Ashvini Menon1, Haitham Khalil2, Babu Naidu1, Ehab Bishay1, Richard Steyn1, Maninder S Kalkat3. 1. Department of Thoracic Surgery, Birmingham Heartlands Hospital, University Hospitals Birmingham Trust, Bordesley Green East, Birmingham, UK. 2. Plastic and Reconstructive Surgery Division, Good Hope Hospital, Sutton Coldfield, Birmingham, West Midlands, UK. 3. Department of Thoracic Surgery, Birmingham Heartlands Hospital, University Hospitals Birmingham Trust, Bordesley Green East, Birmingham, UK. Electronic address: Maninder.Kalkat@heartofengland.nhs.uk.
Abstract
BACKGROUND: Despite therapeutic advances in the management of breast cancer, a significant number of patients present with locoregional recurrence. Treatment with hormonal, chemo or radiotherapy remains standard in such cases. However, in selected patients of recurrent breast cancer involving chest wall, multidisciplinary surgical approach could be considered. METHODS: Between 2010 and 2018, 21 patients with recurrent breast cancer, involving chest wall, were treated at a tertiary care center with resection and reconstruction. The mean age of the patients was 55 years (22-77 years). RESULTS: The median interval from first breast resection to chest wall resection (CWR) for recurrent disease was 6 years (1-24 years). Eighteen patients underwent bony resection and 3 patients required extensive soft tissue resection. Complete resection was achieved in 90% of patients. All patients had chest wall reconstruction. There was no in-hospital mortality. During follow-up, 8 patients died, of which 7 were due to distant metastases. The 1 year and 3-year overall survival were 90% (95% CI 66-97) and 61% (95% CI 31-81) respectively. The disease-free survival at 1 and 3 years was the same at 70% (95% CI 45-86). At a mean follow up of 23 months, the average survival in patients operated for local recurrence is 51.7 months (95% CI 37.7-65.7) and 24.5 months (95% CI 7.3-41.7) for patients with distant metastatic recurrence. CONCLUSION: A multidisciplinary oncoplastic approach for recurrent breast cancer, which includes chest wall resection and reconstruction is a useful adjunct in selected group of patients. This improves local disease control, symptoms and possibly disease-free survival. Crown
BACKGROUND: Despite therapeutic advances in the management of breast cancer, a significant number of patients present with locoregional recurrence. Treatment with hormonal, chemo or radiotherapy remains standard in such cases. However, in selected patients of recurrent breast cancer involving chest wall, multidisciplinary surgical approach could be considered. METHODS: Between 2010 and 2018, 21 patients with recurrent breast cancer, involving chest wall, were treated at a tertiary care center with resection and reconstruction. The mean age of the patients was 55 years (22-77 years). RESULTS: The median interval from first breast resection to chest wall resection (CWR) for recurrent disease was 6 years (1-24 years). Eighteen patients underwent bony resection and 3 patients required extensive soft tissue resection. Complete resection was achieved in 90% of patients. All patients had chest wall reconstruction. There was no in-hospital mortality. During follow-up, 8 patients died, of which 7 were due to distant metastases. The 1 year and 3-year overall survival were 90% (95% CI 66-97) and 61% (95% CI 31-81) respectively. The disease-free survival at 1 and 3 years was the same at 70% (95% CI 45-86). At a mean follow up of 23 months, the average survival in patients operated for local recurrence is 51.7 months (95% CI 37.7-65.7) and 24.5 months (95% CI 7.3-41.7) for patients with distant metastatic recurrence. CONCLUSION: A multidisciplinary oncoplastic approach for recurrent breast cancer, which includes chest wall resection and reconstruction is a useful adjunct in selected group of patients. This improves local disease control, symptoms and possibly disease-free survival. Crown
Authors: Zuhair D Hammood; Abdulwahid M Salih; Snur Othman; Berwn A Abdulla; Shvan H Mohammed; Fahmi H Kakamad; Sharo Naqar Journal: Int J Surg Case Rep Date: 2022-02-12