1005 Background: The MF07-01 trial is a multicenter phase III randomized trial of treatment naive stage IV BC patients comparing loco-regional surgery (LRS) followed by appropriate systemic therapy (ST) vs ST alone. Aims: To compare 3-year survival and loco-regional progression (LRP). Methods: At initial diagnosis patients were randomized 1:1 to LRS group or ST group. After consideration of retrospective studies, we hypothesized at 36 months a survival difference between the two groups to be 18%. Assuming a 10% drop out rate and with a one sided log-rank test with a 95% CI and a 90% power 271 patients needed to be randomized. Results: 274 patients were accrued; 138 in the LRS group and 136 in the ST group. The groups were comparable regarding age, BMI, HER2 neu, tumor type and size, histologic grade, and bone and visceral metastasis (all p > 0.05). There were 76 (55%) deaths in the LRS group and 101 (74%) in the ST group during the median 40 (20-51) months follow-up. At 36 months the survival rate was similar the LRS group and the ST group (60% and 51%, respectively; p = 0.5). Overall survival (OS) was 34% higher in the LRS group compared to the ST group (HR: 0.66, 95%CI 0.49-0.88: p = 0.005). In unplanned subgroup analyses, OS was statistically higher in LRS group than ST group; ER/PR (+) (HR: 0.64, 0.46-0.91, p = 0.01), HER2 neu (-) (HR: 0.64, 95%CI 0.45-0.91; p = 0.01), patients < 55 years (HR: 95%CI 0.57, 0.38-0.86; p = 0.006), and solitary bone only metastasis (HR: 0.47, 95%CI 0.23-0.98; p = 0.04). The median survival was 14 months higher in the LRS group comparing with the ST group in bone only metastasis (56 vs 42 months, respectively; HR 0.67, 95%CI 0.43-1.07; p = 0.09). LRP was 1% (n = 2) in the LRS group and it was 11% (n = 15) in the ST group (p = 0.001). Conclusion: In this trial we did not observe improvement in 36 month survival with surgery. However, longer follow up revealed statistically significant improvement in median survival with surgery (46 vs.37 months) at median 40 months follow up. Additionally, patients with a more indolent form of metastatic BC such as ER (+), HER2 neu (-), solitary bone metastasis, and patients < 55 years old have a significant survival benefit with initial surgery. Clinical trial information: NCT00557986.

Multiple breast cancers may present with different clinical and biological characteristics. The data indicate that multifocal (MF), multicentric (MC), and bilateral synchronous (BS) breast cancers (BC) are more aggressive and have an equivalent or moderately poorer survival rate compared with unilateral cases. However, a comparison of these multiple breast cancers has not been covered in the literature. The aim of this study was to describe the histopathological characteristics of patients suffering from MF, MC, and BS breast carcinoma and to compare their prognoses. Retrospective data for MF, MC, and BS breast carcinoma patients treated in five different breast cancer units in Turkey between 2003 and 2012 were collected. MF and MC cancers were defined as more than one lesion in the same quadrant or in separate quadrants, respectively. There were 507 patients (271 MF, 147 MC, and 89 BS) treated in this time period. BS breast carcinoma patients were younger than the other groups (44.83 ± 9.6, 47.27 ± 11.6, and 51.11 ± 11.8 years for BS, MF, and MC breast carcinoma patients, respectively). MFBC and MCBC patients in this study were younger than the ages reported in Western literature, but this result was similar to the ages reported in Eastern literature. The five-year survival rates and recurrence rates were not statistically different among groups (P = 0.996 and P = 0.263, respectively). According to univariate analyses, tumor size, histological grade, and lymph node status were statistically significant factors that affected survival. However, only lymph node involvement was significant for survival according to multivariate analyses. The clinical significance of MF, MC, and BS breast cancers is still unclear and their influence on prognosis is controversial. Disease-free and overall survival rates of BS breast cancers might be similar to MF and MC breast cancers.

Background: The omission of axillary lymph node dissection (ALND) remains controversial for patients with residual axillary disease after neoadjuvant chemotherapy (NAC), regardless of the residual burden. This study evaluated the oncologic safety and factors associated with outcomes in patients with residual axillary disease. These patients were treated solely with sentinel lymph node biopsy (SLNB) or targeted axillary dissection (TAD), without ALND, after NAC.Methods: A joint analysis of two different multicenter cohorts—the retrospective cohort registry MF18‐02 and the prospective observational cohort registry MF18‐03 (NCT04250129)—was conducted between January 2004 and August 2022. All patients received regional nodal irradiation.Results: Five hundred and one patients with cT1‐4, N1‐3M0 disease who achieved a complete clinical response to NAC underwent either SLNB alone (n = 353) or TAD alone (n = 148). At a median follow‐up of 42 months, axillary and locoregional recurrence rates were 0.4% (n = 2) and 0.8% (n = 4). No significant difference was found in disease‐free survival (DFS) and disease‐specific survival (DSS) rates between patients undergoing TAD alone versus SLNB alone, those with breast positive versus negative pathologic complete response, SLN methodology, total metastatic LN of one versus ≥2, or metastasis types as isolated tumor cells with micrometastases versus macrometastases. In the multivariate analysis, patients with nonluminal pathology were more likely to have a worse DFS and DSS, respectively, without an increased axillary recurrence.Conclusions: The omission of ALND can be safely considered for patients who achieve a complete clinical response after NAC, even if residual disease is detected by pathologic examination. Provided that adjuvant radiotherapy is administered, neither the SLNB method nor the number of excised LNs significantly affects oncologic outcomes.

