PDF(Pubmed)
Abstract：
UNASSIGNED: A growing need for proper geriatric assessment and short-stay surgical programs supported by the availability of less invasive approaches, even in ambulatory settings, is being recognized as a feasible option for breast cancer patients with comorbidities who are usually distressed after standard surgery with ordinary hospitalization. Few studies have been conducted in Italian breast centers with dedicated techniques and approach for frail patients with breast diseases due to a jeopardized approach to ambulatory surgery among institutions.
UNASSIGNED: This study included 58 women diagnosed with breast disease and comorbidities between March 2019 and December 2022 at the Ambulatory of Senology of San Giacomo Hospital in Novi Ligure (AL, Italy) and Civil Hospital in Ovada (AL, Italy). The patients were evaluated by a multidisciplinary consensus according to the guidelines provided to limit sentinel lymph node biopsy (SLNB) in older women. This kind of ambulatory surgery technique has been designed for i) patients with advanced age and/or comorbidities, ii) frail patients who psychologically do not accept other kinds of surgery, iii) patients who do not require SLNB, and iv) patients who need a surgical biopsy for lesions classified as B3 or small lesions with dubious radiological imaging. With this technique, the quadrant and whole breast may be removed in an outpatient setting with local anesthesia to limit blood loss by immediately cutting and suturing small portions of the gland. Local anesthetic infiltration is sequential and occurs stepwise before providing short passages of approximately 2 cm during resection and immediately suturing the surgical wound. This overclock technique, named \"Cut&Sew,\" requires no more than 20-25 min and allows for a 1-2 h patient discharge with no drainage. The follow-up period was set at 60 months during routine yearly visits.
UNASSIGNED: The patients were older or super-older with most primary pT1/pT2 tumors and ductal type cancers, which were distributed in molecular subtypes Luminal A (37.1 %) and Luminal B (41.5 % Luminal B, with 11.2 % being HER2 positive). The tumour grade was mostly G2-G3. Mastectomy was performed in 10 patients, whereas quadrantectomy was performed in 48 patients, with the majority of tumors localized in Q1.While accompanied by a relative or a caregiver, all 58 patients acceded the \"Cut&Sew\" surgical technique in an ambulatory setting reporting negligible pain during the surgery and no pain within 10 days post-surgery. No post-operative complications or readmissions were recorded, and no discomfort or recurrence was detected during scheduled visits. Finally, the extent of satisfaction with the overall surgery was recorded immediately and corroborated by most patients during the follow-up period.
UNASSIGNED: Although the small volume of cases collected does not allow for a controlled study necessary to evaluate the safety and efficacy of this technique for approaching frail and older women with comorbidities, through the \"Cut&Sew\" surgical technique, frail, older, and super older patients may benefit from a minimal psychological impact of surgery, while improving the patients\' disease-free life so to corroborate the advised surgical de-escalation but avoiding undertreatment for this kind of patient category. Moreover, a stricter assessment of patient pain and overall satisfaction with the collection of a larger amount of reliable data could allow this technique to be extended to frail and/or older patients as a valuable and safe alternative to the more common hospitalization with general anesthesia. Other advantages include reduced hospitalization costs for sanitary structures.
UNASSIGNED: This study included 58 women diagnosed with breast disease and comorbidities between March 2019 and December 2022 at the Ambulatory of Senology of San Giacomo Hospital in Novi Ligure (AL, Italy) and Civil Hospital in Ovada (AL, Italy). The patients were evaluated by a multidisciplinary consensus according to the guidelines provided to limit sentinel lymph node biopsy (SLNB) in older women. This kind of ambulatory surgery technique has been designed for i) patients with advanced age and/or comorbidities, ii) frail patients who psychologically do not accept other kinds of surgery, iii) patients who do not require SLNB, and iv) patients who need a surgical biopsy for lesions classified as B3 or small lesions with dubious radiological imaging. With this technique, the quadrant and whole breast may be removed in an outpatient setting with local anesthesia to limit blood loss by immediately cutting and suturing small portions of the gland. Local anesthetic infiltration is sequential and occurs stepwise before providing short passages of approximately 2 cm during resection and immediately suturing the surgical wound. This overclock technique, named \"Cut&Sew,\" requires no more than 20-25 min and allows for a 1-2 h patient discharge with no drainage. The follow-up period was set at 60 months during routine yearly visits.
UNASSIGNED: The patients were older or super-older with most primary pT1/pT2 tumors and ductal type cancers, which were distributed in molecular subtypes Luminal A (37.1 %) and Luminal B (41.5 % Luminal B, with 11.2 % being HER2 positive). The tumour grade was mostly G2-G3. Mastectomy was performed in 10 patients, whereas quadrantectomy was performed in 48 patients, with the majority of tumors localized in Q1.While accompanied by a relative or a caregiver, all 58 patients acceded the \"Cut&Sew\" surgical technique in an ambulatory setting reporting negligible pain during the surgery and no pain within 10 days post-surgery. No post-operative complications or readmissions were recorded, and no discomfort or recurrence was detected during scheduled visits. Finally, the extent of satisfaction with the overall surgery was recorded immediately and corroborated by most patients during the follow-up period.
UNASSIGNED: Although the small volume of cases collected does not allow for a controlled study necessary to evaluate the safety and efficacy of this technique for approaching frail and older women with comorbidities, through the \"Cut&Sew\" surgical technique, frail, older, and super older patients may benefit from a minimal psychological impact of surgery, while improving the patients\' disease-free life so to corroborate the advised surgical de-escalation but avoiding undertreatment for this kind of patient category. Moreover, a stricter assessment of patient pain and overall satisfaction with the collection of a larger amount of reliable data could allow this technique to be extended to frail and/or older patients as a valuable and safe alternative to the more common hospitalization with general anesthesia. Other advantages include reduced hospitalization costs for sanitary structures.
