (CBCS) with axillary staging using advanced energy devices and conventional equipment, respectively. Materials and Methods: We retrospectively reviewed the medical records of 244 patients who underwent BCS with axillary surgery between March 2018 and September 2019 at Severance Hospital. The patients were grouped based on the device used to aid in axillary staging: CBCS group (n=117) used conventional electrocautery; and SIBCS group (n=127) used advanced energy devices and fiberoptic retractors. The two groups were compared for postoperative outcomes. Results: The mean patient age was 55.9 and 53.1 years in the CBCS and SIBCS groups, respectively. Incision size was significantly smaller in the SIBCS group than in the CBCS group (6.3±2.1 cm vs. 7.5±2.5 cm, p=0.044). There were no significant differences between the two groups in terms of operating time (126.0±40.0 min vs. 127.0±63.0 min, p=0.828), operative blood loss (11.0±31.0 mL vs. 7.0±18.0 mL, p=0.100), drainage duration (7.0±3.0 d vs. 8.0±4.0 d, p=0.288), and complications (1.70% vs. 2.36%, p=0.523). Conclusion: Using advanced energy devices for SIBCS with axillary staging reduced incision size and provided better cosmetic outcomes compared to those using the conventional method. Advanced energy devices may offer better surgical outcomes in patients who undergo BCS with axillary staging. [ABSTRACT FROM AUTHOR]

Background: Recent data suggest that breast-conserving surgery (BCS) may positively impact overall survival (OS) in early breast cancer. However, the role of BCS in locally advanced breast cancer (LABC) following neoadjuvant therapy (NAT) remains uncertain. Methods: We conducted a retrospective cohort study involving 530 LABC patients who underwent surgery after NAT between 2010 and 2015. Outcomes examined included OS, distant recurrence rates (DRR), and locoregional recurrence rates (LRRs). Results: Among the 927 breast cancer patients who received NAT, 530 were eligible for our study. Of these, 24.6% underwent BCS, while 75.4% underwent mastectomy (MS). The median follow-up duration was 79 months. BCS patients exhibited a higher pathological complete response (PCR) rate compared to those who underwent MS (22.3% vs. 10%, p < 0.001). The 6-year OS rates for BCS and MS were 81.5% and 62%, respectively (p < 0.000). In multivariate OS analysis, MS was associated with worse outcomes (OR 1.678; 95% CI 1.069-2.635; p = 0.024), as was body mass index (BMI) (OR 1.031; 95% CI 1.006-1.058; p = 0.017), and stage IIIB or IIIC (OR 2.450; 95% CI 1.561-3.846; p < 0.000). Conversely, PCR (OR 0.42; 95% CI 0.220-0.801; p = 0.008) was associated with improved survival. DRR was significantly lower in BCS (15.4%) compared to MS (36.8%) (OR 0.298; 95% CI 0.177-0.504). LRRs were comparable between BCS (9.2%) and MS (9.5%) (OR 0.693; 95% CI 0.347-1.383). Conclusion: Our findings suggest that BCS is oncologically safe, even for patients with large lesions, and is associated with superior OS rates compared to MS. Additionally, lower BMI, lower pretreatment stage, and achieving PCR were associated with improved survival outcomes. [ABSTRACT FROM AUTHOR]

