W ho (should have thyroid surgery)?

W hat (operation should be performed)?

W here (should the surgery be performed)?

W hen (to intervene)?

W hy (should be operate or not)?

How (innovations in surgical technique)

👉Rodrigo Arrangoiz MS, MD, FACS cirujano de tumores de cabeza y cuello y cirugía endocrina de Sociedad Quirúrgica S.C. es experto en el manejo de nódulos tiroides y del cáncer de tiroides.

👉Articulo publicado por el Dr. Arrangoiz sobre el manejo de nódulos tiroides:

https://file.scirp.org/pdf/IJOHNS_2018072717023407.pdf

👉Es pionero en México:

• Cirugia tiroidea minimamente invasiva
• La cirugia minimamente invasiva radio-guiada de paratiroides

👉Su entrenamiento fue el siguiente:

• Cirugia general y gastrointestinal:
• Michigan State University:
• 2004 al 2010• Cirugia oncológica / tumores de cabeza y cuello / cirugia endocrina:
• Fox Chase Cancer Center (Filadelfia):
• 2010 al 2012• Maestria en ciencias (Clinical research for healthprofessionals):
• Drexel University (Filadelfia):
• 2010 al 2012• Cirugia de tumores de cabeza y cuello / cirugiaendocrina
• IFHNOS / Memorial Sloan Kettering Cancer Center:
• 2014 al 2016

http://www.sociedadquirurgica.com

http://www.hiperparatiroidismo.info

http://www.cirugiatiroides.com

#Arrangoiz

#CirugiadeTumoresdeCabezayCuello

#CirugiaEndocrina

#CirugiaOncologica

#HeadandNeckSurgery

#EndocrineSurgery

#SurgicalOncology

Rodrigo Arrangoiz MS, MD, FACScirujano oncology y miembro de Sociedad Quirúrgica S.C en el America British Cowdray Medical Center en la ciudad de Mexico:

• Es experto en el manejo del cáncer de mama.

Training:

• General surgery:

• Michigan State University:

• 2004 al 2010

• Surgical Oncology / Head and Neck Surgery / Endocrine Surgery:

• Fox Chase Cancer Center (Filadelfia):

• 2010 al 2012

• Masters in Science (Clinical research for health professionals):

• Drexel University (Filadelfia):

• 2010 al 2012

• Surgical Oncology / Head and Neck Surgery / Endocrine Surgery:

• IFHNOS / Memorial Sloan Kettering Cancer Center:

• 2014 al 2016

#Arrangoiz

#Surgeon

#Cirujano

#SurgicalOncologist

#CirujanoOncologo

#BreastSurgeon

#CirujanodeMama

#CancerSurgeon

#CirujanodeCancer

REFERENCES

👉Radial scar, a complex sclerosing ductal lesion of the breast, is a common high-risk lesion, noted to occur in 28% of women at autopsy.

👉This lesion, which can be multicentric in 44% of cases, often presents as suspicious lesions on standard imaging, mimicking invasive cancer.

👉These can be confused histologically with scirrhous or tubular carcinomas of the breast, but there is greater reproducibility in its diagnosis by pathologists when compared with other high-risk epithelial lesions.

👉Meanwhile, molecular assessment so far has not provided much practical insight.

👉It has long been known that a substantial proportion of radial scar lesions detected on needle biopsy will be upgraded to cancer.

👉Numerous series have found an association with either DCIS or invasive breast cancer on excision and demonstrate a likelihood of finding malignancy in approximately 9% to 40% of cases.

👉There has been much controversy over the association between radial scar and the presence or development of breast cancer.

👉In a case-control study from a single institution of 1,396 women from whom radial scars were identified in 99 individuals, the risk of breast cancer development was 1.8 times that of controls, whereas the presence of radial scar in association with other lesions, such as proliferative disease without and with atypia, increased a woman’s risk three- to sixfold.

👉In a second series of 9,556 women, among whom 880 (9.2%) had radial scar, the risk of breast cancer was 7.0% over 20.4 years of follow-up compared with 5.5% of controls.

