Clinical observation of the regeneration process of defects after breast cancer resection
Patients
A total of 125 breast cancer patients with small and medium sized breasts, who received breast-conserving surgery in the Breast Surgery Center of Sichuan Tumor Hospital from December 2016 to March 2019, were enrolled in this prospective study. The present study excluded patients with diabetic or mastitis, with poor blood glucose control (blood glucose level is not well-controlled by taking drugs and/or controlling diet, thus remains high). The present study was approved by the Ethics Committee of our hospital, and all patients provided a signed informed consent.
All enrolled patients were divided into two groups: conventional breast-conserving surgery group and artificial material implantation group. According to the type of filling material, patients in the artificial material implantation group were further divided into two groups: oxidized regenerated cellulose group and gelatin sponge group. The clinical factors that were evaluated included age, body mass index, resected breast tissue weight, tumor size, surgical margin status, operative time, length of hospital stay, and acute and chronic complications. The clinicopathological factors included tumor stage, hormone receptor status and adjuvant therapy. Postoperative adjuvant chemotherapy, and endocrine and targeted therapy were performed according to the patient’s condition, and all patients were treated with adjuvant radiotherapy. The Harvard/NSABP/RTOG Breast Cosmetic Grading Scale was used to evaluate the cosmetic effect of patients who had surgery for more than six months, including the surgeon’s evaluation and the patient’s self-evaluation [23].
Study design
Raw material of oxidized regenerated cellulose is the cellulose made from original pulp of the German pine, which is then oxidized by nitrogen dioxide to form cellulosic acid, which, like other biologic physical materials, can be used as a platform for platelet aggregation and hemostasis. It contained about 19.5% carboxyl. It has many forms, such as mesh, gauze, fibrillar tufts, and sponges, all of which are absorbable and can be completely degraded within 1–6 weeks. The one used in this study was hemostatic gauze. Gelatin sponge is made of gelatin and does not contain biological activities. It does not have the helical structures of collagen, but it has hemostasis effects due to its porous structure. Oxidized regenerated cellulose and gelatin sponge used in this study were commercial products purchased from Ethicon, Inc., Johnson & Johnson Corporation in the United States and Jinling Pharmaceutical Co., Ltd in China, respectively.
The location of the tumor was confirmed by clinical physical examination and imaging examination before the operation, and the scope of tumor resection was determined. Intraoperative frozen pathological examination (internal, external, upper, lower and basal incisal margin) was performed to evaluate the surgical margins. If the margin was positive, the extended resection was performed again, and if the frozen pathological examination remained positive after the extended resection, a modified total mastectomy was performed. The position of the incisal margins was marked using a titanium clip. When the local postoperative defect failed to be repaired during the operation, it means that a depression deformity could form in the long term. Artificial material filling materials were used for patients in the artificial material implantation group, which were implanted with a cotton shape, and the shape was identical to the residual cavity to an appropriate degree. After the implantation of artificial materials, the incision was sutured layer by layer to maintain the appropriate tension of the skin. No drainage tube was inserted after the operation, in order to reduce the probability of infection. An appropriate amount of seroma can play a role of long-term organization and shaping. However, it should be noted that when the tension of the local seroma becomes too large after the operation, a syringe can be used for proper suction and decompression. Radiotherapy IMRT DT 50 Gy/25F/5W, axillary lymph node negative, radiotherapy site breast; Axillary lymph node positive breast and axillary. Clinical characteristics and pathological characteristics and staging among the three groups, absorption time between the two materials, as well as complications and survey results in the satisfaction of patients among the three groups were compared.
Statistical analysis
The SPSS 19.0 software package was used for data analysis. The measurement data was presented as mean ± standard deviation. X2-test, One Way ANOVA and Kruskal–Wallis test was used for the statistical analysis of measurement data. P < 0.05 was considered statistically significant.
Published at Sat, 06 Mar 2021 13:07:30 +0000