title: Full-thickness chest wall resection for locally recurrent breast cancer.
abstract: OBJECTIVE
  In spite of available recommendations, therapeutic procedures of locally recurrent breast cancer are very different. In a retrospective study, the possibilities and results of complete, full-thickness chest wall resection are presented.
  
  
  METHODS
  Between 1985 and 2004, 51 women underwent complete, full-thickness chest wall resection with primary coverage. Primary surgical therapy of breast cancer had been mastectomy in 88%. Median age of patients undergoing surgery for a local recurrence was 57 (29 - 81) years. The median interval between surgery of the primary tumour and of the local recurrence was 70.3 (10.7 - 327.2) months; median follow-up was 29.4 (1.8 - 230.9) months. 40 (78.4%) patients required rib resections, 15 (29.4%) of them in combination with partial sternal resection. In 4 (7.8%) patients complete and in 7 (13.7%) patients partial sternal resection without additional rib resection were performed.Coverage was mainly realized using latissimus dorsi myocutaneous flaps (n=44; 86.3%). Survival rates were calculated by means of the Kaplan-Meier method, the relative risk using univariate and multivariate Cox-regression analysis.
  
  
  RESULTS
  In the total collective, cumulative 5-, 10- and 15-year survival (YS) rates were 39%, 31% and 23%, respectively, median survival 46.4 months. R0 resection was associated with a 5-YS of 42%. Prognostic factors were age at the time of primary surgery, disease-free interval and tumour invasion of bony structures. Mortality was 2%, morbidity 35%.
  
  
  CONCLUSIONS
  Full-thickness chest wall resection of locally recurrent breast cancer is possible in almost any patient when performed by a team of thoracic and plastic surgeons. Only radical resection provides good long-term results with low mortality and morbidity.
authors.affiliation: Department of Thoracic Surgery, Schillerhöhe Hospital, Gerlingen, Germany.
authors.forename: Godehard
authors.initials: G
authors.lastname: Friedel
authors.forename: Thomas
authors.initials: T
authors.lastname: Kuipers
authors.forename: Corinna
authors.initials: C
authors.lastname: Engel
authors.forename: Christine
authors.initials: C
authors.lastname: Schopf
authors.forename: Stefanie
authors.initials: S
authors.lastname: Veit
authors.forename: Jutta
authors.initials: J
authors.lastname: Zoller
authors.forename: Thomas
authors.initials: T
authors.lastname: Kyriss
authors.forename: Michael
authors.initials: M
authors.lastname: Greulich
authors.forename: Heikki
authors.initials: H
authors.lastname: Toomes