Objective To summarize the techniques for reconstruction of partial breast defects after breast-conserving surgery in breast cancer. Methods The relevant literatures were reviewed and the oncoplastic techniques and their surgical indications, incision selection, advantages， and disadvantages were summarized. Results Kinds of poor aesthetic outcomes still exist in some patients after breast-conserving surgery due to the breast deformity. How to choose the surgical incision and repair breast defects after tumor resection so as to obtain better cosmetic outcomes is still a focus of breast-conserving surgery. Oncoplastic techniques can not only achieve safe cancer treatments but also have satisfactory aesthetic outcomes. Conclusions Oncoplastic techniques in the breast conservative therapy for early stage breast cancer is a safe and effective procedure， with highly satisfactory cosmetic outcomes in the majority of patients..
ObjectiveTo summarize the research status and biological characteristics of stromal fibroblast in breast cancer. MethodsRelevant literatures about the breast cancer stromal fibroblasts published recently were collected and reviewed. ResultsIn addition to cancer cells, breast cancer included stromal cells. The fibroblasts were the major components of breast cancer stromal, which had significantly different biological characteristics from normal fibroblasts. The fibroblasts were characterized by α-SMA positive, p53 gene mutation, secretion of various cytokines or chemokines in addition to the production of collagen substances, involving in breast cancer growth, migration, invasion and metastasis through a variety of signaling pathways. ConclusionThe biological characteristics of stromal fibroblasts in breast cancer may reflect lesion properties, be of great importance to diagnosis and differential diagnosis and prognosis prediction of breast cancer. More attentions will be paid to the target therapy for stromal fibroblasts in breast cancer.
ObjectiveTo introduce the research status of the immunoregulation function of cancer-associated fibroblasts (CAFs) in tumor microenvironment.MethodThe literatures in recent years on the studies of role of CAFs in the regulation of immune response in the tumor microenvironment were collected and summarized.ResultsThe CAFs played a critical role as the components of the tumor microenvironment. The CAFs could product various growth factors and cytokines that were contributed to the immunoregulation including the polarization of the immune cells and the regulation of the function of immune cells in the tumor microenvironment and eventually resulted in the carcinogenesis, tumor progression, invasion, metastasis and therapy resistance.ConclusionCAFs play a significant role in the immunoregulation in tumor microenvironment, but as a potential target for breast cancer, more studies are still needed to discover the specific markers, heterogeneity, and key signaling pathways.
ObjectiveTo investigate the anatomy and function of pectoralis fascia in breast cancer operation, and the choice of resection and preservation of pectoralis fascia in different operation methods.MethodWe searched the articles related to pectoralis fascia and breast cancer through PubMed, Web of Science, EBSCO, WanFang Medical Network, SinoMed, and other databases, and then selected the Chinese and foreign articles that met the objective of this paper, and made an review after reading the articles.ResultsIn the immediate breast reconstruction of breast prosthesis after breast cancer operation, the preservation of pectoralis fascia was beneficial to the complete coverage of breast prosthesis and improved the cosmetic effect after operation. The purpose of preserving pectoralis fascia adipose tissue in breast-conserving surgery was to reduce the loss of breast volume and to pursue the cosmetic effect after operation. At present, there had been reports on the safety of pectoralis fascia oncology, but there was no final conclusion on the safe distance between tumor and pectoralis fascia, and the current research could not provide sufficient evidence for the preservation of pectoralis fascia.ConclusionsThe question of whether the pectoralis fascia needs to be removed in breast cancer surgery is still controversial. The preservation of pectoralis fascia is more for better immediate breast reconstruction after operation. However, the current evidence of evidence-based medicine is not sufficient. Clinicians need to conduct multicenter, randomized controlled clinical trials to improve the evidence.
