title: Chest wall resection in the treatment of locally recurrent breast carcinoma: indications and outcome for 44 patients.
abstract: BACKGROUND
  Locoregional recurrence after initial treatment of breast carcinoma occurs in up to 35% of patients. In selected patients, chest wall resection (CWR) can be performed to regain local control. Extensive surgery is justifiable only if good palliation and possibly a better prognosis can be offered and the morbidity is limited.
  
  
  METHODS
  The authors conducted a retrospective review of the medical records of 44 females with locally recurrent breast carcinoma who underwent chest wall resection between 1979 and 1995 at the Netherlands Cancer Institute. Preoperative patient characteristics were recorded, and complications were scored. Analysis was made of disease free and overall survival after resection as well as the influence of presumed prognostic factors on survival. The median duration of follow-up was 3.2 years.
  
  
  RESULTS
  The mean patient age at diagnosis of breast carcinoma was 47.5 years. The median interval between first treatment and relapse was 3.9 years. Thirty patients (68%) underwent CWR with curative intent. Postoperative complications occurred in 18 patients, but no mortality occurred. The median disease free interval after curative CWR was 3.3 years; the projected 5-year disease free survival rate was 35%. A disease free interval of more than 2 years after primary treatment predisposed patients to significantly longer tumor free survival after CWR, compared with an interval shorter than 2 years (P = 0.0001). New local recurrence after curative CWR occurred in 6 patients (20%), and distant metastases occurred in 17. Median overall survival was 4.8 years; the projected 5-year survival rate was 45%. After curative resection, these figures were 8.9 years and 58%, respectively, whereas palliative resection resulted in a median survival of 2.3 years and a projected 5-year survival of 21% (P = 0.008). Age > or =35 years at the time of the first diagnosis of breast carcinoma predisposed patients to significantly better survival than age <35 years (P = 0.02).
  
  
  CONCLUSIONS
  CWR can provide local control, good palliation, and an acceptable prognosis for patients with recurrence of breast carcinoma. Outcome mainly depends on the completeness of the resection.
authors.affiliation: Department of Surgery, The Netherlands Cancer Institute/Antoni van Leeuwenhoek ziekenhuis, Amsterdam.
authors.forename: I F
authors.initials: IF
authors.lastname: Faneyte
authors.forename: E J
authors.initials: EJ
authors.lastname: Rutgers
authors.forename: F A
authors.initials: FA
authors.lastname: Zoetmulder
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D001943:Breast Neoplasms / Q000601:surgery*; D000075202:Contraindications; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008408:Mastectomy; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000601:surgery*; D016019:Survival Analysis; D013899:Thoracic Neoplasms / Q000601:surgery*; D013908:Thoracotomy / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome