Immediate microsurgical breast reconstruction and simultaneous sentinel lymph node dissection: issues with node positivity and recipient vessel selection.
Identifieur interne : 004E30 ( Main/Exploration ); précédent : 004E29; suivant : 004E31Immediate microsurgical breast reconstruction and simultaneous sentinel lymph node dissection: issues with node positivity and recipient vessel selection.
Auteurs : Michael S. Curtis [États-Unis] ; Brian Arslanian ; Salih Colakoglu ; Adam M. Tobias ; Bernard T. LeeSource :
- Journal of reconstructive microsurgery [ 1098-8947 ] ; 2011.
Descripteurs français
- KwdFr :
- Adulte d'âge moyen, Aisselle, Anastomose chirurgicale, Artères mammaires (), Biopsie de noeud lymphatique sentinelle, Carcinomes (), Femelle, Humains, Lambeaux chirurgicaux (), Lymphadénectomie, Mammoplastie, Mastectomie, Microchirurgie, Métastase lymphatique, Tumeurs du sein (), Études rétrospectives.
- MESH :
English descriptors
- KwdEn :
- Anastomosis, Surgical, Axilla, Breast Neoplasms (surgery), Carcinoma (surgery), Female, Humans, Lymph Node Excision, Lymphatic Metastasis, Mammaplasty, Mammary Arteries (surgery), Mastectomy, Microsurgery, Middle Aged, Retrospective Studies, Sentinel Lymph Node Biopsy, Surgical Flaps (blood supply).
- MESH :
- blood supply : Surgical Flaps.
- surgery : Breast Neoplasms, Carcinoma, Mammary Arteries.
- Anastomosis, Surgical, Axilla, Female, Humans, Lymph Node Excision, Lymphatic Metastasis, Mammaplasty, Mastectomy, Microsurgery, Middle Aged, Retrospective Studies, Sentinel Lymph Node Biopsy.
Abstract
Sentinel lymph node dissection (SLND) during mastectomy has been increasing given the decreased risk of lymphedema. Simultaneous reconstruction with a microsurgical breast reconstruction is often performed, but with node positivity a completion axillary lymph node dissection (ALND) must be performed subsequently. This study examines the potential risks especially in relation to microsurgical reconstruction. All patients undergoing microsurgical breast reconstruction at an academic institution from 2004 to 2010 were evaluated in a prospective database. Patients with immediate reconstruction and SLND were identified. Management of positive lymph node status was ascertained through extensive chart review. There were 610 reconstructions performed, 170 delayed and 440 immediate. From the immediate reconstructions, 110 patients (25%) had SLND and of these patients, 16 (14.55%) had a positive SLND. All 16 patients had internal mammary recipient vessels for free tissue transfer. Seven patients had intraoperative completion ALND, while nine patients had staged completion ALND at a later date. There were no adverse affects from completion ALND. Simultaneous mastectomy, SLND, and microsurgical reconstruction can be performed safely. The internal mammary vessels are preferred recipient vessels as node positive patients may require subsequent completion ALND. If a thoracodorsal anastomosis is performed, a potential risk exists for vessel injury and flap loss with completion ALND.
DOI: 10.1055/s-0031-1281513
PubMed: 21717397
Affiliations:
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Curtis</name><affiliation wicri:level="2"><nlm:affiliation>Department of Surgery, State University of New York, Upstate Medical University, Syracuse, New York, USA.</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Surgery, State University of New York, Upstate Medical University, Syracuse, New York</wicri:regionArea><placeName><region type="state">État de New York</region></placeName></affiliation></author><author><name sortKey="Arslanian, Brian" sort="Arslanian, Brian" uniqKey="Arslanian B" first="Brian" last="Arslanian">Brian Arslanian</name></author><author><name sortKey="Colakoglu, Salih" sort="Colakoglu, Salih" uniqKey="Colakoglu S" first="Salih" last="Colakoglu">Salih Colakoglu</name></author><author><name sortKey="Tobias, Adam M" sort="Tobias, Adam M" uniqKey="Tobias A" first="Adam M" last="Tobias">Adam M. Tobias</name></author><author><name sortKey="Lee, Bernard T" sort="Lee, Bernard T" uniqKey="Lee B" first="Bernard T" last="Lee">Bernard T. 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Curtis</name><affiliation wicri:level="2"><nlm:affiliation>Department of Surgery, State University of New York, Upstate Medical University, Syracuse, New York, USA.