👉In one recent study of 292 core biopsies showing radial scar, 75% were a pure radial scar, and only one had DCIS.

👉Six other patients had a malignancy, but these were found in association with ADH or lobular neoplasia, suggesting that not all radial scars require excision.

👉Multiple other studies have similarly suggested that in the absence of concurrent high-risk lesions, radial scar may not require excision, although radial scar is only rarely found without concurrent proliferative disease present.

👉Nevertheless, standard practice at this time still remains excision to rule out malignancy at the site of a radial scar found on core biopsy.

👉This is most likely out of an abundance of caution because predictors of malignancy are still being investigated, and observational series remain small, with little follow-up.

Rodrigo Arrangoiz MS, MD, FACScirujano oncology y miembro de Sociedad Quirúrgica S.C en el America British Cowdray Medical Center en la ciudad de Mexico:

• Es experto en el manejo del cáncer de mama.

Training:

• General surgery:

• Michigan State University:

• 2004 al 2010

• Surgical Oncology / Head and Neck Surgery / Endocrine Surgery:

• Fox Chase Cancer Center (Filadelfia):

• 2010 al 2012

• Masters in Science (Clinical research for health professionals):

• Drexel University (Filadelfia):

• 2010 al 2012

• Surgical Oncology / Head and Neck Surgery / Endocrine Surgery:

• IFHNOS / Memorial Sloan Kettering Cancer Center:

• 2014 al 2016

#Arrangoiz

#Surgeon

#Cirujano

#SurgicalOncologist

#CirujanoOncologo

#BreastSurgeon

#CirujanodeMama

#CancerSurgeon

#CirujanodeCancer

• A patient with early breast cancer diagnosis who underwent breast conserving surgery and had one out of two SLN positive for metastatic disease but without extra-capsular extension:
  • Should this patient undergo ALND?
    • The risk of finding additional lymph node metastases in this clinical scenario:
      • Is approximately 27%
  • The standard approach has been to recommend ALND when sentinel nodes are positive:
    • However, the results from ACOSOG Z0011 have changed this practice in node-positive women with T1 to T2 breast cancer treated with breast conservation:
      • This study randomized patients found to have 1 to 2 histologically positive SLNs to no further axillary surgery versus ALND
      • Most patients received whole-breast radiotherapy and systemic therapy
      • At a median follow-up of 6.3 years:
        • The investigators found no significant difference in:
          • Local regional control, overall survival, or disease-free survival between those who received ALND and those who did not
      • Regional recurrence rates were less than 1% in both groups
  • The results of ACOSOG Z0011 were practice changing:
    • As the study emphasized that effective systemic therapy and radiation therapy coupled with less-extensive surgery provided equivalent local control and survival to aggressive axillary surgery in clinically node-negative patients with metastases in 1 or 2 SLNs
  • There is no evidence that removal of additional lymph nodes is beneficial
• A positive sentinel node:
  • Is no longer an indication for ALND in the setting of breast conservation when no more than 2 nodes are involved

• REFERENCES
  1. Caudle AS, Cupp JA, Kuerer HM. Management of axillary disease. Surg Oncol Clin N Am. 2014;23:473-486. doi: 10.1016/j.soc.2014.03.007. Epub 2014 Apr 13. http://www.ncbi.nlm.nih.gov/pubmed/24882346
  2. Giuliano AE, Hunt KK, Ballman KV, et al. Axillary dissection vs no axillary dissection in women with invasive breast cancer and sentinel node metastasis: a randomized clinical trial. JAMA. 2011;305:569-575. doi: 10.1001/jama.2011.90. http://jama.jamanetwork.com/article.aspx?doi=10.1001/jama.2011.90

👉Rodrigo Arrangoiz MS, MD, FACS cirujano oncology y miembro de Sociedad Quirúrgica S.C en el America British Cowdray Medical Center en la ciudad de Mexico:

• Es experto en el manejo del cáncer de mama.

