title: Chest wall resection for locally recurrent breast cancer: is it worthwhile?
abstract: OBJECTIVE
  The effectiveness of chest wall resection for locally recurrent breast cancer as cancer treatment remains poorly defined, possibly because of the general impression that locally recurrent disease is a harbinger of rapidly progressive metastatic disease and that extensive surgical treatment in these patients is inappropriate. Reports to date have focused on technical feasibility, not long-term outcome.
  
  
  METHODS
  We reviewed our experience with 38 women who underwent chest wall resection for locally recurrent breast cancer between October 1987 and May 1997. Overall survival was calculated by the Kaplan-Meier method and the significance of prognostic variables evaluated by log-rank and Cox regression analyses.
  
  
  RESULTS
  The operative mortality rate was 0%. Overall survival at 1, 3, and 5 years after chest wall resection was 74%, 41%, and 18%, respectively, and the proportion of patients free of local recurrence at 1, 3, and 5 years was 59%, 42%, and 13%, respectively. Regional nodal disease and size of largest tumor nodule (>4 cm) were significant predictors of local re-recurrence (P <.01, P =.04); lymph node metastasis was the only predictor of long-term survival (P <.01). Patients with and without synchronous sites of metastatic disease had near-identical 3-year survivals.
  
  
  CONCLUSIONS
  Chest wall resection for locally recurrent breast cancer has a low mortality. However, a significant number of patients have the development of local re-recurrence or metastases, and 5-year survival is limited. It is unlikely that complete resection of all locally recurrent disease improves survival. Future studies should focus on the quality of palliation achieved.
authors.affiliation: Divisions of Thoracic Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA. downeyr@mskcc.org
authors.forename: R J
authors.initials: RJ
authors.lastname: Downey
authors.forename: V
authors.initials: V
authors.lastname: Rusch
authors.forename: F I
authors.initials: FI
authors.lastname: Hsu
authors.forename: L
authors.initials: L
authors.lastname: Leon
authors.forename: E
authors.initials: E
authors.lastname: Venkatraman
authors.forename: D
authors.initials: D
authors.lastname: Linehan
authors.forename: M
authors.initials: M
authors.lastname: Bains
authors.forename: K
authors.initials: K
authors.lastname: van Zee
authors.forename: R
authors.initials: R
authors.lastname: Korst
authors.forename: R
authors.initials: R
authors.lastname: Ginsberg
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000401:mortality* / Q000601:surgery*; D005260:Female; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality* / Q000601:surgery*; D011379:Prognosis; D015996:Survival Rate; D019616:Thoracic Surgical Procedures