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Article ; Online: Sentinel lymph node biopsy after nipple-sparing mastectomy in early postoperative period: Is it feasible?

Kara, Halil / Arikan, Akif Enes / Dülgeroğlu, Onur / Uras, Cihan

2024 Volume 60, Issue 2, Page(s) 237–241

Abstract: Background: Axillary lymph node status is one of the most important prognostic factors for breast cancer. Sentinel lymph node biopsy (SLNB) after mastectomy is highly controversial. There is not enough data about SLNB in the early period after nipple- ... ...

Abstract	Background: Axillary lymph node status is one of the most important prognostic factors for breast cancer. Sentinel lymph node biopsy (SLNB) after mastectomy is highly controversial. There is not enough data about SLNB in the early period after nipple-sparing mastectomy (NSM). This study investigated the feasibility of SLNB in the early postoperative period of NSM. Materials and methods: Patients who were operated on for breast cancer in Acibadem Maslak Hospital between 2009 and 2018 were searched retrospectively. Results of SLNB as the second session in patients whose final pathology report revealed breast carcinoma after contralateral/bilateral prophylactic mastectomy and mastectomy for benign lesions were evaluated. Results: In the early period (median 14 days) after NSM, SLNB was performed by intradermal radioisotope injection in five patients with occult breast cancer in contralateral/bilateral prophylactic mastectomy and in one patient with preoperatively suspicious mass which yielded breast cancer at final pathology. In five (80%) patients, SLNB was performed, whereas in one patient axillary lymph node dissection (ALND) was performed due to the undetectability of SLN. In one patient, micrometastasis was observed, whereas no metastasis was observed in other patients including the one who underwent ALND. No complication due to SLNB was detected. No recurrence and distant metastasis were detected in a mean follow-up of 42.82 (19-70) months. While SLNB did not change the treatment of patients with contralateral occult carcinoma, other patients had hormonal therapy due to negative SLNB. Conclusion: SLNB in the early postoperative period of NSM can be performed by intradermal radioisotope injection. However, further studies are needed to determine the feasibility of SLNB in the early postoperative period of NSM.
MeSH term(s)	Humans ; Female ; Sentinel Lymph Node Biopsy/methods ; Breast Neoplasms/surgery ; Breast Neoplasms/pathology ; Mastectomy ; Retrospective Studies ; Nipples/surgery ; Nipples/pathology ; Lymphatic Metastasis/pathology ; Lymph Node Excision ; Lymph Nodes/pathology ; Radioisotopes ; Axilla/pathology
Chemical Substances	Radioisotopes
Language	English
Publishing date	2024-03-20
Publishing country	India
Document type	Journal Article
ZDB-ID	410194-7
ISSN	1998-4774 ; 0019-509X
ISSN (online)	1998-4774
ISSN	0019-509X
DOI	10.4103/ijc.IJC_1175_20
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Zs.B 581: Show issues

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Article ; Online: Implant selection in natural and stable direct-to-implant reconstruction with ten steps at nipple-sparing mastectomy.

Sağir, Mehmet / Güven, Erdem / Eröz, Seda / Uras, Cihan

Medicine

2023 Volume 102, Issue 19, Page(s) e33758

Abstract: Direct-to-implant reconstruction is one of the breast repair techniques after mastectomy. Implant selection is critical in the short- and long-term success of direct-to-implant reconstruction after nipple-sparing mastectomy. In this study we developed a ... ...

