Background:. In the United Kingdom, the rise in simple mastectomies without drain placement has contributed to improving rates of day-case surgery. However, this practice has resulted in increased rates of symptomatic seromas and greater resource burden in clinics. For postoperative incision management, we have implemented the use of closed incision negative pressure therapy (ciNPT) with foam dressings that cover the entire incision and surrounding tissues. The aim of this study was to establish whether the use of full-coverage ciNPT after mastectomy reduced seroma-related interventions. Methods:. Seroma intervention data were collected for patients undergoing mastectomies at a single center. Thirty sequential patients with conventional dressings placed between December 2020 and May 2021 and 25 sequential patients with ciNPT with full-coverage dressings between August 2021 and January 2022 were included in the study. Results:. There were 31 mastectomy cases in each arm (including bilateral cases). Twenty cases in the control group and 15 cases in the ciNPT group required a return to the clinic for seroma. In the control group, 16 incisions required at least 1 aspiration, versus 12 in the ciNPT group. Compared with the control group, the ciNPT group required fewer aspirations per mastectomy (P = 0.048) and had lower total aspiration volumes (P = 0.031). Conclusions:. In our clinic, nearly two-thirds of drainless mastectomy patients required postoperative visits for seromas. Patients managed with ciNPT dressings covering the entire breast required fewer seroma-related visits and experienced reduced total seroma volume.

Background Partial breast reconstruction (PBR) using chest wall perforator flaps (CWPFs) is an oncoplastic technique utilised to facilitate breast conservation surgery (BCS). It is particularly applicable in women with a larger tumour-to-breast volume ratio requiring volume replacement rather than volume displacement. This single-centre retrospective cohort study aimed to explore the safety and efficacy of PBR using CWPFs. Method All patients who underwent PBR using a CWPF following wide local excision between March 2016 and August 2024 were reviewed. Data was extracted from hospital electronic patient records and statistical analysis performed using R-Studio® (alpha = 0.05). Results Of 290 cases identified: 237 had invasive cancers and 53 ductal carcinoma in situ (DCIS). The median age at presentation was 59 years and the median tumour size 22 mm, with multifocal tumours in 22.1 % of cases and extensive DCIS in 27.0 % of invasive cancers. Overall, complication rates were low (n = 83, 28.6 %) with 6.9 % of patients requiring a return to theatre. Margins were involved in 17.8 %, with 15.6 % requiring re-excision. The locoregional recurrence (LRR) rate was 2.9 % and disease-free survival (DFS) 93.8 % with a median follow-up of 3.1 years (n = 276). A subset analysis of women receiving surgery before January 2020 (n = 96) with a follow-up of 5.1 years had a LRR of 4.2 %. Conclusion This study reports acceptable rates of complications, margin re-excision and LRR, demonstrating the safety and efficacy of utilising PBR with CWPFs for the treatment of breast cancer. CWPFs offer the opportunity to extend the boundaries of BCS to those women who may otherwise require a mastectomy.

Introduction As the treatment of breast cancer advances, the focus has shifted from solely improving oncological endpoints to a greater weight being placed on cosmetic and psychological outcomes. The advent of advanced oncoplastic techniques allows for successful breast-conserving surgery (BCS) to patients who otherwise would have required a mastectomy. The aim of this study is to ascertain if the adoption of these procedures has assisted in the reduction of mastectomies performed. Methods A dataset of all breast cancer procedures based upon coding between April 2016 and July 2023 was evaluated, categorising procedures into: BCS, mastectomy, oncoplastic BCS and total reconstructions. R-Studio Software 4.3.1 (®) was used to explore statistical analysis and data visualisation. Registered as a clinical services evaluation study (Project ID: 14649). Results During the period stated, 3,875 index breast cancer procedures were recorded (sample size= 3,638 patients). The BCS rate increased from 66.2% in 2016 to 80.7% in 2023. Using a linear regression model, the BCS rate demonstrates an increase of 2.1% each year (coefficient= 2.12, p-value= 0.0069). Concurrently, the rate of oncoplastic BCS increased from 10.5% to 22.9% (coefficient= 2.14, p-value= 0.00017). Using Pearson’s product-moment, a positive correlation between these two variables is seen (coefficient= 0.86, p-value= 0.0056). Conclusion Having reviewed 3,875 index breast cancer procedures over the past eight years, the BCS rate has shown a statistically significant increase and a positive correlation with the oncoplastic BCS rate. This suggests oncoplastic surgery has helped to reduce the rates of mastectomy at the centre.

Introduction: The use of primary endocrine therapy (PET) in managing breast cancer in the elderly has become widespread. Whilst a Cochrane review concluded no difference in overall survival in comparison with surgery, PET was found to be inferior in local disease control with a limited duration of efficacy (2–3 years). The International Society of Geriatric Oncology (SIOG) state that PET may be considered in patients with a short life expectancy (<2y) or considered unfit for surgery. Frequently, decision making for PET allocation is subjective.

Surgery is essential for global cancer care in all resource settings. Of the 15.2 million new cases of cancer in 2015, over 80% of cases will need surgery, some several times. By 2030, we estimate that annually 45 million surgical procedures will be needed worldwide. Yet, less than 25% of patients with cancer worldwide actually get safe, affordable, or timely surgery. This Commission on global cancer surgery, building on Global Surgery 2030, has examined the state of global cancer surgery through an analysis of the burden of surgical disease and breadth of cancer surgery, economics and financing, factors for strengthening surgical systems for cancer with multiple-country studies, the research agenda, and the political factors that frame policy making in this area. We found wide equity and economic gaps in global cancer surgery. Many patients throughout the world do not have access to cancer surgery, and the failure to train more cancer surgeons and strengthen systems could result in as much as US $6.2 trillion in lost cumulative gross domestic product by 2030. Many of the key adjunct treatment modalities for cancer surgery--e.g., pathology and imaging--are also inadequate. Our analysis identified substantial issues, but also highlights solutions and innovations. Issues of access, a paucity of investment in public surgical systems, low investment in research, and training and education gaps are remarkably widespread. Solutions include better regulated public systems, international partnerships, super-centralisation of surgical services, novel surgical clinical trials, and new approaches to improve quality and scale up cancer surgical systems through education and training. Our key messages are directed at many global stakeholders, but the central message is that to deliver safe, affordable, and timely cancer surgery to all, surgery must be at the heart of global and national cancer control planning.

Richard Sullivan, Olusegun Isaac Alatise, Benjamin O Anderson, Riccardo Audisio, Philippe Autier, Ajay Aggarwal, Charles Balch, Murray F Brennan, Anna Dare, Anil D’Cruz, Alexander M M Eggermont, Kenneth Fleming, Serigne Magueye Gueye, Lars Hagander, Cristian A Herrera, Hampus Holmer, André M Ilbawi, Anton Jarnheimer, Jia-fu Ji, T Peter Kingham, Jonathan Liberman, Andrew J M Leather, John G Meara, Swagoto Mukhopadhyay, Shilpa S Murthy, Sherif Omar, Groesbeck P Parham, C S Pramesh, Robert Riviello, Danielle Rodin, Luiz Santini, Shailesh V Shrikhande, Mark Shrime, Robert Thomas, Audrey T Tsunoda, Cornelis van de Velde, Umberto Veronesi, Dehannathparambil Kottarathil Vijaykumar, David Watters, Shan Wang, Yi-Long Wu, Moez Zeiton, Arnie Purushotham