Training:

• General surgery:

• Michigan State University:

• 2004 al 2010

• Surgical Oncology / Head and Neck Surgery / Endocrine Surgery:

• Fox Chase Cancer Center (Filadelfia):

• 2010 al 2012

• Masters in Science (Clinical research for health professionals):

• Drexel University (Filadelfia):

• 2010 al 2012

• Surgical Oncology / Head and Neck Surgery / Endocrine Surgery:

• IFHNOS / Memorial Sloan Kettering Cancer Center:

• 2014 al 2016

#Arrangoiz

#Surgeon

#Cirujano

#SurgicalOncologist

#CirujanoOncologo

#BreastSurgeon

#CirujanodeMama

#CancerSurgeon

#CirujanodeCancer

http://www.sociedadquirurigca.com

• Patients with PABC are often found to have advanced disease at diagnosis:
  • With the median size of tumor ranging from 3.4 cm to 4 cm
  • Reported incidence of axillary lymph node metastasis between 56% to 73%
• Delay in diagnosis is often due to the physiologic changes that occur in breasts during pregnancy that can pose challenges for differentiating a new mass from engorged and nodular breast tissue on a physical examination:
  • In the first and second trimesters:
    • There is active proliferation and differentiation of the lobules, alveoli, and lactiferous ducts:
      • Leading to enlargement and increased overall density of breast tissue
  • The prolactin level rises during the third trimester:
    • Which stimulates milk-producing cells to differentiate, and alveoli and milk ducts are filled with colostrum:
      • Around parturition:
        • The breasts undergo lactogenesis:
          • Which leads to the secretion of colostrum and then milk
• Despite frequent visits to the obstetrician / gynecologist and physical examinations during and following pregnancy, new breast masses can be difficult to detect:
  • Physicians and patients must be vigilant of breast masses occurring during pregnancy:
    • Any palpable abnormality in a pregnant or postpartum woman persisting for more than a few weeks needs a careful investigative workup to rule out PABC
• Workup of a palpable breast mass during pregnancy:

• Although up to 90% of PABC presents as a palpable mass:
  • There can be atypical presentations:
    • Including milk rejection from the affected breast or bloody nipple discharge:
      • Bloody nipple discharge can be especially confounding as it may happen due to pregnancy-induced changes:
        • Leading to delicate intraductal epithelial spurs that are easily traumatized and shed and thus not considered pathologic in all cases
      • In the absence of clinically detectable masses or abnormality on cytology, these patients may be followed closely:
        • However, if bloody nipple discharge persists after several months postpartum:
          • Diagnostic studies should be performed to rule out pathology

👉Rodrigo Arrangoiz MS, MD, FACS cirujano oncology y miembro de Sociedad Quirúrgica S.C en el America British Cowdray Medical Center en la ciudad de Mexico:

• Es experto en el manejo del cáncer de mama.

Training:

• General surgery:

• Michigan State University:

• 2004 al 2010

• Surgical Oncology / Head and Neck Surgery / Endocrine Surgery:

• Fox Chase Cancer Center (Filadelfia):

• 2010 al 2012

• Masters in Science (Clinical research for health professionals):

• Drexel University (Filadelfia):

• 2010 al 2012

• Surgical Oncology / Head and Neck Surgery / Endocrine Surgery:

• IFHNOS / Memorial Sloan Kettering Cancer Center:

• 2014 al 2016

#Arrangoiz

#Surgeon

#Cirujano

#SurgicalOncologist

#CirujanoOncologo

#BreastSurgeon

#CirujanodeMama

#CancerSurgeon

#CirujanodeCancer

http://www.sociedadquirurigca.com

👉The thyroid gland is shaped like a butterfly with two wings or lobes on either side of the windpipe that are joined together by a bridge of tissue, called the isthmus, which crosses over the front of the windpipe.

👉Most thyroid cancers are found in the lobes and only 2% to 9% of cancers are located in the isthmus.

👉Investigators have reported that cancers in isthmus are more likely to spread outside of the thyroid.

