Chest wall resection and reconstruction for locally recurrent breast cancer: From technical aspects to biological assessment.
BACKGROUND
Breast cancer is the leading cause of cancer death among women in the industrialized countries. The incidence of local recurrences after mastectomy and breast-conserving therapy varies between 5% and 40% depending on risk factors and primary therapy.


METHODS
From April 1999 to April 2011, 40 patients underwent chest wall resection and reconstruction for locally recurrent breast carcinoma with chest wall invasion. The main goal of surgery was local disease control to palliate clinical symptoms.


RESULTS
Local radical resection was achieved in 26 patients (65%). One, 2 and 5 year overall survival rates were 94.4%, 82.0% and 68.5%; 1, 2 and 5 year disease-free survival rates were 94.4%, 73.6% and 45.5% respectively. Univariate analysis indicated age (p = 0.002) and synchronous distant metastases (p = 0.020) as factors having a negative impact on overall survival; multivariate analysis disclosed age (p = 0.052) and synchronous metastases (p = 0.059) as factors with a slight negative impact on overall survival. Older age was associated with improved overall survival. Univariate analysis indicated synchronous distant metastases (p = 0.029) and the need of post resectional additional treatments (p = 0.022) as factors adversely conditioning disease-free survival or time to progression; multivariate analysis disclosed the need of post resectional additional treatments (p = 0.036) as the only factor adversely conditioning disease-free survival or time to progression.


CONCLUSIONS
Chest wall resection and reconstruction for locally recurrent breast cancer is a feasible and safe procedure providing adequate local disease control and an excellent palliation of very disabling symptoms in a selected group of patients.
Department of Thoracic Surgery, European Institute of Oncology, Italy. Electronic address: francesco.petrella@ieo.it.
Francesco
F
Petrella
Department of Epidemiology and Biostatistics, European Institute of Oncology, Italy.
Davide
D
Radice
Department of Thoracic Surgery, European Institute of Oncology, Italy.
Alessandro
A
Borri
Department of Thoracic Surgery, European Institute of Oncology, Italy.
Domenico
D
Galetta
Department of Thoracic Surgery, European Institute of Oncology, Italy.
Roberto
R
Gasparri
Department of Thoracic Surgery, European Institute of Oncology, Italy.
Monica
M
Casiraghi
Department of Thoracic Surgery, European Institute of Oncology, Italy.
Adele
A
Tessitore
Department of Thoracic Surgery, European Institute of Oncology, Italy.
Alessandro
A
Pardolesi
Department of Thoracic Surgery, European Institute of Oncology, Italy.
Piergiorgio
P
Solli
Department of Thoracic Surgery, European Institute of Oncology, Italy.
Giulia
G
Veronesi
Department of Radiology, European Institute of Oncology, Italy.
Stefania
S
Rizzo
Department of Plastic and Reconstructive Surgery, European Institute of Oncology, Italy.
Stefano
S
Martella
Department of Plastic and Reconstructive Surgery, European Institute of Oncology, Italy.
Mario
M
Rietjens
Department of Thoracic Surgery, European Institute of Oncology, Italy; University of Milan School of Medicine, Italy.
Lorenzo
L
Spaggiari
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000032:analysis*; D001943:Breast Neoplasms / Q000378:metabolism / Q000601:surgery* / Q000628:therapy; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D008408:Mastectomy / Q000379:methods*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology / Q000378:metabolism / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D035441:Thoracic Wall / Q000601:surgery*; D013905:Thoracoplasty / Q000379:methods*; D013997:Time Factors
D014408:Biomarkers, Tumor
Breast cancer; Chest wall reconstruction; Chest wall resection