Abstract:
INTRODUCTION:Breast cancer usually necessitates breast-conserving surgery or mastectomy, which adversely affect appearance and wellbeing. Immediate reconstruction restores the breast mound but its availability and efficacy are uncertain. MATERIALS AND METHODS:Two discrete datasets were used to evaluate mastectomies in England: Hospital Episode Statistics to measure overall activity and variation over time and by region and a national prospective audit to evaluate immediate reconstruction decision making, complication rates and patient-reported satisfaction with information, choice and outcomes. RESULTS:The 2005-08 Hospital Episode Statistics analyses identified 20% breast-conserving surgery reoperation rates nationally, frequently involving mastectomy. Rates were higher with in-situ disease present (30% vs 18%) and varied across NHS trusts (10th-90th centiles 12-30%). The 2008-09 national audit examined 18,216 women. The 19% immediate reconstruction rate varied regionally (9-43%), as did 2006-09 Hospital Episode Statistics data (8-32%). A total of 48% of women were offered immediate reconstruction, again varying regionally (24-75%). Offer likelihood fell with increasing age. National immediate reconstruction rates increased from 10% to 23% from 2000 to 2014, but regional variation persisted. Despite high care satisfaction, just 65% of mastectomy patients received the right amount of reconstructive information (90% for immediate reconstruction). Women from deprived areas experienced higher complication rates. Flap-based immediate reconstruction led to greater satisfaction with breast area appearance, emotional and sexual wellbeing and overall outcome than mastectomy; implant-only immediate reconstruction scored no better. CONCLUSION:Reconstruction is central to improving breast cancer outcomes. The differential outcomes and persistent regional inequalities identified should facilitate decision making, support improved access to all reconstructive options and inform the development of an optimal patient pathway.
journal_name
Ann R Coll Surg Engljournal_title
Annals of the Royal College of Surgeons of Englandauthors
Jeevan Rdoi
10.1308/rcsann.2019.0101subject
Has Abstractpub_date
2020-02-01 00:00:00pages
110-114issue
2eissn
0035-8843issn
1478-7083journal_volume
102pub_type
杂志文章abstract::A retrospective review of surgical treatment for portal hypertension during a 23-year period in a regional unit is reported and the immediate and subsequent management of patients with bleeding oesophageal varices is discussed. Fifty-four patients with recurrent varix haemorrhage uncontrolled by conservative methods h...
journal_title:Annals of the Royal College of Surgeons of England
pub_type: 杂志文章
doi:
更新日期:1975-09-01 00:00:00
abstract::Introduction During ankle fracture fixation, iatrogenic trauma to retro fibula structures can result in morbidity and reoperation. We describe a safe zone for lag screw insertion. Materials and methods This study was completed in three sections. We identified the average entry and exit points for the lag screw using 4...
journal_title:Annals of the Royal College of Surgeons of England
pub_type: 杂志文章
doi:10.1308/rcsann.2018.0063
更新日期:2018-05-01 00:00:00
abstract:INTRODUCTION:Osteoarthritis of the trapeziometacarpal joint (TMJ) is a common condition causing significant disability. Conservative treatments include intra-articular steroid injections. PATIENTS AND METHODS:This clinical, observational study prospectively reviewed the longevity of benefit of steroid injections into ...
journal_title:Annals of the Royal College of Surgeons of England
pub_type: 临床试验,杂志文章,评审
doi:10.1308/003588410X12699663905078
更新日期:2010-11-01 00:00:00
abstract::Orthopaedic outpatient waiting lists are long and the majority of referrals are for conditions that do not respond to surgical intervention. Many of these patients are best managed by physiotherapy, orthotics or steroid injections, which can be administered by an appropriately trained physiotherapist. The effectivenes...
journal_title:Annals of the Royal College of Surgeons of England
pub_type: 杂志文章
doi:
更新日期:1995-03-01 00:00:00
abstract::We present a case of distal venous embolisation of a peripheral intravenous cannula tip that had lost its structural integrity through repeated failed attempts of insertion of the same cannula, contrary to protocols for intravenous access. Radiological imaging confirmed the presence of a foreign body in the middle fin...
journal_title:Annals of the Royal College of Surgeons of England
pub_type: 杂志文章
doi:10.1308/003588413X13629960047830
更新日期:2013-10-01 00:00:00
abstract::Extensive cephalic spread of solution occurred in three out of seven cases studied during coeliac plexus blockade. Spread on to cardiac nerves and plexus may be a factor in hypotension following this procedure. Incremental dosage and careful screening is recommended. ...
journal_title:Annals of the Royal College of Surgeons of England
pub_type: 杂志文章
doi:
更新日期:1989-01-01 00:00:00
abstract:INTRODUCTION:The usefulness of thoracic damage control (DC) for trauma requiring a thoracotomy is not established. The aim of this study was to clarify the usefulness of thoracic packing as DC surgery. METHODS:This was a retrospective case series study of 12 patients with thoracic trauma suffering uncontrollable intra...