Abstract	Direct-to-implant reconstruction is one of the breast repair techniques after mastectomy. Implant selection is critical in the short- and long-term success of direct-to-implant reconstruction after nipple-sparing mastectomy. In this study we developed a 10-step algorithm that we use before and during surgery. We aimed to obtain natural and stable breast reconstruction with this algorithm. In addition, we also aimed to evaluate which implants were selected using this algorithm and their short- and long-term outcomes. This retrospective study included 218 patients aged 27 to 60 years who underwent mastectomy and direct-to-implant reconstruction between November 2018 and December 2021. The patients were assigned into 4 groups according to amount of breast tissue removed. We developed a 10-step algorithm and these included: breast base, amount of breast tissue removed, evaluation of mastectomy skin flap, breast projection, ptosis, unilateral/bilateral reconstruction, chest wall deformity, patient's request, comorbid conditions and stabilization and arrangement of novel sulcus. The evaluation was made when the patient's photographs were taken at least 1 year after the surgery. The highest number of patients was recorded in group 3; in addition, mean age was also highest in group 3. The lowest number of patients was recorded in group 4. The body mass index showed a progressive increase from group 1 to group 4. Medium height moderate profile prosthesis was used in 81.7% while medium height moderate plus profile prosthesis was used in 18.3% of breasts included. We used larger prosthesis up to 58.1% when compared to the tissue removed in group 1 while we used smaller prosthesis by 25.6% in group 4. In the anterior view, the medial and lateral arch of the lower pole of the breast was obtained in all patients. Obvious asymmetry developed in 4 patients. In lateral and oblique views, upper and lower pole natural breast images were obtained in all patients, except for 5 patients. There was no sulcus inferior displacement in any patient. Implant extrusion did not occur in any patient. This algorithm is an easy to use and effective method to obtain a stable and natural breast image in the long-term.
MeSH term(s)	Humans ; Female ; Mastectomy/methods ; Nipples/surgery ; Retrospective Studies ; Breast Neoplasms/surgery ; Mammaplasty/methods ; Breast Implants
Language	English
Publishing date	2023-04-27
Publishing country	United States
Document type	Journal Article
ZDB-ID	80184-7
ISSN	1536-5964 ; 0025-7974
ISSN (online)	1536-5964
ISSN	0025-7974
DOI	10.1097/MD.0000000000033758
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Ua VI Zs.171: Show issues

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Article ; Online: Adherence to adjuvant tamoxifen and associated factors in breast cancer survivors.

Uslu, Yasemin / Kocatepe, Vildan / Sezgin, Derya Subaşı / Uras, Cihan

Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer

2023 Volume 31, Issue 5, Page(s) 285

Abstract: Purpose: Adjuvant endocrine therapy reduces the recurrence and mortality of early hormone receptor-positive breast cancer in both pre- and postmenopausal women. The aim of this study was to investigate adjuvant tamoxifen adherence and associated factors ...

Abstract	Purpose: Adjuvant endocrine therapy reduces the recurrence and mortality of early hormone receptor-positive breast cancer in both pre- and postmenopausal women. The aim of this study was to investigate adjuvant tamoxifen adherence and associated factors in breast cancer survivors. Methods: This descriptive, prospective study was conducted in 2019-2020 with the participation of 531 women who survived breast cancer and were under follow-up at the Senology Institute of a hospital in Istanbul. Inclusion criteria were having completed treatment for early hormone receptor-positive breast cancer, being prescribed tamoxifen, and being 18 years or older. Data were collected using a patient information form and the Morisky Medication Adherence Scale-8 (MMAS-8). Results: The mean age of the participants was 44.9 ± 6.5 years, and the mean duration of tamoxifen use was 834.4 ± 685.7 days. The women's mean MMAS-8 score was 6.86 ± 1.39. Medication adherence was significantly positively correlated with current age (p = 0.006) and age at diagnosis (p = 0.002). There was a statistically significant difference between tamoxifen adherence according to participants' employment status (p = 0.028), chronic disease status (p = 0.018), loss of libido (p = 0.012), treatment-related changes in mood changes (p = 0.004), and having negative effects affecting daily life (p < 0.001). Conclusion: Overall, breast cancer survivors in this study reported moderate adherence to tamoxifen. The women's individual characteristics and the adverse effects of treatment influenced medication adherence. Healthcare professionals can help increase adherence to this treatment, which reduces the risk of mortality, by explaining the importance of the medication, identifying and eliminating barriers to adherence, and informing women about evidence-based interventions to increase medication compliance.
MeSH term(s)	Female ; Humans ; Adult ; Middle Aged ; Tamoxifen/therapeutic use ; Breast Neoplasms/drug therapy ; Cancer Survivors ; Antineoplastic Agents, Hormonal/adverse effects ; Prospective Studies ; Chemotherapy, Adjuvant ; Medication Adherence ; Adjuvants, Immunologic/therapeutic use ; Adjuvants, Pharmaceutic/therapeutic use ; Aromatase Inhibitors/therapeutic use
Chemical Substances	Tamoxifen (094ZI81Y45) ; Antineoplastic Agents, Hormonal ; Adjuvants, Immunologic ; Adjuvants, Pharmaceutic ; Aromatase Inhibitors
Language	English
Publishing date	2023-04-20
Publishing country	Germany
Document type	Journal Article
ZDB-ID	1134446-5
ISSN	1433-7339 ; 0941-4355
ISSN (online)	1433-7339
ISSN	0941-4355
DOI	10.1007/s00520-023-07742-2
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Zs.A 3697: Show issues