ObjectiveTo evaluate the clinical and cosmetic outcome of patients with early breast cancer underwent oncoplastic techniques in breast conserving surgery. MethodsClinical data of 59 patients with early stage breast cancer who underwent oncoplastic techniques in the breast conserving surgery were analyzed retrospectively from January 2007 to March 2011. Cosmetic outcome score and patient satisfaction questionnaire were also assessed. ResultsThe age of the patients was (53.5±9.8) years (range, 32 to 77 years). The diameter of tumors was (1.6±0.7) cm (range, 0.5 to 4.0 cm). The foci located at upper quadrant in 38, lower quadrant in 17, central area in 4. During operation, single incision approach was used in 25 patients, two incisions approach in 34 patients. A variety of methods were used to repair breast defects including mammary gland direct suture in 9 patients, mammary gland pedicle flaps in 35, local flaps or adipofascial flap in 9, latissimus dorsi myocutaneous flaps in 2, and reduction mammaplasty with “J” or double ring incision in 4. The mean followup period was 30 months (range, 3 to 53 months), no local recurrence was detected. However, bone metastases was found in one patient on 14 months after operation. Fifty-three patients (89.8%) had good to excellent aesthetic results with cosmetic outcome score ≥26. Patient satisfaction questionnaire showed that 40 patients (67.8%) were excellent, 14 (23.7%) good, 3 (5.1%) fair, and 2 (3.4%) poor. ConclusionOncoplastic techniques in the breast conservative therapy for early stage breast cancer is a safe and effective procedure, with highly satisfactory cosmetic outcomes in the majority of patients.
ObjectiveTo summarize the application of adjacent tissue flap for reconstruction of partial breast defect in breast conserving surgery. MethodsThe relevant literatures in recent 5 years were reviewed, and the oncoplastic techniques, classification of the adjacent tissue flaps, were summarized. Furthermore, the indications, advantages and disadvantages of the adjacent tissue flaps were evaluated. ResultsCurrently, there were various ways to reconstruct the breast defect following breast conserving surgery. For the patient, whose breast defect volume was bigger, the application of the adjacent tissue flap was one of the effective methods to obtain better aesthetic outcomes. The adjacent tissue flaps included the following:the lateral thoracodorsal fasciocutaneous flap, thoracodorsal artery perforator flap, inframammary adipofascial flap of the anterior rectus sheath, inter-costal artery perforator flap, internal mammary artery pedicled fasciocutaneous island flap, and so on. ConclusionThe adjacent tissue flap replacement technique in breast conserving surgery for reconstruction of the breast defect is a safe and effective procedure, and patients are satisfied with breast shape and overall cosmetic outcomes for it.
Objective To summarize research status and mechanism about effects of carcinoma-associated fibroblasts (CAFs) on breast cancer stem cells. Method Relevant literatures about the relationship between the CAFs and breast cancer stem cells were collected and reviewed. Results CAFs were the majority type of the breast cancer stromal cells. The cancer stromal cell was also the important part of the tumor microenvironment, which could promote the proliferation, adhesion, invasion, and metastasis of the breast cancer. A subpopulation of cancer stem cells with the potentials of self-renewal and multi-directional differentiation in the breast cancer tissues might cause the tumor development. There was a phenotypic heterogeneity in the beast cancer stem cells, it was related to the tumor recurrence and therapy resistance. The CAFs could promote the formation of breast cancer stem cells through the epithelial mesenchymal transition and promote the transformation of tumor stem cell phenotype. More research needed to be done to prove these processes. Conclusion CAFs play an important role in formation of breast cancer stem cells and transformation of tumor stem cell phenotype, which might provide a new idea about treating breast cancer.
Objective To understand anatomy of parathyroid gland and explore its application value in protection of parathyroid gland function during thyroidectomy. Methods The literatures, which were associated with the parathyroid anatomy and hypoparathyroidism were collected. The origin, function, anatomical location, number, blood supply, lymphatic system of the parathyroid gland and its relationship with surrounding tissues of parathyroid gland and its clinical significance in the thyroidectomy, were reviewed. Results The position of the superior parathyroid gland was relatively constant, and the inferior parathyroid gland was more likely to be ectopic. The number of the parathyroid gland was uncertain. The mainstream view was that the arterial supply of the parathyroid glands was mainly ensured by the inferior thyroid artery, a few by anastomosis of the superior and inferior thyroid arteries, or by the superior thyroid artery. However, the alternative view was that the blood supply of the parathyroid gland was not mainly derived from the inferior thyroid artery. The parathyroid gland was not easily distinguished from the adipose tissue and lymph node. Whether there was an independent lymphatic system in the parathyroid gland was still controversial. In the thyroidectomy, the parathyroid gland and its blood supply were reserved or protected by distinguishing from the Zuckerkandl tubercle, recurrent laryngeal nerve, and parathyroid specific attachment fat, which were identified by utilizing of the nanocarbon, loupe magnification, etc.. Especially in the central lymph neck dissection, the main thyroid artery trunk and its important branches should be carefully dissected or retained through the gentle capsular dissection and the correct use of energy devices for vessel sealing. The parathyroid gland in situ was reserved according to the parathyroid type. If it was not possible to be preserved, the parathyroid autotransplantation was necessary during the thyroidectomy. Conclusions Understanding origin and location of parathyroid gland, it could provide a direction for searching parathyroid gland during thyroidectomy. Being familiar with blood supply of parathyroid gland makes it possible to protect blood vessel and preserve parathyroid gland. Gentle capsular dissection, rational use of energy device, and indocyanine green angiography seem to be more important. Number of parathyroid gland allows us to treat each parathyroid gland as the last one, if it is not preserved in situ , parathyroid gland need to be autografted to avoid hypoparathyroidism.
