TY - JOUR
T1 - Chest wall resection for locally recurrent breast cancer
T2 - Is it worthwhile?
AU - Downey, Robert J.
AU - Rusch, Valerie
AU - Hsu, F. Ida
AU - Leon, Larry
AU - Venkatraman, Ennapadam
AU - Linehan, David
AU - Bains, Manjit
AU - Van Zee, Kimberly
AU - Korst, Robert
AU - Ginsberg, Robert
PY - 2000
Y1 - 2000
N2 - Objective: The effectiveness of chest wall resection for locally recurrent breast cancer as cancer treatment remains poorly defined, possibly because of the general impression that locally recurrent disease is a harbinger of rapidly progressive metastatic disease and that extensive surgical treatment in these patients is inappropriate. Reports to date have focused on technical feasibility, not long-term outcome. Methods: We reviewed our experience with 38 women who underwent chest wall resection for locally recurrent breast cancer between October 1987 and May 1997. Overall survival was calculated by the Kaplan-Meier method and the significance of prognostic variables evaluated by log-rank and Cox regression analyses. Results: The operative mortality rate was 0%. Overall survival at 1, 3, and 5 years after chest wall resection was 74%, 41%, and 18%, respectively, and the proportion of patients free of local recurrence at 1, 3, and 5 years was 59%, 42%, and 13%, respectively. Regional nodal disease and size of largest tumor nodule (>4 cm) were significant predictors of local re-recurrence (P < .01, P = .04); lymph node metastasis was the only predictor of long-term survival (P < .01). Patients with and without synchronous sites of metastatic disease had near-identical 3-year survivals. Conclusions: Chest wall resection for locally recurrent breast cancer has a low mortality. However, a significant number of patients have the development of local re-recurrence or metastases, and 5-year survival is limited. It is unlikely that complete resection of all locally recurrent disease improves survival. Future studies should focus on the quality of palliation achieved.
AB - Objective: The effectiveness of chest wall resection for locally recurrent breast cancer as cancer treatment remains poorly defined, possibly because of the general impression that locally recurrent disease is a harbinger of rapidly progressive metastatic disease and that extensive surgical treatment in these patients is inappropriate. Reports to date have focused on technical feasibility, not long-term outcome. Methods: We reviewed our experience with 38 women who underwent chest wall resection for locally recurrent breast cancer between October 1987 and May 1997. Overall survival was calculated by the Kaplan-Meier method and the significance of prognostic variables evaluated by log-rank and Cox regression analyses. Results: The operative mortality rate was 0%. Overall survival at 1, 3, and 5 years after chest wall resection was 74%, 41%, and 18%, respectively, and the proportion of patients free of local recurrence at 1, 3, and 5 years was 59%, 42%, and 13%, respectively. Regional nodal disease and size of largest tumor nodule (>4 cm) were significant predictors of local re-recurrence (P < .01, P = .04); lymph node metastasis was the only predictor of long-term survival (P < .01). Patients with and without synchronous sites of metastatic disease had near-identical 3-year survivals. Conclusions: Chest wall resection for locally recurrent breast cancer has a low mortality. However, a significant number of patients have the development of local re-recurrence or metastases, and 5-year survival is limited. It is unlikely that complete resection of all locally recurrent disease improves survival. Future studies should focus on the quality of palliation achieved.
UR - http://www.scopus.com/inward/record.url?scp=0034064201&partnerID=8YFLogxK
U2 - 10.1016/S0022-5223(00)70119-X
DO - 10.1016/S0022-5223(00)70119-X
M3 - Article
C2 - 10694599
AN - SCOPUS:0034064201
SN - 0022-5223
VL - 119
SP - 420
EP - 428
JO - Journal of Thoracic and Cardiovascular Surgery
JF - Journal of Thoracic and Cardiovascular Surgery
IS - 3
ER -