👉While overall prognosis of papillary thyroid cancer is good, the prognosis of patients with cancer spreading out of the thyroid is less favorable.

👉Specific ultrasound features of nodules that are suspicious of cancer are: taller-than-wide shape, an irregular margin, markedly dark appearance and microcalcifications.

👉However, these findings are based on cancers located in the thyroid lobes and so far there are no reports on characteristics of suspicious nodules located in the isthmus.

👉Hahn SY et al. Published the following study:

– Ultrasound findings of papillary thyroid carcinoma originating in the isthmus: comparison with lobe originating papillary thyroid carcinoma. AJR Am J Roentgenol 2014;203:637-42.

👉At total of 48 patients with papillary thyroid cancer located in the isthmus and 96 patients with papillary thyroid cancer located in lobes were identified between 2007 and 2008.

👉All the patients had undergone preoperative ultrasound of the neck, total thyroidectomy with bilateral central-lymph-node dissection and postoperative follow-up for at least 2 years.

👉The cancers located in the isthmus showed a higher frequency of the cancer spreading outside of the thyroid as compared with cancers located in the lobe (83% vs. 66%).

👉Both groups showed no differences in term of other prognostic factors.

👉Ultrasound imaging showed that cancers located in the isthmus were associated with a higher incidence of the following features than tumors located in the lobes: wider-than-tall shape (91.7% vs. 56.3%) and ultrasound findings suspicious for tumor spreading outside the thyroid (93.8% vs. 53.1%).

👉In addition, in the group of patients with spread of the cancer to the lymph nodes, cancers located in the lobe tended to associate with lymph node spread at the same side of the cancer (84.6%), whereas patients with isthmus cancers tended to have lymph node involvement on the both sides of the neck (50%).

👉The results of this study suggest that papillary thyroid cancers located in the isthmus are more likely to spread outside of the thyroid than cancers located in the lobes.

👉Because of these findings, a biopsy should be performed in all isthmus nodules with suspicious findings by ultrasound and special attention should be paid to search for abnormal lymph nodes on both sides of the neck – Rodrigo Arrangoiz MS, MD, FACS

Rodrigo Arrangoiz MS, MD, FACS cirujano de tumores de cabeza y cuello y cirugía endocrina de Sociedad Quirúrgica S.C. es experto en el manejo de nódulos tiroides y del cáncer de tiroides.

Articulo publicado por el Dr. Arrangoiz sobre el manejo de nódulos tiroides:

https://file.scirp.org/pdf/IJOHNS_2018072717023407.pdf

Es pionero en México:

• Cirugia tiroidea minimamente invasiva
• La cirugia minimamente invasiva radio-guiada de paratiroides

Su entrenamiento fue el siguiente:

• Cirugia general y gastrointestinal:
• Michigan State University:
• 2004 al 2010• Cirugia oncológica / tumores de cabeza y cuello / cirugia endocrina:
• Fox Chase Cancer Center (Filadelfia):
• 2010 al 2012• Maestria en ciencias (Clinical research for healthprofessionals):
• Drexel University (Filadelfia):
• 2010 al 2012• Cirugia de tumores de cabeza y cuello / cirugiaendocrina
• IFHNOS / Memorial Sloan Kettering Cancer Center:
• 2014 al 2016

http://www.sociedadquirurgica.com

http://www.hiperparatiroidismo.info

http://www.cirugiatiroides.com

#Arrangoiz

#CirugiadeTumoresdeCabezayCuello

#CirugiaEndocrina

#CirugiaOncologica

#HeadandNeckSurgery

#EndocrineSurgery

#SurgicalOncology

👉Pregnancy-associated breast cancer (PABC) is defined as breast cancer diagnosed during pregnancy or in the first postpartum year.

👉Breast cancer is the second most common malignancy affecting pregnant women.

👉It is estimated that one in 3,000 pregnant women is diagnosed with breast cancer and that up to 3% of all breast cancers are associated with pregnancy.

