Innovations for the future of breast surgery
| Autor: | Daniel R. Leff, Christopher Holcombe, A Carmichael, C C Kirwan, Deborah Fenlon, A Subramanian, L. Romics, Mark A. Green, E R St John, Shelley Potter, Rachel O'Connell, Ramsey I. Cutress, Fairbrother P, Stuart McIntosh, John R. Benson, Raghavan Vidya |
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| Rok vydání: | 2021 |
| Předmět: |
Reconstructive surgery
medicine.medical_specialty Cost effectiveness business.industry Breast surgery medicine.medical_treatment Sentinel lymph node Breast Neoplasms Mastectomy Segmental medicine.disease Oncoplastic Surgery 03 medical and health sciences 0302 clinical medicine Breast cancer 030220 oncology & carcinogenesis Adjuvant therapy Breast-conserving surgery Humans Medicine Female Surgery 030212 general & internal medicine business Intensive care medicine Forecasting |
| Zdroj: | Vidya, R, Leff, D, Green, M, McIntosh, S, Kirwan, C, Romics, L, Cutress, R, Potter, S, Carmichael, A, Subramanian, A, O'Connell, R, Fairbrother, P, Fenlon, D, Benson, J & Holcombe, C 2021, ' Innovations for the Future of Breast Surgery ', British Journal of Surgery, vol. 108, no. 8, pp. 908-916 . https://doi.org/10.1093/bjs/znab147 |
| ISSN: | 1365-2168 0007-1323 |
| DOI: | 10.1093/bjs/znab147 |
| Popis: | Background Future innovations in science and technology with an impact on multimodal breast cancer management from a surgical perspective are discussed in this narrative review. The work was undertaken in response to the Commission on the Future of Surgery project initiated by the Royal College of Surgeons of England. Methods Expert opinion was sought around themes of surgical de-escalation, reduction in treatment morbidities, and improving the accuracy of breast-conserving surgery in terms of margin status. There was emphasis on how the primacy of surgical excision in an era of oncoplastic and reconstructive surgery is increasingly being challenged, with more effective systemic therapies that target residual disease burden, and permit response-adapted approaches to both breast and axillary surgery. Results Technologies for intraoperative margin assessment can potentially half re-excision rates after breast-conserving surgery, and sentinel lymph node biopsy will become a therapeutic procedure for many patients with node-positive disease treated either with surgery or chemotherapy as the primary modality. Genomic profiling of tumours can aid in the selection of patients for neoadjuvant and adjuvant therapies as well as prevention strategies. Molecular subtypes are predictive of response to induction therapies and reductive approaches to surgery in the breast or axilla. Conclusion Treatments are increasingly being tailored and based on improved understanding of tumour biology and relevant biomarkers to determine absolute benefit and permit delivery of cost-effective healthcare. Patient involvement is crucial for breast cancer studies to ensure relevance and outcome measures that are objective, meaningful, and patient-centred. |
| Databáze: | OpenAIRE |
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