摘要：
■对适当的老年评估和短期手术计划的需求不断增长，并得到侵入性较小的方法的支持，即使在非卧床环境中，对于患有合并症的乳腺癌患者来说，这是一种可行的选择，这些患者通常在标准手术和普通住院后感到痛苦。由于机构之间的门诊手术方法受到危害，因此在意大利乳腺中心进行的研究很少有针对脆弱的乳腺疾病患者的专用技术和方法。
■这项研究包括了在2019年3月至2022年12月期间在诺维利古尔圣贾科莫医院的Senology门诊诊断出患有乳腺疾病和合并症的58名妇女（AL，意大利）和奥瓦达（AL，意大利）。根据限制老年女性前哨淋巴结活检（SLNB）的指南，通过多学科共识对患者进行评估。这种门诊手术技术是为i)高龄和/或合并症患者设计的，ii)心理上不接受其他手术的虚弱患者，iii）不需要SLNB的患者，和iv)需要对分类为B3的病变或具有可疑放射成像的小病变进行手术活检的患者。有了这项技术,在门诊患者中，可以在局部麻醉下切除象限和整个乳房，以通过立即切割和缝合小部分腺体来限制失血。局部麻醉浸润是连续的,并且在切除期间提供大约2cm的短通道并立即缝合手术伤口之前逐步发生。这种超频技术，名为\"剪切和缝纫，“需要不超过20-25分钟，并且允许1-2小时的患者出院而没有引流。在常规年度访视期间，随访期定为60个月。
■患者年龄较大或超高龄，患有大多数原发性pT1/pT2肿瘤和导管型癌症，其分子亚型分布在LuminalA(37.1%)和LuminalB(41.5%LuminalB,11.2%为HER2阳性)。肿瘤分级主要为G2-G3。对10例患者进行了乳房切除术，而48例患者进行了四肢切除术，大多数肿瘤位于Q1。在亲属或看护人的陪同下，所有58例患者均在非卧床环境中接受了“切割和缝合”手术技术，报告手术过程中疼痛可忽略不计，术后10天内无疼痛。无术后并发症或再入院记录，在定期访视期间未发现不适或复发.最后,在随访期间,大多数患者立即记录并证实了对整体手术的满意程度.
尽管收集的病例数量较少，但无法进行必要的对照研究，以评估该技术对患有合并症的体弱和老年妇女的安全性和有效性，通过“切割和缝合”手术技术，脆弱,年长的,超级老年患者可能受益于手术的最小心理影响，同时改善患者的无病生活，以证实建议的手术降级，但避免此类患者的治疗不足。此外，对患者疼痛进行更严格的评估,以及对收集更多可靠数据的总体满意度,可以将该技术推广到体弱和/或老年患者,作为更常见的全身麻醉住院的一种有价值且安全的替代方案.其他优点包括降低卫生结构的住院费用。
■这项研究包括了在2019年3月至2022年12月期间在诺维利古尔圣贾科莫医院的Senology门诊诊断出患有乳腺疾病和合并症的58名妇女（AL，意大利）和奥瓦达（AL，意大利）。根据限制老年女性前哨淋巴结活检（SLNB）的指南，通过多学科共识对患者进行评估。这种门诊手术技术是为i)高龄和/或合并症患者设计的，ii)心理上不接受其他手术的虚弱患者，iii）不需要SLNB的患者，和iv)需要对分类为B3的病变或具有可疑放射成像的小病变进行手术活检的患者。有了这项技术,在门诊患者中，可以在局部麻醉下切除象限和整个乳房，以通过立即切割和缝合小部分腺体来限制失血。局部麻醉浸润是连续的,并且在切除期间提供大约2cm的短通道并立即缝合手术伤口之前逐步发生。这种超频技术，名为\"剪切和缝纫，“需要不超过20-25分钟，并且允许1-2小时的患者出院而没有引流。在常规年度访视期间，随访期定为60个月。
■患者年龄较大或超高龄，患有大多数原发性pT1/pT2肿瘤和导管型癌症，其分子亚型分布在LuminalA(37.1%)和LuminalB(41.5%LuminalB,11.2%为HER2阳性)。肿瘤分级主要为G2-G3。对10例患者进行了乳房切除术，而48例患者进行了四肢切除术，大多数肿瘤位于Q1。在亲属或看护人的陪同下，所有58例患者均在非卧床环境中接受了“切割和缝合”手术技术，报告手术过程中疼痛可忽略不计，术后10天内无疼痛。无术后并发症或再入院记录，在定期访视期间未发现不适或复发.最后,在随访期间,大多数患者立即记录并证实了对整体手术的满意程度.
尽管收集的病例数量较少，但无法进行必要的对照研究，以评估该技术对患有合并症的体弱和老年妇女的安全性和有效性，通过“切割和缝合”手术技术，脆弱,年长的,超级老年患者可能受益于手术的最小心理影响，同时改善患者的无病生活，以证实建议的手术降级，但避免此类患者的治疗不足。此外，对患者疼痛进行更严格的评估,以及对收集更多可靠数据的总体满意度,可以将该技术推广到体弱和/或老年患者,作为更常见的全身麻醉住院的一种有价值且安全的替代方案.其他优点包括降低卫生结构的住院费用。
