ObjectiveTo discuss the strategy of locoregional surgery for breast cancer patients after neoadjuvant chemotherapy. MethodThe pertinent literatures about locoregional surgery concerning breast-conserving therapy, factors of ipsilateral breast tumor recurrence, pathological shrinkage modes of breast primary tumor, and sentinel lymph node biopsy after neoadjuvant chemotherapy were reviewed. Results①The major benefit of neoadjuvant chemotherapy was to increase the proportion of breast-conserving therapy after downstaging the primary breast tumor. However, the use of breast-conserving therapy after neoadjuvant chemotherapy might remain a higher risk of ipsilateral breast tumor recurrence. It was now widely recognized that the risk factors for ipsilateral breast tumor recurrence were multifocal pattern of residual tumor and pathologic residual tumor larger than 2 cm. The shrinkage mode of the primary breast tumor after neoadjuvant chemotherapy and its relative factors were still unclear. 2 Sentinel lymph node biopsy(SLNB) was feasible either before or after neoadjuvant chemotherapy and approval by SLNB guideline and expert consensus. Patients with a cN0 status could get more benefits from SLNB after neoadjuvant chemotherapy. Although there was a bright future for SLNB as an alternative to ALND for patients with primary cN1 and downstaging to cN0 after neoadjuvant chemotherapy, it needed to obtain the accepted clinical identification rate, false negative rate, as well as similar regional recurrence rate and overall survival as compared to ALND. ConclusionsCurrently, surgical management is crucial for reducing the locoregional recurrence risk of breast cancer after neoadjuvant chemotherapy, no matter what the clinical and radiographic efficacy of neoadjuvant chemotherapy is. In the era of genomics and SLNB, individual locoregional surgical management could be arrived according to the primary stage and neoadjuvant chemotherapy response.
ObjectiveTo investigate the feasibility and safety of the double cavity casing negative pressure drainage by inside and outside of the intestine in the primary resection and anastomosis of left colon cancer combined with acute obstruction. MethodsEighty-one cases of left colon cancer combined with acute obstruction who underwent surgeries in our hospital from January 2009 to December 2012 were collected prospectively, and were divided into one-stage surgery group (n=41) and control group (n=40). Cases of one-stage surgery group received double cavity casing negative pressure drainage by inside and outside of the intestine in the primary resection and anastomosis, and cases of control group underwent two-stage surgeries. Comparison of operation time, blood loss, time of anal exhaust after operation, hospital stay, hospital expense, and incidence of complication between the 2 groups was performed. ResultsThere were no significant difference in the operation time[(166±19) minutes vs. (173±23) minutes], blood loss[(253±42) mL vs. (273±50) mL], and time of anal exhaust after operation[(3.24±0.73) days vs. (3.50±0.95) days]beeween one-stage surgery group and control group, but hospital stay[(15.1±2.3) days vs. (23.1±4.1) days]and hospital expense[(3.70±0.68) ×105 yuan vs. (5.77±0.95) ×105 yuan]of one-stage surgery group were lower than those of control group (P<0.05). In addition, there were no significant difference in the incidences of wound infection[7.3% (3/41) vs. 10.0% (4/40)], intraabdominal infection[4.9% (2/41) vs. 10.0% (4/10)], pulmonary infection[12.2% (5/41) vs. 15.0% (6/40)], and anastomotic leakage[2.4% (1/41) vs. 5.0% (2/40)]beeween one-stage surgery group and control group (P>0.05). All of the cases were followed up for 1-36 months, and the median time were 22 months. There were no significant difference in the mortality[0 (0/41) vs. 2.5% (1/40)], recurrence rate[2.4% (1/41) vs. 5.0% (2/40)], and metastasis rate[7.3% (3/41) vs. 10.0% (4/40)]beeween one-stage surgery group and control group too (P>0.05). ConclusionIn the case of negative pressure drainage of double cavity casing, underwent decompression of the small bowel, and irrigation of colon, the primary resection and anastomosis of left colon cancer combined with acute obstruction was safe and feasible.