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Article ; Online: Impact of preoperative PET/CT for axillary staging in patients with early breast cancer.

Dulgeroglu, Onur / Arikan, Akif Enes / Kara, Halil / Uras, Cihan

Annali italiani di chirurgia

2022 Volume 93, Page(s) 504–509

Abstract: Background: Preoperative evaluation of axillary lymph node status is very important for the choice of primary treatment in breast cancer. This study assessed predictive properties of positron emission tomography-computerized tomography for axillary ... ...

Abstract	Background: Preoperative evaluation of axillary lymph node status is very important for the choice of primary treatment in breast cancer. This study assessed predictive properties of positron emission tomography-computerized tomography for axillary lymph node metastasis. Methods: Patients who were operated between 2014-2019 for early breast cancer and who had preoperative positron emission tomography-computerized tomography images were included. Positron emission tomography-computerized tomography results and histopathologic results were compared retrospectively. Results: Medical records of 223 patients who were operated for early breast cancer and have had positron emission tomography-computerized tomography were evaluated. positron emission tomography-computerized tomography revealed that axillary lymph node status is positive in 97 patients and negative in 126 patients. In histopathological examination, tumor cells were found in 86 patients, of those 27 were negative while 59 were positive in positron emission tomography-computerized tomography. Furthermore, 137 patients were free from tumor cells, in which 99 were negative and 38 were positive in positron emission tomography-computerized tomography. Positive and negative predictive value of positron emission tomography-computerized tomography for metastatic axillary lymph nodes were found 60.8% and 78.5%, respectively. Conclusions: Clinically, positron emission tomography-computerized tomography has low negative predictivity for determination of axilla in early stage or operable breast cancer. Even though it is valuable for the systematic scanning, positron emission tomography-computerized tomography can be overlooked for axillary evolution. Key words: Axilla, Breast Cancer, Cancer Staging, PET-CT.
MeSH term(s)	Axilla/pathology ; Breast Neoplasms/diagnostic imaging ; Breast Neoplasms/surgery ; Female ; Fluorodeoxyglucose F18 ; Humans ; Lymph Nodes/diagnostic imaging ; Lymph Nodes/pathology ; Neoplasm Staging ; Positron Emission Tomography Computed Tomography ; Positron-Emission Tomography/methods ; Radiopharmaceuticals ; Retrospective Studies
Chemical Substances	Radiopharmaceuticals ; Fluorodeoxyglucose F18 (0Z5B2CJX4D)
Language	English
Publishing date	2022-10-17
Publishing country	Italy
Document type	Journal Article
ZDB-ID	418927-9
ISSN	2239-253X ; 0003-469X
ISSN (online)	2239-253X
ISSN	0003-469X
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Zs.B 50: Show issues

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Article: Transmesocolic approach in laparoscopic complete mesocolic excision for right sided colon cancers.

