Objective To explore the tumor shrinking pattern, the image evaluation methods of the residual lesions after neoadjuvant chemotherapy, and the indications, the resection range, the surgical margins, the management of sentinel lymph node biopsy (SLNB) and axillary lymph nodes of breast conserving surgery after neoadjuvant chemotherapy. Methods Domestic and foreign literatures about the breast conserving surgery after neoadjuvant chemotherapy were collected and reviwed. Results Breast conserving surgery after neoadjuvant chemotherapy raised the rate of breast conserving surgery and improved the postoperative life quality of patients, while the overall survival rate had no significant difference compared with mastectomy. Tumor shrinking pattern and its related factors after neoadjuvant chemotherapy remain required further study. At present, the indications for breast conserving surgery after neoadjuvant chemotherapy still mainly refered to that for early stage breast cancer. Resection range was more recognized to the scope of residual tumor lesions after chemotherapy. The margins were more widely accepted as which were without tumor involved. Although there were some controversies about the use of SLNB and the management of axillary lymph nodes based on the results of SLNB in breast conserving surgery after neoadjuvant chemotherapy, it was still considered necessary at the basis of the accurate biopsy technique acquired. Conclusions At present, breast conserving treatment after neoadjuvant chemotherapy is considered safe and effective. However, it is necessary to proceed cautiously under the conditions of adequate communication of local recurrence rate, standardized local treatment, standard postoperative radiotherapy, systemic adjuvant therapy, and regular follow-up.
Percutaneous ventricular assist device (PVAD) is a minimally invasive treatment which can replace the function of the failing heart. It provides circulatory support for patients with severe emergent cardiovascular diseases such as complex coronary artery disease, acute myocardial infarction complicated by cardiogenic shock, and acute decompensated chronic heart failure. PVAD has been developed since the rise of the Hemopump, to the prosperity of the Impella, and increasingly been used as a haemodynamic support to improve prognosis. This article will review the evolution and clinical application of PVAD.