👉In general, breast cancer in young women is rare; the estimated incidence of breast cancer in women younger than 40 years of age was less than 4% in 2015 in the United States.

👉However, by definition, PABC occurs in women of reproductive age, and the average age of women with PABC is between 32 and 38 years of age.

👉The birth rate for women age 30 to 44 years has been steadily increasing in the past few decades, and as more women are delaying childbearing for various reasons, the incidence of PABC has risen and is expected to continue to rise.

👉As in non-PABC, the risk of PABC seems to be age related.

👉A large Canadian population cohort study using birth data from a national registry reported that PABC appeared to be more common among women with a first-term pregnancy occurring after the age of 35

👉Rodrigo Arrangoiz MS, MD, FACS cirujano oncology y miembro de Sociedad Quirúrgica S.C en el America British Cowdray Medical Center en la ciudad de Mexico:

• Es experto en el manejo del cáncer de mama.

Training:

• General surgery:

• Michigan State University:

• 2004 al 2010

• Surgical Oncology / Head and Neck Surgery / Endocrine Surgery:

• Fox Chase Cancer Center (Filadelfia):

• 2010 al 2012

• Masters in Science (Clinical research for health professionals):

• Drexel University (Filadelfia):

• 2010 al 2012

• Surgical Oncology / Head and Neck Surgery / Endocrine Surgery:

• IFHNOS / Memorial Sloan Kettering Cancer Center:

• 2014 al 2016

#Arrangoiz

#Surgeon

#Cirujano

#SurgicalOncologist

#CirujanoOncologo

#BreastSurgeon

#CirujanodeMama

#CancerSurgeon

#CirujanodeCancer

http://www.sociedadquirurigca.com

👉Meta-analysis demonstrates a 28% reduction in surgical site infection (SSI) risk with the use of triclosan-coated sutures.

👉Four globally recognized health authorities recommend the use of triclosan-coated sutures for SSI prevention

👉CDC, WHO, NICE, and ACS/SIS guidelines on reducing the risk of surgical site infections are general to triclosan-coated sutures and are not specific to any one brand.

👉Sutures—like all implanted materials—can be a nidus for infection, because they lower the infective threshold; ie, they decrease the amount of bacteria needed to cause an SSI.

👉In fact, 67% of all SSIs are confined to the incision.

👉Plus Sutures have been shown in vitro to inhibit bacterial colonization of the suture for 7 days or more, for protection against the most common organisms associated with SSI.

👉Determining the ability of triclosan-coated sutures to help reduce the risk of SSI is the subject of 11 meta-analyses of 28 randomized controlled trials (RCTs) involving over 7,000 patients.

👉Prospectively planned meta-analyses of RCTs performed on the use of suture containing triclosan to lower SSI rates

👉Plus Sutures are available in barbed and non‑barbed designs and handle and perform just like non‑antibacterial sutures.

References:

1. de Jonge SW, Atema JJ, Solomkin JS, Boermeester MA. Meta-analysis and trial sequential analysis of triclosan-coated sutures for the prevention of surgical-site infection. Br J Surg. 2017;104(2):e118-e133. 

2. Berríos-Torres SI, Umscheid CA, Bratzler DW, et al. Centers for Disease Control and Prevention Guideline for the Prevention of Surgical Site Infection. JAMA Surg. 2017;152(8):784-791. doi:10.1001/jamasurg.2017.0904 

3. WHO Global Guidelines for the Prevention of Surgical Site Infection, 2016. 

4. Ban KA, Minei JP, Laronga C, et al. American College of Surgeons and Surgical Infection Society: Surgical Site Infection Guidelines, 2016 Update. J Am Coll Surg.2016;224:59-74. 

5. National Institute for Health and Care Excellence (2019) Surgical site infections: prevention and treatment (NICE Guideline 33). Available at: https://www.nice.org.uk/guidance/ng125/chapter/Recommendations#intraoperative-phase. Accessed 1 July 2019. 