Çapkınoğlu, Emir / Arıkan, Akif Enes / Dülgeroğlu, Onur / Uras, Cihan

Wideochirurgia i inne techniki maloinwazyjne = Videosurgery and other miniinvasive techniques

2022 Volume 17, Issue 4, Page(s) 699–704

Abstract: Introduction: A mesocolic plane, central vascular ligation (CVL) and proper proximal-distal margins are the essential components of complete mesocolic excision (CME). In the transmesocolic approach, we identify the middle colic vessels and enter the ... ...

Abstract	Introduction: A mesocolic plane, central vascular ligation (CVL) and proper proximal-distal margins are the essential components of complete mesocolic excision (CME). In the transmesocolic approach, we identify the middle colic vessels and enter the lesser sac through the mesocolon for ascending colon and caecum tumors. Aim: To investigate the feasibility and identify the technical details of this technique. Material and methods: The clinical and pathological findings of 26 patients who had undergone laparoscopic right hemicolectomy with CME between 2010 and 2020 were collected retrospectively. All operation videos were recorded and reviewed by the authors with regard to the components of CME. In the transmesocolic approach, dissection starts with identification of the middle colic vessels directly. After division of the middle colic vessels, we enter the omental bursa and dissection continues from superior to inferior direction. Results: There were 26 patients in the study. The mean age was 59.3 ±16.1. There were 15 female and 11 male patients with a mean body mass index of 25.9 ±16.1 kg/m Conclusions: The transmesocolic approach seems to be feasible and safe for CME in right sided colon cancers. However, more prospective randomized studies are needed to use the transmesocolic approach as a standard technique.
Language	English
Publishing date	2022-08-10
Publishing country	Poland
Document type	Journal Article
ZDB-ID	2596147-0
ISSN	2299-0054 ; 1895-4588
ISSN (online)	2299-0054
ISSN	1895-4588
DOI	10.5114/wiitm.2022.118683
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Article ; Online: Comparison of mammography and ultrasound findings in the follow-up of patients with breast cancer treated with segmental mastectomy followed by intraoperative electron radiotherapy versus external whole breast radiotherapy

Tutar, Burçin / Esen İçten, Gül / Altınok, Ayşe / Eröz, Seda / Beşe, Nuran / Uras, Cihan

Diagnostic and interventional radiology (Ankara, Turkey)

2023 Volume 29, Issue 6, Page(s) 761–770

Abstract: Purpose: This study aims to describe imaging findings in patients treated with intraoperative electron radiotherapy and compare them with those detected in patients treated with external whole breast radiotherapy (WBRT).: Methods: The study ... ...

Abstract	Purpose: This study aims to describe imaging findings in patients treated with intraoperative electron radiotherapy and compare them with those detected in patients treated with external whole breast radiotherapy (WBRT). Methods: The study population consisted of 25 patients who received intraoperative radiotherapy [IORT (21 Gy)] as single-dose radiotherapy and a control group of 25 patients who received WBRT at the same institution. Mammography and ultrasound (US) findings were divided into three groups: minor, intermediate, and advanced. On mammography, mass lesions were considered advanced, and asymmetries or architectural distortions were considered intermediate. Oil cysts, linear scars, and the increase in parenchymal density were considered minor findings. On US, irregular non-mass lesions were considered advanced, and circumscribed hypoechoic lesions or planar irregular scars with shadowing were considered intermediate. Oil cysts, fluid collections, or linear scars were considered minor findings. Results: On mammography, skin thickening ( Conclusion: Ill-defined non-mass lesions detected on US in the IORT group have not been defined previously. Radiologists should be aware of these lesions because they can be confusing, especially in early follow-up studies. This study has found that minor findings are seen more frequently in low-density breasts, while major findings are more common in high-density breasts in the IORT group. This has not been reported before, and further studies with more cases are needed to verify these results.
MeSH term(s)	Humans ; Female ; Breast Neoplasms/diagnostic imaging ; Breast Neoplasms/radiotherapy ; Breast Neoplasms/surgery ; Mastectomy, Segmental/methods ; Follow-Up Studies ; Cicatrix/etiology ; Electrons ; Radiotherapy, Adjuvant/adverse effects ; Radiotherapy, Adjuvant/methods ; Mastectomy ; Mammography ; Intraoperative Care/methods ; Cysts
Language	English
Publishing date	2023-03-20
Publishing country	Turkey
Document type	Journal Article
ZDB-ID	2184145-7
ISSN	1305-3612 ; 1305-3612
ISSN (online)	1305-3612
ISSN	1305-3612
DOI	10.4274/dir.2023.211218
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Article ; Online: ASO Author Reflection: Getting Closer to Solving the Mystery Behind Mastalgia: Evening Primrose Oil and Factors Affecting Its Therapeutic Efficacy.