BackgroundRecent data suggest that breast-conserving surgery (BCS) may positively impact overall survival (OS) in early breast cancer. However, the role of BCS in locally advanced breast cancer (LABC) following neoadjuvant therapy (NAT) remains uncertain.MethodsWe conducted a retrospective cohort study involving 530 LABC patients who underwent surgery after NAT between 2010 and 2015. Outcomes examined included OS, distant recurrence rates (DRR), and loco-regional recurrence rates (LRRs).ResultsAmong the 927 breast cancer patients who received NAT, 530 were eligible for our study. Of these, 24.6% underwent BCS, while 75.4% underwent mastectomy (MS). The median follow-up duration was 79 months. BCS patients exhibited a higher pathological complete response (PCR) rate compared to those who underwent MS (22.3% vs. 10%, p < 0.001). The 6-year OS rates for BCS and MS were 81.5% and 62%, respectively (p < 0.000). In multivariate OS analysis, MS was associated with worse outcomes (OR 1.678; 95% CI 1.069–2.635; p = 0.024), as was body mass index (BMI) (OR 1.031; 95% CI 1.006–1.058; p = 0.017), and stage IIIB or IIIC (OR 2.450; 95% CI 1.561–3.846; p < 0.000). Conversely, PCR (OR 0.42; 95% CI 0.220–0.801; p = 0.008) was associated with improved survival. DRR was significantly lower in BCS (15.4%) compared to MS (36.8%) (OR 0.298; 95% CI 0.177–0.504). LRRs were comparable between BCS (9.2%) and MS (9.5%) (OR 0.693; 95% CI 0.347–1.383).ConclusionOur findings suggest that BCS is oncologically safe, even for patients with large lesions, and is associated with superior OS rates compared to MS. Additionally, lower BMI, lower pretreatment stage, and achieving PCR were associated with improved survival outcomes.

Abstract Objective Nipple-sparing mastectomy (NSM) has been traditionally used in selected cases with tumor-to-nipple distance > 2 cm and negative frozen section of the base of the nipple. Recommending NSM in unselected populations remains controversial. The present study evaluated the oncological outcomes of patients submitted to NSM in an unselected population seen at a single center. Methods This retrospective cohort study included unselected patients with invasive carcinoma or ductal carcinoma in situ (DCIS) who underwent NSM in 2010 to 2020. The endpoints were locoregional recurrence, disease-free survival (DFS), and overall survival (OS), irrespective of tumor size or tumor-to-nipple distance. Results Seventy-six patients (mean age 46.1 years) (58 invasive carcinomas/18 DCIS) were included. The most invasive carcinomas were hormone-positive (60%) (HER2 overexpression: 24%; triple-negative: 16%), while 39% of DCIS were high-grade. Invasive carcinomas were T2 in 66% of cases, with axillary metastases in 38%. Surgical margins were all negative. All patients with invasive carcinoma received systemic treatment and 38% underwent radiotherapy. After a mean of 34.8 months, 3 patients with invasive carcinoma (5.1%) and 1 with DCIS (5.5%) had local recurrence. Two patients had distant metastasis and died during follow-up. The 5-year OS and DFS rates for invasive carcinoma were 98% and 83%, respectively. Conclusion In unselected cases, the 5-year oncological outcomes following NSM were found to be acceptable and comparable to previous reports. Further studies are required.

Background: Survival after breast conserving surgery (BCS) vs. modified radical mastectomy (MRM) is a controversial issue. In this study, we want to compare the disease-free survival (DFS) of women who underwent BCS with those treated by MRM.Method: In this historical cohort study, a total of 1097 women who were diagnosed with breast cancer between 2001 and 2007 and received modified MRM or BCS were entered into the study and followed up to March 2017. Kaplan-Meier estimator and extended cox model, and Cox proportional hazards model with propensity score weighting were implemented to compare overall survival between two groups.Results: A total of 283 women with a maximum follow-up of 11.1 years and age 47.17 ± 11.278 were met the inclusion criteria. The results of the extended cox model did not show any difference between the survival of two groups (P = 0.35). After implementing the Cox model with propensity score weighting, the inferences remained unchanged (P = 0.67).Conclusion: The patients treated with BCS tend to have the same DFS rate as those who underwent a mastectomy in a randomized controlled trial-like setting using propensity score weighting.