6. Mangram J, Horan TC, Pearson ML, Silver LC, Jarvis WR. Guideline for Prevention of Surgical Site Infection, 1999. Centers for Disease Control Prevention (CDC) Hospital Infection Control Practices Advisory Committee. Am J Infect Control. 1999;27(2):97-132. 

7. WHO Guidelines for Safe Surgery 2009: Safe Surgery Saves Lives. Geneva: World Health Organization; 2009. 

8. Hendley JO, Ashe KM. Effect of topical antimicrobial treatment on aerobic bacteria in the stratum corneum of human skin. Antimicrob Agents Chemother. 1991;35(4):627-631. 

9. Ward KH, Olson ME, Lam K, Costerton JW. Mechanism of persistent infection associated with peritoneal implants. J Med Microbiol.1992;36(6):406-413. 

10. Kathju S, Nistico L, Hall-Stoodley L, et al. Chronic surgical site infection due to suture-associated polymicrobial biofilm. Surg Infect (Larchmt). 2009;10(5):457-461. 

11.Rothenburger S, Spangler D, Bhende S, Burkely D. In vitro antimicrobial evaluation of Coated VICRYL* Plus Antibacterial Suture (coated polyglactin 910 with triclosan) using zone of inhibition assays. Surg Infect (Larchmt).2002;3(Suppl 1):S79-S87. 

12. Ming X, Rothenburger S, Yang D. In vitro antibacterial efficacy of MONOCRYL plus antibacterial suture (poliglecaprone 25 with triclosan). Surg Infect (Larchmt). 2007;8(2):201-207. 

13. Ming X, Rothenburger S, Nichols M. In vivo and in vitro antibacterial efficacy of PDS plus (polidioxanone with triclosan) suture. Surg Infect (Larchmt).2008;9(4):451-457. 

14. Leaper DJ, Edmiston CE Jr, Holy CE. Meta-analysis of the potential economic impact following introduction of absorbable antimicrobial sutures. Br J Surg.2017;104(2):e134-e144. 

15. Apisarnthanarak A, Singh N, Bandong AN, et al. Triclosan-Coated Sutures Reduce the Risk of Surgical Site Infections: A Systematic Review and Meta-Analysis. Infect Control Hosp Epidemiol.2015;36:169-179. 

16. Chang WK, Srinivasa S, Morton R, et al. Triclosan-Impregnated Sutures to Decrease Surgical Site Infections: Systematic Review and Meta-Analysis of Randomized Trials. Ann Surg. 2012;255:854-859. 

17. Daoud FC, Edmiston CE Jr, Leaper D. Meta-analysis of prevention of surgical site infections following incision closure with triclosan-coated sutures: Robustness to new evidence. Surg Infect (Larchmt). 2014;15:165-181. 

18. Daoud FC. Systematic Literature Review Update of the PROUD Trial: Potential Usefulness of a Collaborative Database. Surg Infect (Larchmt).2014;15:857-858. 

19. Edmiston CE, Daoud FC, Leaper D. Is there an evidence-based argument for embracing an antimicrobial (triclosan)-coated suture technology to reduce the risk for surgical-site infections?: A meta-analysis. Surgery. 2013;154:89-100. 

20. Guo J, Pan LH, Li YX, et al. Efficacy of triclosan-coated sutures for reducing risk of surgical site infection in adults: a meta-analysis of randomized clinical trials. J Surg Res. 2016;201:105-117. 21. Sajid MS, Craciunas L, Sains P, et al. Use of antibacterial sutures for skin closure in controlling surgical site infections: a systematic review of published randomized, controlled trials. Gastroenterol Rep.2013;1:42-50. 

22. Sandini M, Mattavelli I, Nespoli L, Uggeri F, Gianotti L. Systematic review and meta-analysis of sutures coated with triclosan for the prevention of surgical site infection after elective colorectal surgery according to the PRISMA statement. Medicine (Baltimore).2016;95(35):e40-57 

23. Wang ZX, Jiang CP, Cao Y, et al. Systematic review and meta-analysis of triclosan-coated sutures for the prevention of surgical-site infection. Brit J Surg. 2013;100:465-473. 