</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Surgery, State University of New York, Upstate Medical University, Syracuse, New York</wicri:regionArea><placeName><region type="state">État de New York</region></placeName></affiliation></author><author><name sortKey="Arslanian, Brian" sort="Arslanian, Brian" uniqKey="Arslanian B" first="Brian" last="Arslanian">Brian Arslanian</name></author><author><name sortKey="Colakoglu, Salih" sort="Colakoglu, Salih" uniqKey="Colakoglu S" first="Salih" last="Colakoglu">Salih Colakoglu</name></author><author><name sortKey="Tobias, Adam M" sort="Tobias, Adam M" uniqKey="Tobias A" first="Adam M" last="Tobias">Adam M. Tobias</name></author><author><name sortKey="Lee, Bernard T" sort="Lee, Bernard T" uniqKey="Lee B" first="Bernard T" last="Lee">Bernard T. Lee</name></author></analytic><series><title level="j">Journal of reconstructive microsurgery</title><idno type="eISSN">1098-8947</idno><imprint><date when="2011" type="published">2011</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Anastomosis, Surgical</term><term>Axilla</term><term>Breast Neoplasms (surgery)</term><term>Carcinoma (surgery)</term><term>Female</term><term>Humans</term><term>Lymph Node Excision</term><term>Lymphatic Metastasis</term><term>Mammaplasty</term><term>Mammary Arteries (surgery)</term><term>Mastectomy</term><term>Microsurgery</term><term>Middle Aged</term><term>Retrospective Studies</term><term>Sentinel Lymph Node Biopsy</term><term>Surgical Flaps (blood supply)</term></keywords><keywords scheme="KwdFr" xml:lang="fr"><term>Adulte d'âge moyen</term><term>Aisselle</term><term>Anastomose chirurgicale</term><term>Artères mammaires ()</term><term>Biopsie de noeud lymphatique sentinelle</term><term>Carcinomes ()</term><term>Femelle</term><term>Humains</term><term>Lambeaux chirurgicaux ()</term><term>Lymphadénectomie</term><term>Mammoplastie</term><term>Mastectomie</term><term>Microchirurgie</term><term>Métastase lymphatique</term><term>Tumeurs du sein ()</term><term>Études rétrospectives</term></keywords><keywords scheme="MESH" qualifier="blood supply" xml:lang="en"><term>Surgical Flaps</term></keywords><keywords scheme="MESH" qualifier="surgery" xml:lang="en"><term>Breast Neoplasms</term><term>Carcinoma</term><term>Mammary Arteries</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Anastomosis, Surgical</term><term>Axilla</term><term>Female</term><term>Humans</term><term>Lymph Node Excision</term><term>Lymphatic Metastasis</term><term>Mammaplasty</term><term>Mastectomy</term><term>Microsurgery</term><term>Middle Aged</term><term>Retrospective Studies</term><term>Sentinel Lymph Node Biopsy</term></keywords><keywords scheme="MESH" xml:lang="fr"><term>Adulte d'âge moyen</term><term>Aisselle</term><term>Anastomose chirurgicale</term><term>Artères mammaires</term><term>Biopsie de noeud lymphatique sentinelle</term><term>Carcinomes</term><term>Femelle</term><term>Humains</term><term>Lambeaux chirurgicaux</term><term>Lymphadénectomie</term><term>Mammoplastie</term><term>Mastectomie</term><term>Microchirurgie</term><term>Métastase lymphatique</term><term>Tumeurs du sein</term><term>Études rétrospectives</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Sentinel lymph node dissection (SLND) during mastectomy has been increasing given the decreased risk of lymphedema. Simultaneous reconstruction with a microsurgical breast reconstruction is often performed, but with node positivity a completion axillary lymph node dissection (ALND) must be performed subsequently. This study examines the potential risks especially in relation to microsurgical reconstruction. All patients undergoing microsurgical breast reconstruction at an academic institution from 2004 to 2010 were evaluated in a prospective database. Patients with immediate reconstruction and SLND were identified. Management of positive lymph node status was ascertained through extensive chart review. There were 610 reconstructions performed, 170 delayed and 440 immediate. From the immediate reconstructions, 110 patients (25%) had SLND and of these patients, 16 (14.55%) had a positive SLND. All 16 patients had internal mammary recipient vessels for free tissue transfer. Seven patients had intraoperative completion ALND, while nine patients had staged completion ALND at a later date. There were no adverse affects from completion ALND. Simultaneous mastectomy, SLND, and microsurgical reconstruction can be performed safely. The internal mammary vessels are preferred recipient vessels as node positive patients may require subsequent completion ALND. If a thoracodorsal anastomosis is performed, a potential risk exists for vessel injury and flap loss with completion ALND.</div></front></TEI><affiliations><list><country><li>États-Unis</li></country><region><li>État de New York</li></region></list><tree><noCountry><name sortKey="Arslanian, Brian" sort="Arslanian, Brian" uniqKey="Arslanian B" first="Brian" last="Arslanian">Brian Arslanian</name><name sortKey="Colakoglu, Salih" sort="Colakoglu, Salih" uniqKey="Colakoglu S" first="Salih" last="Colakoglu">Salih Colakoglu</name><name sortKey="Lee, Bernard T" sort="Lee, Bernard T" uniqKey="Lee B" first="Bernard T" last="Lee">Bernard T. Lee</name><name sortKey="Tobias, Adam M" sort="Tobias, Adam M" uniqKey="Tobias A" first="Adam M" last="Tobias">Adam M. Tobias</name></noCountry><country name="États-Unis"><region name="État de New York"><name sortKey="Curtis, Michael S" sort="Curtis, Michael S" uniqKey="Curtis M" first="Michael S" last="Curtis">Michael S. Curtis</name></region></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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