Objectives: The incidence of papillary microcarcinomas, which are defined as thyroid cancers of <10mm in size, has been increasing in the last decade. Herein, we present internet-based questionnaire results performed by the Turkish Association of Endocrine Surgery with the aim to evaluate the perspective of the management of papillary microcarcinomas in Turkey. Material and Methods: The user-friendly questionnaire consisted of 13 questions in total. These questions mainly addressed the surgical management of nodules and cancer of <1 cm in size. Patient management before, during, and after surgical intervention was also included; additionally, the "active surveillance approach" was questioned. Results: There were 420 responders in total who were of multidisciplinary origin (endocrinologists, surgeons, nuclear medicine specialists, pathologists, and oncologists). Total thyroidectomy was the predominant treatment approach (65%) for the classical type of microcarcinoma limited in one lobe, whereas in cases of microcarcinomas incidentally diagnosed during hemithyroidectomy, complementary surgery approach was advised by 40% of the responders. The responders found capsule invasion (86%) and patient based management (94%) of high importance. The percentage of the responders who recommended radioactive iodine ablation in incidental cancers having no aggressive criteria was 51%. The survey participants that were against routine central dissection in these cases accounted for 73% of the responders. The recommendation of active surveillance (follow-up without any interventional therapy) was limited with 9% responders. Conclusion: The results of the questionnaire demonstrated that there have been various choices in Turkey for the surgical treatment of the papillary microcarcinomas.

Objective: In early 2020, the spread of coronavirus disease-2019 (COVID-19) led the World Health Organization to declare this disease a pandemic. Initial epidemiological data showed that patients with cancer were at high risk of developing severe forms of COVID-19. National scientific societies published recommendations modifying the patients' breast cancer (BC) management to preserve, in theory, quality oncologic care, avoiding the increased risk of contamination. The Senology International Society (SIS) decided to take an inventory of the actions taken worldwide. This study investigates COVID-19-related changes concerning BC management and analyzes the will to maintain them after the pandemic, evaluating their oncological safety consequences. Materials and Methods: SIS network members participated in an online survey using a questionnaire (Microsoft (R) Forms) from June 15th to July 31st, 2020. Results: Forty-five responses from 24 countries showed that screening programs had been suspended (68%); magnetic resonance imagines were postponed (73%); telemedicine was preferred when possible (71%). Surgeries were postponed: reconstructive (77%), for benign diseases (84%), and in patients with significant comorbidities (66%). Chemotherapy and radiotherapy protocols had been adapted in 28% of patients in both. Exception for telemedicine (34%), these changes in practice should not be continued. Conclusion: The SIS survey showed significant changes in BC's diagnosis and treatment during the first wave of the COVID-19 pandemic, but most of these changes should not be maintained. Indeed, women have fewer severe forms of COVID-19 and are less likely to die than men. The risk of dying from COVID-19 is more related to the presence of comorbidities and age than to BC. Stopping screening and delaying treatment leads to more advanced stages of BC. Only women aged over 65 with BC under treatment and comorbidities require adaptation of their cancer management.

Although extensive research has been carried out on the respiratory and renal effects of intra-abdominal pressure increase, there is limited research with regard to its effects on bacterial translocation. The objective of this study was to discuss whether the high intra-abdominal pressure due to carbon dioxide (CO2) insufflation during laparoscopy leads to bacterial translocation. Eighteen male dogs, 7 of which constituted the control group, were used in the study. Two study groups, in which the intra-abdominal pressure was raised to 15 mm Hg and kept at that level for 30 and 120 minutes, respectively, were set. Blood gases and blood pressure values were observed throughout the experiments. Samples of peritoneal smear, portal vein blood, mesenteric lymph node, liver, spleen, and cecum were examined to detect bacterial translocation. Histopathological examinations of all samples were also carried out. No translocation was detected in the samples of peritoneal smear, portal blood, mesenteric lymph node, liver, or spleen, but in the samples of cecum, bacterial colonization for the second group (p<0.05) and for the third group (p<0.05) was significantly higher compared with the control group. There was a considerable difference between the second and third groups (p<0.05). The changes in the mesenteric lymph nodes were interpreted to be a result of bacterial drainage. Histopathological examination disclosed active changes in the mesenteric lymph nodes in all groups, but there was considerable sinus histiocytosis only in the third group. We conclude that the intraabdominal pressure of 15 mm Hg created by carbon dioxide insufflation does not lead to bacterial translocation but causes intraluminal bacterial colonization in the cecum after 30 minutes and after 2 hours.