24. Wu X, Kubilay NZ, Ren J, et al. Antimicrobial-coated sutures to decrease surgical site infections: a systematic review and meta-analysis. Eur J Clin Microbiol Infect Dis.2017;36(1):19-32. doi: 10.1007/s10096-016-2765-y. 

25. Ford HR, Jones P, Gaines B, Reblock K, Simpkins DL. Intraoperative Handling and Wound Healing: Controlled Clinical Trial Comparing Coated VICRYL Plus Antibacterial Suture (Coated Polyglactin 910 Suture with Triclosan) with Coated VICRYL Suture (Coated Polyglactin 910 Suture). Surg Infect (Larchmt).2005;6(3):313-321.

👉Computer modeling has found that performing a prophylactic oophorectomy at age 40 years and prophylactic mastectomy at age 25 years, is the most effective combination strategy to obtain a 26% survival gain by age 70 years compared with no interventions.

👉However, performing a prophylactic oophorectomy early in life can limit reproductive options and cause early menopause and its accompanying health risks. 

👉In a recent study of 5783 BRCA1 and BRCA2 mutation carriers from a prospective international registry, preventive oophorectomy was associated with an 80% reduction in the risk of ovarian, fallopian tube, or peritoneal cancer and a 77% reduction in all-cause mortality.

👉The authors also concluded that the data support the recommendation for BRCA1 mutation carriers to undergo oophorectomy at age 35 years.

👉After this age, the risk of ovarian cancer increases. 

Rodrigo Arrangoiz MS, MD, FACS cirujano oncology y miembro de Sociedad Quirúrgica S.C en el America British Cowdray Medical Center en la ciudad de Mexico:

• Es experto en el manejo del cáncer de mama.

Training:

• General surgery:

• Michigan State University:

• 2004 al 2010

• Surgical Oncology / Head and Neck Surgery / Endocrine Surgery:

• Fox Chase Cancer Center (Filadelfia):

• 2010 al 2012

• Masters in Science (Clinical research for health professionals):

• Drexel University (Filadelfia):

• 2010 al 2012

• Surgical Oncology / Head and Neck Surgery / Endocrine Surgery:

• IFHNOS / Memorial Sloan Kettering Cancer Center:

• 2014 al 2016

#Arrangoiz

#Surgeon

#Cirujano

#SurgicalOncologist

#CirujanoOncologo

#BreastSurgeon

#CirujanodeMama

#CancerSurgeon

#CirujanodeCancer

http://www.sociedadquirurigca.com

REFERENCES

👉Although observed 5-year recurrence rates were lower among a subset of low-risk patients commensurate with ASTRO “suitable” APBI guidelines (1.5%, ELIOT trial), this subset was small and follow-up short.

👉Therefore, recent critical analyses of both the ELIOT and TARGIT trials concluded that IORT should only be offered as part of a strict institutional research protocol and is not yet standard of care for adjuvant post-lumpectomy radiation. 

REFERENCES

Rodrigo Arrangoiz MS, MD, FACScirujano oncology y miembro de Sociedad Quirúrgica S.C en el America British Cowdray Medical Center en la ciudad de Mexico:

• Es experto en el manejo del cáncer de mama.

Training:

• General surgery:

• Michigan State University:

• 2004 al 2010

• Surgical Oncology / Head and Neck Surgery / Endocrine Surgery:

• Fox Chase Cancer Center (Filadelfia):

• 2010 al 2012

• Masters in Science (Clinical research for health professionals):

• Drexel University (Filadelfia):

• 2010 al 2012

• Surgical Oncology / Head and Neck Surgery / Endocrine Surgery:

• IFHNOS / Memorial Sloan Kettering Cancer Center:

• 2014 al 2016

#Arrangoiz

#Surgeon

#Cirujano

#SurgicalOncologist

#CirujanoOncologo

#BreastSurgeon

#CirujanodeMama

#CancerSurgeon

#CirujanodeCancer

http://www.sociedadquirurigca.com