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.
Objective To explore perioperative management and postoperative effectiveness of hemophilia induced lesions of the foot and ankle. Methods Between June 1998 and February 2012, 10 cases (12 feet) of hemophilia induced lesions of the foot and ankle were treated with surgery, including 9 cases (11 feet) of hemophilia A and 1 case (1 foot) of hemophilia B. Single foot was involved in 8 cases and both feet in 2 cases, including 3 left feet and 9 right feet. All were males, aged from 13-41 years (mean, 22.6 years). Disease duration was 5-84 months (mean, 32.2 months). Preoperative American Orthopaedic Foot and Ankle Society (AOFAS) score was 43.2 ± 21.1. Short Form 36 Health Survey Scale (SF-36) score was 45.4 ± 20.0. All patients were given clotting factors (2 000-3 500 U) for pre-experiment and clotting factors substitution therapy was performed perioperatively. Four cases (4 feet) underwent arthrodesis, and 7 cases (8 feet) underwent Achilles tendon lengthening/tendon transposition (1 patient underwent tendon lengthening on the left foot and arthrodesis on the right foot). Results The operation time was 65-265 minutes (mean, 141.1 minutes); 1 case had 400 mL blood loss and 200 mL autogenous blood transfusion, the other cases had less than 50 mL blood loss and no blood transfusion. Wounds healed by first intention in all patients, no postoperative infection, deep vein thrombosis, or other complications occurred. All cases were followed up 6 months to 14 years and 3 months (median, 22 months). The X-ray films at last follow-up showed the patients undergoing arthrodesis obtained complete joint fusion. AOFAS scores at postoperative 6 months and last follow-up were 78.8 ± 14.7 and 75.8 ± 14.5, respectively; SF-36 scores were 76.6 ± 13.1 and 75.5 ± 13.2, respectively; and significant differences were found when compared with preoperative scores (P lt; 0.05), but no significant difference between postoperative 6 months and last follow-up (P gt; 0.05). Conclusion For patients with hemophilia induced lesions of the foot and ankle, surgical treatment could relieve foot and ankle pain and improve the function. Clotting factors pre-experiment at preoperation and substitution therapy at perioperation can reduce the risk of severe postoperative hemorrhage.