Assessment of Laparoscopically Harvested Omental Flap Used in Immediate Reconstruction in Breast Cancer Cases Eligible for Breast Conservative Surgery

Abstract
Background and Purpose: Breast conservative surgery is considered a standard surgical modality for treatment of early breast cancer. Omental pedicled flap is used for volume replacement after breast conservative surgery.
Aim of Study: The aim of this study was to assess the fate of laparoscopically harvested omental flap used in immediate reconstruction in breast cancer cases eligible for breast con-servative surgery.
Patients and Methods: Ten female patients were included in this retrospective study which was conducted at The Surgical Oncology Unit, Department of General Surgery, Tanta Uni-versity Hospitals, from June 2016 to July 2018. Every patient was subjected to mammography with complementary ultra-sonography, Doppler ultrasound and Tru-cut needle biopsy from the omental flap and histopathology with different stains.
Results: Nodules were detected in 40% of cases which were proved to be benign in nature by Histopathology. Doppler revealed that two cases had partial infarction and degeneration of the omental flap. Histopathology revealed minimal inflam-matory reaction, extensive fat necrosis and dense fibrosis in 50% of the studied cases. Vasculitis was detected in 30% of the studied cases. No recurrence of malignancy could be detected over the follow-up period. With CD31, various degrees of neovascularization were detected in the omental flap, mild in 20% of cases, moderate in 40% of cases and severe in 40% of cases. With CD8, T-Killer cells were found mild in 50% of cases and moderate in 40% of cases. CD44 detected presence of stem cells in 20% of cases.
Conclusion: The laparoscopically harvested omental flap had a promising oncological safety during the follow up. In spite of the fibrosis and nodulation found, no change was observed in the shape or contour of the breast. The inflamma-tory reaction and enhanced local immunity by the omentum is not studied as a possible preventive factor for recurrence. Vasculitis, angiogenesis and the presence of stem cells are not studied as a possible potentiating factor for recurrence of breast cancer. So, long term follow-up is essential to see whether the omental flap could be a barrier against recurrence or it may enhance it.