Balci, Fatih Levent / Uras, Cihan / Feldman, Sheldon

Annals of surgical oncology

2020 Volume 27, Issue Suppl 3, Page(s) 717–718

MeSH term(s)	Case-Control Studies ; Female ; Humans ; Linoleic Acids/administration & dosage ; Mastodynia/drug therapy ; Plant Oils/administration & dosage ; Retrospective Studies ; gamma-Linolenic Acid/administration & dosage
Chemical Substances	Linoleic Acids ; Plant Oils ; evening primrose oil (3Q9L08K71N) ; gamma-Linolenic Acid (78YC2MAX4O)
Language	English
Publishing date	2020-08-18
Publishing country	United States
Document type	Journal Article
ZDB-ID	1200469-8
ISSN	1534-4681 ; 1068-9265
ISSN (online)	1534-4681
ISSN	1068-9265
DOI	10.1245/s10434-020-09032-1
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Zs.A 4042: Show issues

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Article ; Online: Clinical Factors Affecting the Therapeutic Efficacy of Evening Primrose Oil on Mastalgia.

Balci, Fatih Levent / Uras, Cihan / Feldman, Sheldon

Annals of surgical oncology

2020 Volume 27, Issue 12, Page(s) 4844–4852

Abstract: Background: Saturated fatty acid esters may cause mastalgia via hypersensitivity of breast epithelium to circulating hormones. Evening primrose oil (EPO) may restore the saturated/unsaturated fatty acid balance and decrease sensitivity to steroidal ... ...

Abstract	Background: Saturated fatty acid esters may cause mastalgia via hypersensitivity of breast epithelium to circulating hormones. Evening primrose oil (EPO) may restore the saturated/unsaturated fatty acid balance and decrease sensitivity to steroidal hormones or prolactin. Conflicting results exist regarding EPO treatment for mastalgia. The aim of this study was to determine the effectiveness of EPO and factors affecting its efficacy in treatment of mastalgia. Methods: The study included 1015 patients, ages 14-82 (mean age 42.21 ± 10.8), admitted to Acibadem Breast Clinic between January 2015 and March 2018. The patients were divided into group I (n = 581) treated with EPO (1300 mg, twice a day) and group II (n = 434) treated with paracetamol (500 mg, twice a day). The visual analog scale was used to assess EPO's therapeutic efficacy, compared with paracetamol, measured at admittance, 2 weeks, and 6 weeks. Clinical factors affecting the efficacy of EPO were analyzed. Results: The therapeutic efficacy of EPO on mastalgia was significantly higher than with paracetamol (p < 0.001). Factors significantly affecting the efficacy of EPO treatment were hormone replacement therapy (HRT), IUD-with-levonorgestrel, iron deficiency, overt hypothyroidism, and Hashimoto thyroiditis (p < 0.01). Replacement of iron or thyroid hormone efficiently treated mastalgia in patients that did not respond to EPO treatment. Side effects (allergy, anxiety, blurred vision, constipation, and nausea) were rare and not statistically significant (p = 0.88). Conclusion: EPO can be used in the treatment of mastalgia without significant side effects. HRT, IUD-with-levonorgestrel, iron deficiency, overt hypothyroidism, and Hashimoto thyroiditis significantly affect the efficacy of EPO on mastalgia.
MeSH term(s)	Adolescent ; Adult ; Aged ; Aged, 80 and over ; Humans ; Linoleic Acids ; Mastodynia/drug therapy ; Mastodynia/etiology ; Middle Aged ; Plant Oils ; Young Adult ; gamma-Linolenic Acid/therapeutic use
Chemical Substances	Linoleic Acids ; Plant Oils ; evening primrose oil (3Q9L08K71N) ; gamma-Linolenic Acid (78YC2MAX4O)
Language	English
Publishing date	2020-08-03
Publishing country	United States
Document type	Journal Article
ZDB-ID	1200469-8
ISSN	1534-4681 ; 1068-9265
ISSN (online)	1534-4681
ISSN	1068-9265
DOI	10.1245/s10434-020-08949-x
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Zs.A 4042: Show issues

