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Innovationen in der operativen Therapie des Mammakarzinoms

Update

Innovations in the operative therapy of breast cancer

Update

  • Leitthema
  • Published:
Der Gynäkologe Aims and scope

Zusammenfassung

Hintergrund

Die operative Therapie des Mammakarzinoms hat in den letzten Dekaden einen grundlegenden Wandel hin zu signifikant reduzierter Radikalität und Wahrung der onkologischen Sicherheit durchgemacht. In den letzten Jahren setzt sich dieser Trend weiter fort mit Änderungen im axillären Staging im Rahmen der Sentinel-Node-Biopsie (SNB) sowie reduzierter Radikalität im Sinne des Resektionsrandes. Gleichzeitig nehmen onkoplastische Operationsverfahren in Deutschland immer mehr zu, was belegt, dass es trotz reduzierter Radikalität weiterhin Indikationen zur Mastektomie gibt und geben wird. Dieser Trend reflektiert letztlich den vermehrten Wunsch nach ansprechenden kosmetischen Ergebnissen unter Wahrung der onkologischen Sicherheit.

Ziel der Arbeit

Die Arbeit versucht, einen Überblick über die aktuelle Literatur, Leitlinien und Empfehlungen zum Thema der lokoregionären Chirurgie insbesondere zum Thema Resektionsränder und Sentinel-Node-Biospsie zu geben. Des Weiteren sollen Indikationen, Zeitpunkt und operative Konzepte der rekonstruktiven Brustchirurgie beleuchtet werden.

Abstract

Background

In the last decades the operative treatment of breast cancer has undergone a fundamental change towards significantly reducing radicality and safeguarding oncological safety. This trend has continued in recent years with changes in axillary staging through sentinel lymph node biopsies (SNB) and reduced radicality with respect to the resection margins. Simultaneously, oncoplastic surgical procedures are steadily increasing in Germany, a trend which confirms that there are and always will be indications for mastectomy despite reduced radicality. This trend ultimately reflects the increased desire for aesthetically pleasing cosmetic results while safeguarding oncological safety.

Objectives

This article gives an overview of the current literature, guidelines and recommendations on the topic of locoregional surgery with particular emphasis on resection margins and sentinel lymph node biopsies. Furthermore, the indications, timing and operative concepts for reconstructive breast surgery are illustrated.

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Literatur

  1. Fisher B, Anderson S, Bryant J et al (2002) Twenty-year follow-up of a randomized trial comparing total mastectomy. N Engl J Med 347:1233–1241

    Article  PubMed  Google Scholar 

  2. Veronesi U, Cascinelli N (2002) Twenty-year follow-up of a randomized study comparing breast-conserving surgery. N Engl J Med 347:1227–1232

    Article  PubMed  Google Scholar 

  3. Wood C (2013) Close/positive margins after breast-conserving therapy: additional resection or no resection? Breast 22(Suppl 2):115–117

    Article  Google Scholar 

  4. Veronesi U, Cascinelli N, Mariani L et al (2002) Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med 347(16):1227–1232

    Article  PubMed  Google Scholar 

  5. Wöckel A, Wolters R, Wiegel T et al (2014) The impact of adjuvant radiotherapy on the survival of primary breast cancer patients: a retrospective multicenter cohort study of 8935 subjects. Ann Oncol 25(3):628–632

    Article  PubMed  Google Scholar 

  6. Luini A, Rsoschansky J, Gatti G et al (2009) The surgical margin status after breast conserving surgery: discussion of an open issue. Breast Cancer Res Treat 113(2):397–402

    Article  PubMed  Google Scholar 

  7. Houssami N, Macaskill P, Marinovich ML et al (2010) Meta-analysis of the impact of surgical margins on local recurrence in women with early stage invasive breast cancer treated with breast-conserving therapy. Eur J Cancer 46(18):3219–3232

