Understanding the Psychosocial Needs of Women who Present with Advanced Breast Cancer.

Introduction: Advanced breast cancer (ABC) remains common in Singapore. In 2019, 22.1% of breast cancer patients presented with ABC in our institution.

Mastectomy rates remain high in Singapore and are not associated with poorer survival after adjusting for age.

Recent reports have suggested that women undergoing mastectomy, instead of wide local excision (WLE) for Stage I and II breast cancers have poorer overall survival. This is particularly important in our setting where mastectomy rates are high. In this study, we evaluated the trends in mastectomy and WLE over a 10-year period at a single institute, identified factors more common among women who underwent mastectomy and specifically examined the effect of surgery on outcome.

Extent of margin involvement, lymphovascular invasion, and extensive intraductal component predict for residual disease after wide local excision for breast cancer.

Unlabelled: In the present study, we identified predictors of residual disease after an inadequate wide local excision. Residual tumor was more likely when tumor was present at the inked margin, when more than a single radial margin was affected, and in tumors associated with lymphovascular invasion and an extensive intraductal component.

Background: Positive margins after wide local excision (WLE) increase the probability of residual disease, and additional surgery is often recommended.

Limiting the use of primary endocrine therapy in elderly women with breast cancer.

Primary endocrine therapy (PET) is often included as a treatment option in elderly women with operable breast cancer. Elderly women tend to have pre-existing comorbidities and are often reluctant to undergo surgery. The benefit of surgery needs to be weighed against a relatively higher potential for operative morbidity and mortality, and a limited life expectancy.

Adopting ambulatory breast cancer surgery as the standard of care in an asian population.

Introduction. Ambulatory surgery is not commonly practiced in Asia. A 23-hour ambulatory (AS23) service was implemented at our institute in March 2004 to allow more surgeries to be performed as ambulatory procedures.

Sentinel Lymph Node Biopsy Should Be Included with the Initial Surgery for High-Risk Ductal Carcinoma-In-Situ.

Background. A proportion of those diagnosed preoperatively with ductal carcinoma-in-situ (DCIS) will be histologically upgraded to invasive carcinoma. Repeat surgery for sentinel lymph node (SLN) biopsy will be required if it had not been included with the initial surgery.

Achieving breast cancer surgery in a single setting with intraoperative frozen section analysis of the sentinel lymph node.

Background: Current guidelines recommend full axillary lymph node dissection (ALND) whenever the SLN is positive for metastases. In our institute, we aim to complete surgery in a single setting and base the decision for ALND on the intraoperative FS analysis of the SLN. In this study, we evaluate the efficacy this practice in terms of the accuracy of FS analysis, patient recall rate, and additional time required for FS analysis.

Pitfalls in paediatric appendicitis: Highlighting common clinical features of missed cases.

Objective: Missed cases of paediatric appendicitis lead to a delay in diagnosis and increased complications during the subsequent surgery. We aim to identify the common clinical features of such cases at the time of first hospital attendance.

Methods: Case records of patients with a missed diagnosis were reviewed retrospectively, documenting the presentation, preliminary investigations, initial diagnosis and eventual outcome.