title: Full-thickness resection with myocutaneous flap reconstruction for locally recurrent breast cancer.
abstract: BACKGROUND
  Despite available recommendations, therapeutic procedures of locally recurrent breast cancer are very different. This retrospective study presents the possibilities and results of complete, full-thickness chest wall resection.
  
  
  METHODS
  Between 1985 and 2006, 63 women (mean age, 58 years) with local recurrence of breast cancer invading the chest wall underwent chest wall resection with myocutaneous flap coverage and are included in this study. Adequate lung, cardiovascular, renal, and hepatic functions were additional eligibility requirements for inclusion. Preoperative known extrapulmonary metastases, pleural dissemination, and Eastern Cooperative Oncology Group (ECOG) status 3 or 4 were exclusion criteria. Survival rates were calculated by the Kaplan-Meier method. Univariable and multivariable Cox regression analysis was used for relative risk factors.
  
  
  RESULTS
  The median interval between operation for the primary tumor and of the local recurrence was 89 months, with median follow-up at 28 months. In the total collective, cumulative 5-, 10- and 15-year survival rates were 46%, 29%, and 22%, respectively, with a median survival of 56 months. R0 resection was associated with a 5-year survival of 50.4%. Prognostic factors were patient age at the time of the primary operation and tumor invasion of bony structures. Mortality was 1.6% and morbidity was 25%.
  
  
  CONCLUSIONS
  Full-thickness chest wall resection of locally recurrent breast cancer performed by a team of thoracic and plastic surgeons provides the best survival rates, with low mortality and morbidity. An earlier application of this method may lead to further improvement of these results.
authors.affiliation: Department of Thoracic Surgery, Schillerhöhe Hospital at Robert Bosch Hospital, Gerlingen, Germany. godehard.friedel@klinik-schillerhoehe.de
authors.forename: Godehard
authors.initials: G
authors.lastname: Friedel
authors.forename: Thomas
authors.initials: T
authors.lastname: Kuipers
authors.forename: Jürgen
authors.initials: J
authors.lastname: Dippon
authors.forename: Fawaz
authors.initials: F
authors.lastname: Al-Kammash
authors.forename: Thorsten
authors.initials: T
authors.lastname: Walles
authors.forename: Thomas
authors.initials: T
authors.lastname: Kyriss
authors.forename: Stefanie
authors.initials: S
authors.lastname: Veit
authors.forename: Michael
authors.initials: M
authors.lastname: Greulich
authors.forename: Volker
authors.initials: V
authors.lastname: Steger
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000401:mortality / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D016462:Mammaplasty / Q000379:methods*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000601:surgery*; D011183:Postoperative Complications / Q000401:mortality / Q000601:surgery; D012086:Reoperation; D012189:Retrospective Studies; D013524:Surgical Flaps