ObjectiveTo investigate the adequate surgical procedures for well-differentiated thyroid cancer (WDTC) located in the isthmus.MethodsNineteen patients with WDTC located in the isthmus were identified with WDTC and managed by surgery in Department of General Surgery in Xuanwu Hospital of Capital University from Jun. 2013 to May. 2018.ResultsAmong the nineteen cases, fifteen patients had a solitary malignant nodule confined to the isthmus, four patients had malignant nodules located separately in the isthmus and unilateral lobe. One patient received extended isthmusectomy as well as relaryngeal and pretracheal lymphectomy; six patients received isthmusectomy with unilateral lobectomy and central compartment lymph node dissection of unilateral lobe; four patients received isthmusectomy with unilateral lobectomy and subtotal thyroidectomy on the other lobe as well as central compartment lymph node dissection of unilateral lobe; seven patients received total thyroidectomy or isthmusectomy with unilateral lobectomy and nearly total thyroidectomy on the other lobe, as well as central compartment lymph node dissection of both sides; one patient received total thyroidectomy and central compartment lymph node dissection of both sides, as well as lateral thyroid lymph node dissection of both sides. The median operative time was 126 minutes (67–313 minutes), the median intraoperative blood loss was 30 mL (10–85 mL), and the median hospital stay was 6 days (4–11 days). Hypocalcemia occurred in 12 patients. There were no complications of recurrent laryngeal nerve palsy or laryngeal nerve palsy occurred. All the nineteen patients were well followed. During the follow up period (14–69 months with median of 26 months), there were no complications of permanent hypoparathyroidism occurred, as well as the 5-year disease-specific survival rate and survival rate were both 100%.ConclusionsFor patients with well-differentiated thyroid cancer located in the isthmus with different diameters and sentinel node status, individualized surgical procedures should be adopted.
ObjectiveTo investigate the role of intraoperative frozen section pathology in central lymph node metastasis of papillary thyroid microcarcinoma (PTMC), and to analyze the risk factors of central lymph node metastasis.MethodsClinical data of 481 patients diagnosed with PTMC from January 2015 to June 2019 in our hospital were included. The consistency of frozen pathological results of intraoperative prelaryngeal lymph nodes, pretracheal lymph nodes, and paratracheal lymph nodes with postoperative paraffin pathological results, as well as the relationship between the numbers of intraoperative lymph nodes sent for examination and postoperative pathological results were analyzed. Then the Kappa value were calculated respectively. Furthermore, univariate and multivariate analysis were used to analyze the factors affecting central lymph node metastasis.ResultsCentral lymph node metastasis was found in 207 patients with PTMC (43.0%). Of the 207 patients, 192 patients were examined by frozen section, with 139 patients had positive results. The Kappa value of prelaryngeal lymph nodes, paratracheal lymph nodes, pretracheal lymph nodes, and central lymph nodes were 0.300, 0.643, 0.560, and 0.755, respectively (P<0.001). Simultaneous intraoperative examination of three anatomic lymph nodes in the central region has a high accuracy in evaluating whether there was lymph node metastasis. The consistency test between intraoperative frozen and postoperative paraffin pathological results showed that when the number of lymph nodes was less than 5, the Kappa value was 0.690 (P<0.001), and when more than or equal to 5, the Kappa value was 0.816 (P<0.001). The results of logistic regression showed that, maximum value of tumor diameter, tumor number, and thyroid capsule involvement were risk factors for central region lymph node metastasis in PTMC (P<0.05).ConclusionsCentral region lymph node metastasis in PTMC was common. Prelaryngeal lymph nodes, pretracheal lymph nodes, and paratracheal lymph nodes should be selected for frozen pathological examination during the operation, which could effectively indicate whether the central lymph nodes were involved. And combined with the risk factors of lymph node metastasis, such as maximum value of tumor diameter, number of tumors, and thyroid capsule involvement, a more accurate individualized operation plan can be designed for patients.