journal_title:Annals of the Royal College of Surgeons of England
pub_type: 杂志文章
doi:10.1308/003588413x13511609956057
更新日期:2013-01-01 00:00:00
abstract::Introduction Venous thromboembolism (VTE) is a potentially fatal complication of hip arthroplasty and knee arthroplasty. The National Institute for Health and Care Excellence recommend rivaroxaban for VTE prevention. Amid concerns over bleeding complications, the modified thromboprophylaxis policy of Chelsea and Westm...
journal_title:Annals of the Royal College of Surgeons of England
pub_type: 杂志文章
doi:10.1308/rcsann.2016.0197
更新日期:2016-09-01 00:00:00
abstract::General anaesthesia is infrequently requested for bronchography in small children. The clinical indications, recommendations for the anaesthetic technique, and problems associated with the investigation are discussed. ...
journal_title:Annals of the Royal College of Surgeons of England
pub_type: 杂志文章
doi:
更新日期:1980-05-01 00:00:00
abstract::Infection is an important arbiter of success or failure of surgical practice and the incidence of infection is incorporated into all surgical audit systems. If audit is to be of value the outcome end points of clinical practice must be defined. We have attempted to derive clinical definitions suitable for bedside diag...
journal_title:Annals of the Royal College of Surgeons of England
pub_type: 指南,杂志文章,实务指引
doi:
更新日期:1991-11-01 00:00:00
abstract::Introduction The National Institute for Health and Care Excellence guidance Improving Supportive and Palliative Care for Adults with Cancer (2004) and the Cancer Reform Strategy (2007) support the premise that assessment and discussion of patients' needs for physical, social, psychological, and spiritual wellbeing sho...
journal_title:Annals of the Royal College of Surgeons of England
pub_type: 杂志文章
doi:10.1308/rcsann.2017.0215
更新日期:2018-03-01 00:00:00
abstract:BACKGROUND:Oral cavity cancers are on the increase in the UK. Understanding site-specific epidemiological trends is important for cancer control measures. This study demonstrates the changing epidemiological trends in lip, intra-oral cavity and tongue base cancers in south-east England from 1987 to 2006. AIM: METHODS...
journal_title:Annals of the Royal College of Surgeons of England
pub_type: 杂志文章
doi:10.1308/003588414X14055925061676
更新日期:2015-04-01 00:00:00
abstract::Traumatic wounding to the upper aerodigestive tract can cause acute airway compromise. In these circumstances establishment of a safe airway is vital. We present a case report illustrating the decision making pathway in such a difficult case. ...
journal_title:Annals of the Royal College of Surgeons of England
pub_type: 杂志文章
doi:10.1308/003588412X13171221499342
更新日期:2012-01-01 00:00:00
abstract::Neutropaenic patients are at particular risk of developing a pseudomonal fasciitis known as ecthyma gangraenosum. Despite the similarities with necrotising fasciitis, Fournier's gangrene has a very different aetiology and management. ...
journal_title:Annals of the Royal College of Surgeons of England
pub_type: 杂志文章
doi:
更新日期:2001-01-01 00:00:00
abstract::A case of trephine colostomy is presented in which air insufflation incorrectly identified the distal limb. Disaster was averted by correct identification at laparotomy. The probable cause of the error and methods of avoidance are discussed. ...
journal_title:Annals of the Royal College of Surgeons of England
pub_type: 杂志文章
doi:
更新日期:1995-11-01 00:00:00
abstract::We studied prospectively 247 consecutive patients given morphine by continuous intravenous infusion for 24 h to provide pain relief following elective abdominal surgery. Using a dose of 1 mg/kg supplemented by additional intramuscular morphine 5 mg as necessary, only 26% required more than two additional intramuscular...
journal_title:Annals of the Royal College of Surgeons of England
pub_type: 杂志文章
doi:
更新日期:1988-09-01 00:00:00
abstract::A prospective controlled randomised study has been performed of 100 consecutive patients undergoing varicose vein surgery. One group underwent saphenofemoral flush ligation and multiple lower leg avulsions with the leg exsanguinated with a Rhys-Davies cuff, and ischaemia maintained with a pneumatic tourniquet. The oth...
journal_title:Annals of the Royal College of Surgeons of England
pub_type: 临床试验,杂志文章,随机对照试验
doi:
更新日期:1990-03-01 00:00:00
abstract::Bleeding from the edge of an ileostomy site is a common problem. In those who have undergone a proctocolectomy with ileostomy formation in conjunction with a risk of chronic liver disease (even with normal liver function tests), this may be due to peristomal varices. If this is the case, significant, difficult-to-cont...
journal_title:Annals of the Royal College of Surgeons of England
pub_type: 杂志文章
doi:10.1308/147870806X129223
更新日期:2006-09-01 00:00:00
abstract::The authors present a case of pyomyositis of the piriformis muscle. This case, the first in the English speaking literature of piriformis involvement in a juvenile, serves to illustrate the need for a high index of suspicion when treating children with symptoms related to impalpable pathology deep in the pelvis and th...