Background: Survival after breast conserving surgery (BCS) vs. modified radical mastectomy (MRM) is a controversial issue. In this study, we want to compare the disease-free survival (DFS) of women who underwent BCS with those treated by MRM. Method: In this historical cohort study, a total of 1097 women who were diagnosed with breast cancer between 2001 and 2007 and received modified MRM or BCS were entered into the study and followed up to March 2017. Kaplan-Meier estimator and extended cox model, and Cox proportional hazards model with propensity score weighting were implemented to compare overall survival between two groups. Results: A total of 283 women with a maximum follow-up of 11.1 years and age 47.17 ± 11.278 were met the inclusion criteria. The results of the extended cox model did not show any difference between the survival of two groups (P = 0.35). After implementing the Cox model with propensity score weighting, the inferences remained unchanged (P = 0.67). Conclusion: The patients treated with BCS tend to have the same DFS rate as those who underwent a mastectomy in a randomized controlled trial-like setting using propensity score weighting. [ABSTRACT FROM AUTHOR]

Background: This study aimed to review specific indications of radiation therapy for triple-negative breast cancer (TNBC), and to introduce the hypothesis of TNBC as an independent predictor for postmastectomy radiation therapy (PMRT ). Materials and methods: Two reviewers independently searched two electronic databases (Pubmed and Embase), with the inclusion dates of January 2000 to December 2021, for the following terms: “mastectomy” or “breast conserving surgery” or “lumpectomy”, and “radiation” or “radiotherapy”, and “triple negative” and “recurrence”. All evidence was explored by two reviewers, then organized into a narrative review considering grades of recommendation. Results: Patients with TNBC are candidates for breast conserving surgery (grade of recommendation B). Postoperative whole-breast irradiation must be offered following breast conserving surgery (grade of recommendation A). Do not omit postoperative radiation therapy in older patients with TNBC (grade of recommendation B). Do not use partial-breast irradiation in patients with TNBC (grade of recommendation B). Postmastectomy radiation therapy should be offered for women with T3–T4 or node- positive TNBC, for any number of positive nodes (grade of recommendation A). Radiation therapy following mastectomy might also benefit patients with T1–T2 node-negative TNBC (grade of recommendation B). For patients treated with neoadjuvant systemic therapy, radiation therapy indication is based on pretreatment features. Retrospective studies suggest that residual TNBC is sensitive to radiation therapy to optimize locoregional control (grade of recommendation C). Conclusions: Postoperative radiation therapy should be offered for most patients with TNBC. Upcoming studies, preferably prospective randomized trials, should evaluate the indications of radiation therapy, especially in the context of novel systemic treatments. [ABSTRACT FROM AUTHOR]

Purpose: The use of advanced energy devices for mastectomy and axillary lymph node dissection can reduce perioperative blood loss, seroma formation, and drainage duration/volume. Retraction using fiberoptic retractors can help visualize deep and narrow surgical fields. We aimed to compare the postoperative outcomes between single-incision breast-conserving surgery (SIBCS) and conventional breast-conserving surgery (CBCS) with axillary staging using advanced energy devices and conventional equipment, respectively., Materials and Methods: We retrospectively reviewed the medical records of 244 patients who underwent BCS with axillary surgery between March 2018 and September 2019 at Severance Hospital. The patients were grouped based on the device used to aid in axillary staging: CBCS group (n=117) used conventional electrocautery; and SIBCS group (n=127) used advanced energy devices and fiberoptic retractors. The two groups were compared for postoperative outcomes., Results: The mean patient age was 55.9 and 53.1 years in the CBCS and SIBCS groups, respectively. Incision size was significantly smaller in the SIBCS group than in the CBCS group (6.3±2.1 cm vs. 7.5±2.5 cm, p =0.044). There were no significant differences between the two groups in terms of operating time (126.0±40.0 min vs. 127.0±63.0 min, p =0.828), operative blood loss (11.0±31.0 mL vs. 7.0±18.0 mL, p =0.100), drainage duration (7.0±3.0 d vs. 8.0±4.0 d, p =0.288), and complications (1.70% vs. 2.36%, p =0.523)., Conclusion: Using advanced energy devices for SIBCS with axillary staging reduced incision size and provided better cosmetic outcomes compared to those using the conventional method. Advanced energy devices may offer better surgical outcomes in patients who undergo BCS with axillary staging., Competing Interests: Hyung Seok Park has received honoraria from AstraZeneca, Takeda, Ethicon, Medtronic, and Intuitive Surgical. The rest of co-authors have no conflict of interest to disclose., (© Copyright: Yonsei University College of Medicine 2024.)

