Women Planned for Immediate Lymphatic Reconstruction During Axillary Lymph Node Dissection Should Be Reconstructable: Improving Intraoperative Team Collaboration
Notice bibliographique
Résumé
Introduction: Immediate lymphatic reconstruction (ILR) during axillary lymph node dissection (ALND) has been shown to reduce breast cancer-related lymphedema (BCRL). However, some authors report many “non-reconstructable” patients, meaning that there were no suitable lymphatics or veins available in the axilla to complete the reconstructive procedure once the extirpative portion was complete. In contrast, almost all of our patients planned for ALND/ILR have had appropriate donor and recipient vessels. The purpose of our study was to contrast the incidence of “non-reconstructable” patients in the literature with our experience and highlight tips to improve the reconstructable rate. Methods: Step 1: A systematic review identified publications on ILR during ALND, which reported the number of “non-reconstructable” patients. Step 2: A chart review of ILR cases at the University of Calgary was conducted. From both data sets, patient demographics, cancer stage, node dissection results, treatment details and operative details were collected. The data was then analyzed to identify factors that could contribute to the number of “non-reconstructable” patients. Results: 11 studies were identified in the review, which included 949 patients planned for ILR during ALND. One hundred and thirty-three (14%) were deemed “non-reconstructable,” and did not undergo ILR. Analysis of 68 consecutive ALND/ILR cases at the University of Calgary identified 4 (5.9%, p = . 03) “non-reconstructable” patients. A similar method of lymphatic mapping was used in the review studies as at the University of Calgary. The patients’ demographics and treatment details were similar in the review and our prospective series: average age (49 vs 54, p = . 07, BMI (27 vs. 27, p = . 47) and receipt of radiation (76.5% vs. 69%, p = . 79). The only difference noted was the presence and the level of involvement of a plastic surgeon throughout the extirpative portion of the procedure, in order to identify and preserve vessels. At our institution, the plastic surgeon attends throughout and participates in a well-coordinated “dance” between the oncologic surgeon and the plastic surgeon. This coordination was not described in any of the studies reviewed. Conclusions: For ILR, coordinated plastic surgical involvement during ALND may reduce the number of “non-reconstructable” patients.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,008 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».