journal_title:Annals of the Royal College of Surgeons of England
pub_type: 杂志文章,评审
doi:10.1308/147870804894
更新日期:2005-01-01 00:00:00
abstract:BACKGROUND:In 1999, a statement of best practice in primary total hip replacement was approved by the Council of the British Orthopaedic Association (BOA) and by the British Hip Society (BHS) to provide a basis for regional and national auditable standards. We have compared practice in the North West Region of England ...
journal_title:Annals of the Royal College of Surgeons of England
pub_type: 杂志文章
doi:10.1308/003588404322827509
更新日期:2004-03-01 00:00:00
abstract::The problems encountered in introducing a pulmonary artery (PA) pressure and cardiac output (CO) measurement facility in a district general hospital intensive care unit are enumerated. The indications for its use are briefly reviewed. ...
journal_title:Annals of the Royal College of Surgeons of England
pub_type: 杂志文章
doi:
更新日期:1983-09-01 00:00:00
abstract::Necrotising enterocolitis (NEC) is a rare cause of the acute abdomen in adults and carries one of the highest mortality rates in gastroenterology. However, its rarity confines research to small case reports. Both its pathogenesis and aetiology remain enigmatic in adult patients, proving timely diagnosis and management...
journal_title:Annals of the Royal College of Surgeons of England
pub_type: 杂志文章,评审
doi:10.1308/rcsann.2020.0075
更新日期:2020-10-01 00:00:00
abstract::Chemotherapy may cause oral ulceration but a thorough investigation of symptoms and signs is important to determine the underlying diagnosis accurately. We describe a case of a patient with a poorly differentiated urothelial carcinoma of the bladder developing a tongue metastasis. This is a challenging diagnosis to ma...
journal_title:Annals of the Royal College of Surgeons of England
pub_type: 杂志文章
doi:10.1308/003588414X14055925060794
更新日期:2015-03-01 00:00:00
abstract:OBJECTIVE:The objective of this study was to describe the impact of a 'fast-track' unit, combined with a computerised system for information collection and analysis, on the clinical practice and finance of a cardiothoracic department over the first 12 month period of its application. METHODS:Within 12 months, starting...
journal_title:Annals of the Royal College of Surgeons of England
pub_type: 杂志文章
doi:
更新日期:2000-01-01 00:00:00
abstract::This study investigates incidence and outcome of iatrogenic vascular complications needing surgery in a single vascular unit serving interventional vascular radiology and interventional cardiology. Evolution of diagnostic and interventional cardiovascular radiology, along with the introduction of non-surgical therapie...
journal_title:Annals of the Royal College of Surgeons of England
pub_type: 杂志文章
doi:
更新日期:1999-01-01 00:00:00
abstract::Information was collected about 302 women referred for breast symptoms and seen in surgical outpatient or outreach clinics during one month at two hospitals in Sheffield. Three-quarters of the women (n = 244) were referred to specialist breast clinics, 22% (n = 70) were referred to general surgical clinics and 3% (n =...
journal_title:Annals of the Royal College of Surgeons of England
pub_type: 杂志文章
doi:
更新日期:1999-07-01 00:00:00
abstract::The pattern of preoperative investigation was audited in 256 patients entering hospital for elective surgery over a 12-week period. During the initial 6 weeks (phase one), no guidance was given to the house surgeons and the investigations were assessed as being 'indicated' or 'not indicated' according to preset criter...
journal_title:Annals of the Royal College of Surgeons of England
pub_type: 杂志文章
doi:
更新日期:1993-05-01 00:00:00
abstract::The recording of medical data has developed from crude non-specific classifications to complex systems tailor-made for individual practices. The development of the Read Clinical Classification has produced a complex classification which is user friendly and covers the whole of medicine. The classification allows uniqu...
journal_title:Annals of the Royal College of Surgeons of England
pub_type: 杂志文章
doi:
更新日期:1994-05-01 00:00:00
abstract:INTRODUCTION:The optimal method for creation of a pericardial window (PW) is still controversial and it remains a surgical challenge, mainly in obese patients. The aim of this study was to evaluate the efficacy and safety of a novel approach that has not been described previously, for creation of a PW in patients with ...
journal_title:Annals of the Royal College of Surgeons of England
pub_type: 杂志文章
doi:10.1308/003588415X14181254789925
更新日期:2015-07-01 00:00:00
abstract::Apposition of skin edges in plastic surgical procedures can be achieved by sutures or stainless steel staples. This retrospective study reviews 45 skin falp operations and finds that 20.6% of sutured flaps are complicated by partial necrosis or slow healing. These complications occur in 62.5% of stapled flaps. It is p...
journal_title:Annals of the Royal College of Surgeons of England
pub_type: 杂志文章
doi:
更新日期:1986-01-01 00:00:00