title: Disease-related surgery in patients with distant metastatic breast cancer.
abstract: BACKGROUND
  This study evaluates the frequency of and indications for disease-related surgical procedures in the palliative breast cancer (BC) situation.
  
  
  METHODS
  Based on a cohort of women who were treated for newly diagnosed BC during a 20-year period (1990-2009), we analyzed 340 patients who developed distant metastatic disease (DMD) until 2011 and died (i.e. still ongoing palliative disease courses were not included).
  
  
  RESULTS
  One hundred and twenty-seven surgical procedures were performed in 100 patients (29.4% of all patients with metastatic disease). The most common site for surgery was breast (n = 60, 47.2%). The primary tumor was removed at first diagnosis of DMD in 43 patients (33.9%); sixteen operations (12.6%) were performed for local recurrence. In 37 patients, 50 surgical procedures (39.4%) were necessary to stabilize osseous structures due to metastases. Procedures were rarely performed on other common metastatic sites: lung: n = 1 (0.8%); liver: n = 1 (0.8%), brain: n = 4 (3.1%). When excluding surgery for primary breast tumors at initial diagnosis of DMD from analysis, 34 of 84 surgeries (40.4%) were performed in the first third of survival follow-up (i.e. period of metastatic disease survival); operations in the last two-thirds each totaled 29.8% (n = 25). The median survival after surgery was 16 months (range: 0.5-89 months).
  
  
  CONCLUSIONS
  In a cohort of BC patients who had primary or developed secondary DMD, nearly one third of the patients received disease-related surgical procedures during their palliative disease course. This high rate of operations shows that surgery has a clearly established role in the palliative therapy concept.
authors.affiliation: Cantonal Hospital Winterthur, Department of Gynecology and Obstetrics, Brauerstrasse 15, CH-8401 Winterthur, Switzerland; Breast Center "SenoSuisse", Brauerstrasse 15, CH-8401 Winterthur, Switzerland.
authors.forename: E
authors.initials: E
authors.lastname: Amann
authors.forename: D J
authors.initials: DJ
authors.lastname: Huang
authors.forename: W P
authors.initials: WP
authors.lastname: Weber
authors.forename: S
authors.initials: S
authors.lastname: Eppenberger-Castori
authors.forename: S M
authors.initials: SM
authors.lastname: Schmid
authors.forename: T H
authors.initials: TH
authors.lastname: Hess
authors.forename: U
authors.initials: U
authors.lastname: Güth
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D016208:Databases, Factual; D005260:Female; D006801:Humans; D015412:Mastectomy, Segmental; D008875:Middle Aged; D010166:Palliative Care / Q000379:methods; D011446:Prospective Studies; D012086:Reoperation; D013514:Surgical Procedures, Operative / Q000401:mortality / Q000592:standards / Q000706:statistics & numerical data*; D016019:Survival Analysis; D013557:Switzerland / Q000453:epidemiology; D016896:Treatment Outcome
keywords: Breast cancer; Distant metastases; Palliative situation; Surgery