[Significance of multidisplinary surgery in chest wall resection and reconstruction for selected patients with breast cancer].
OBJECTIVE
To evaluate the clinical significance and survival benefits of chest wall resection and reconstruction (CWRR) by multidisciplinary surgery for selected patients with locally advanced or recurrent breast cancer in order to address the importance of collaboration between ablative (breast surgery or/and thoracic surgery) and reconstructive teams during CWRR.


METHODS
The data of 44 patients who underwent multidisciplinary CWRR at The University of Texas M. D. Anderson Cancer Center between March 2001 and June 2004 were retrospectively analyzed, which included the CWRR techniques used, patient characteristics and treatment outcomes. Survival of patients with primary, recurrent or metastatic disease, and that of those with curative or palliative resection were also compared.


RESULTS
All patients were female aged 34-83 years with primary (n=19), recurrent (n=15) or metastatic breast cancer (n=10). The surgery modes included curative resection(n=36) and palliative (n=8) with a mean defect size of skin: 218.4 cm2; of bony chest wall: 113.9 cm2 (n=15). Immediate reconstruction (n=43) with prosthesis (n=10) or without (n=34) for most of these patients. All of them required soft tissue coverage with pedicled flap (n=37) or free flap (n=13). The average hospital and ICU stay was 6.6 days and 3.4 days (n=8), respectively. The morbidity was acceptable and no 30-day mortality happened. Neither was there difference in median survival (44.7 m vs. 36.0 m, P = 0.752) nor in 1-, 2-, and 3-year survival rates between primary breast cancer (78.4%, 78.4%, 39.2%) and recurrent one (70.9%, 70.9%, 70.9%, P > 0.05). However, both median survival (16.0 m) and the 1-, 2-, and 3-year survival rates (30.0%, 15.0%, 0) in patients with metastasis were much poorer than that in those with primary breast cancer (P = 0.003) or recurrence(P =0. 018). The survival of patients underwent curative resection (36.0 m, 71.5%, 65.7%, 65.7%) were much longer than those with palliative resection (15.1 m, 35.1%, 23.4%, 7.8%, P = 0.018).


CONCLUSIONS
With full control of systemic and local disease by up-front multidisciplinary strategy, chest wall resection and reconstruction could improve long-term survival if curative resection achieved or the quality of life if palliative resection done for breast cancer patients with tumor invading the chest wall or local recurrence. Ablative and reconstructive surgeons should be included in surgery team in order to guarantee the possibility of extensive resection and effective reconstruction in a single stage with high safety, good survival and minimal morbidity.
Chen
Ke-neng
KN
Department of Thoracic Surgery, Peking University School of Oncology, Beijing Cancer Hospital, Beijing 100036, China. chenkeneng@yahoo.com.cn
Yu
Peirong
P
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008408:Mastectomy / Q000379:methods*; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000601:surgery*; D009367:Neoplasm Staging; D010166:Palliative Care; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D013524:Surgical Flaps; D016019:Survival Analysis; D019616:Thoracic Surgical Procedures; D035441:Thoracic Wall / Q000473:pathology*