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Article: Do prognosis and clinicopathological features differ in young early-stage breast cancer?

Arikan, Akif Enes / Kara, Halil / Dülgeroğlu, Onur / Erdoğan, Esin Nur / Capkinoglu, Emir / Uras, Cihan

Frontiers in surgery

2022 Volume 9, Page(s) 900363

Abstract: Background: Breast cancer is the most frequently detected cancer and the leading cause of cancer-related death in women. Although it is mostly seen in older patients, breast cancer affects women aged 24 to >70 years, with poorer prognosis in young ... ...

Abstract	Background: Breast cancer is the most frequently detected cancer and the leading cause of cancer-related death in women. Although it is mostly seen in older patients, breast cancer affects women aged 24 to >70 years, with poorer prognosis in young patients. Young age remains a controversial topic in the literature. This study aimed to identify subtype differences and the effect of age on early-stage breast cancer outcomes. Methods: A total of 300 consecutive patients underwent surgery between 2011 and 2015 for early-stage breast cancer. Of these, 248 were eligible for this study and were divided into three groups: group Y (aged ≤35 years), group M (aged >35 and ≤45 years), and group E (aged >45 years). The clinical and pathological features and data related to recurrence, metastasis, and death were recorded. Results: No statistical differences were found between groups regarding histopathological features except for higher histological grade and Ki-67 levels in group M. Additionally, group Y recorded no progression (recurrence or metastasis) or death. Disease-free survival was 117.8 months (95% CI 111.8-123.8) for group M, which was significantly shorter than that for group E ( Conclusion: A very young age cannot be considered an independent risk factor for poor prognosis. Rather than age, histological grade and Ki-67 index are more important factors in early-stage breast cancer.
Language	English
Publishing date	2022-10-19
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2773823-1
ISSN	2296-875X
ISSN	2296-875X
DOI	10.3389/fsurg.2022.900363
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Article: Has the COVID-19 Pandemic Affected Breast Cancer Stage and Surgical Volume?

Kara, Halil / Arikan, Akif Enes / Dulgeroglu, Onur / Tutar, Burcin / Tokat, Fatma / Uras, Cihan

Frontiers in surgery

2022 Volume 9, Page(s) 811108

Abstract: Background: This study investigates the effects of COVID-19 on the breast cancer stage and the volume of breast cancer surgery in a specialized breast institute.: Methods: Data of 332 patients who were diagnosed and treated for breast cancer between ... ...

Abstract	Background: This study investigates the effects of COVID-19 on the breast cancer stage and the volume of breast cancer surgery in a specialized breast institute. Methods: Data of 332 patients who were diagnosed and treated for breast cancer between December 2019 and November 2020 were evaluated retrospectively according to periods of pandemic. Results: A significant decrease in the number of operations, especially upfront surgeries rather than surgeries after neoadjuvant chemotherapy, was detected in the early period of the COVID-19 pandemic. It was found that patients with complaints were mostly admitted during this period ( Conclusion: Surgical volume is significantly affected in the early period of the COVID-19 pandemic. To overcome overload due to delayed surgeries related to pandemics, some hospitals should be spared for oncological treatments. Following the early period, mostly luminal type, early-stage patients were admitted, probably because of increased self-awareness and short wave duration, but the breast cancer stage was not affected.
Language	English
Publishing date	2022-02-07
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2773823-1
ISSN	2296-875X
ISSN	2296-875X
DOI	10.3389/fsurg.2022.811108
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