Background: Recent data suggest that breast-conserving surgery (BCS) may positively impact overall survival (OS) in early breast cancer. However, the role of BCS in locally advanced breast cancer (LABC) following neoadjuvant therapy (NAT) remains uncertain., Methods: We conducted a retrospective cohort study involving 530 LABC patients who underwent surgery after NAT between 2010 and 2015. Outcomes examined included OS, distant recurrence rates (DRR), and loco-regional recurrence rates (LRRs)., Results: Among the 927 breast cancer patients who received NAT, 530 were eligible for our study. Of these, 24.6% underwent BCS, while 75.4% underwent mastectomy (MS). The median follow-up duration was 79 months. BCS patients exhibited a higher pathological complete response (PCR) rate compared to those who underwent MS (22.3% vs. 10%, p < 0.001). The 6-year OS rates for BCS and MS were 81.5% and 62%, respectively ( p < 0.000). In multivariate OS analysis, MS was associated with worse outcomes (OR 1.678; 95% CI 1.069-2.635; p = 0.024), as was body mass index (BMI) (OR 1.031; 95% CI 1.006-1.058; p = 0.017), and stage IIIB or IIIC (OR 2.450; 95% CI 1.561-3.846; p < 0.000). Conversely, PCR (OR 0.42; 95% CI 0.220-0.801; p = 0.008) was associated with improved survival. DRR was significantly lower in BCS (15.4%) compared to MS (36.8%) (OR 0.298; 95% CI 0.177-0.504). LRRs were comparable between BCS (9.2%) and MS (9.5%) (OR 0.693; 95% CI 0.347-1.383)., Conclusion: Our findings suggest that BCS is oncologically safe, even for patients with large lesions, and is associated with superior OS rates compared to MS. Additionally, lower BMI, lower pretreatment stage, and achieving PCR were associated with improved survival outcomes., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Nobrega, Mota, de Freitas, Maesaka, Mota, Goncalves, Trinconi, Ricci, Piato, Soares-Jr, Baracat and Filassi.)

Background: The Geometric Compensation Technique (GCT) and the Split Reduction Technique (SRT) enables breast conserving surgery (BCS) in selected patients with breast cancer initially candidates to mastectomy., Methods: Observational study of patients with breast cancer who underwent GCT consecutively treated. Evaluated retrospectively: indications, clinical characteristics, surgical features and recurrences. Cosmesis were evaluated prospectively by the BCCT.core software, Harris/Harvard and Garbay scales. Descriptive statistics were performed, chi-square test was used to compare aesthetic outcomes; Kappa and Weighted Kappa test was used to assess agreement between the postoperative evaluations; Kaplan-Meier model for follow-up and recurrence. A systematic review was carried out using PRISMA methodology., Results: Thirty-six patients were evaluated, 26 (72.2%) with medium/large breasts with or without ptosis, seven (19.4%) with small breasts with or without ptosis, a profile undergoing GCT not previously identified in the literature. The mean tumor clinical size was 3.65 ± 1.59 cm. 34 (94.4%) patients underwent GCT. Mean follow-up time was 36.6 ± 16.8 months, with no local recurrences. According to BCCT.core, the postoperative aesthetic was good in 17 (51.5%) patients and 11 (33.3%) was reasonable. In the systematic review, 3.584 articles were evaluated, 20 articles were selected, 243 patients undergoing GCT were found, with several indications for BCS instead of mastectomy, with high rates of free margins, low recurrence and good aesthetic outcomes., Conclusion: GCT, an oncologically safe and aesthetically satisfactory option, has been extended to patients with small and medium breasts with ptosis, large tumors to breast volume or in unfavorable resection sites, initially candidates for mastectomy., Competing Interests: Declaration of competing interest The authors declare no conflicts of interest., (Copyright © 2022 Elsevier Ltd. All rights reserved.)