    Article  PubMed  Google Scholar 

  8. Morrow M (2008) Margins in breast-conserving therapy: have we lost sight of the big picture? Expert Rev Anticancer Ther 8(8):1193–1196

    Article  PubMed  Google Scholar 

  9. Morrow M (2009) Breast conservation and negative margins: how much is enough? Breast 18 (Suppl 3):S84-86

    Article  PubMed  Google Scholar 

  10. Fisher B, Anderson S, Redmonk CK et al (1995) Reanalysis and results after 12 years of follow-up in a randomized clinical trial comparing total mastectomy with lumpectomy with or without irradiation in the treatment of breast cancer. N Engl J Med 333(22):1456–1461

    Article  CAS  PubMed  Google Scholar 

  11. S3 Leitlinie zur Diagnostik, Therapie und Nachsorge des Mammakarzinoms. 2012 http://www.awmf.org/uploads/tx_szleitlinien/032-045OL_l_S3__Brustkrebs_Mammakarzinom_Diagnostik_Therapie_Nachsorge_2012-07.pdf

  12. Arbeitsgemeinschaft gynäkologische Onkologie (AGO) Empfehlungen 2014. http://www.ago-online.de/de/infothek-fuer-aerzte/leitlinienempfehlungen/mamma/

  13. Dunne C, Burke JP, Morrow M et al (2009) Effect of margin status on local recurrence after breast conservation and radiation therapy for Ductal carcinoma in situ. J Clin Oncol 27:1615–1620

    Article  PubMed  Google Scholar 

  14. Worni M, Greenup RA, Mackey AM, Akushevich I (2014) Trends in treatment patterns and outcomes for DCIS patients: a SEER population-based analysis. ASCO Annual Meeting 2014. J Clin Oncol 32:5s (suppl;abstr 1007)

    Article  Google Scholar 

  15. Bergkvist L, Frisell J, Liljegren G et al (2001) Multicentre study of detection and falsenegative rates in sentinel node biopsy for breast cancer. Br J Surg 88(12):1644–1648

    Article  CAS  PubMed  Google Scholar 

  16. Kim T, Giuliano AE, Lyman GH (2006) Lymphatic mapping and sentinel lymph node biopsy in early stage breast carcinoma: a metaanalysis. Cancer 106(1):416

    Google Scholar 

  17. Krag D, Weaver D, Ashikaga T et al (1998) The sentinel node in breast cancer a multicenter validation study. N Engl J Med 339(14):941–946

    Article  CAS  PubMed  Google Scholar 

  18. Tafra L, Lannin DR, Swanson MS et al (2001) Multicenter trial of sentinel node biopsy for breast cancer using both technetium sulfur colloid and isosulfan blue dye. Ann Surg 233(1):51–59

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  19. Fleissig A, Fallowfield LJ, Langridge CI et al (2006) Postoperative arm morbidity and quality of life. Results of the ALMANAC randomised trial comparing sentinel node biopsy with standard axillary treatment in the management of patients with early breast cancer. Breast Cancer Res Treat 95(3):279–293

    Article  PubMed  Google Scholar 

  20. Veronesi U, Paganelli G, Viale G et al (2003) A randomized comparison of sentinel node biopsy with routine axillary dissection in breast cancer. N Engl J Med 349(6):546–553

    Article  PubMed  Google Scholar 

  21. Giuliano AE, Haigh PI, Brennan MB et al (2000) Prospective observational study of sentinel lymphadenectomy without further axillary dissection in patients with sentinel node-negative breast cancer. J Clin Oncol 18(13):2553–2559

    CAS  PubMed  Google Scholar 

  22. Giuliano AE, McCall L, Beitsch P et al (2010) Locoregional recurrence after sentinel lymph node dissection with or without axillary dissection in patients with sentinel lymph node metastases: the American College of Surgeons Oncology Group Z0011 randomized trial. Ann Surg 252(3):426–432

    PubMed  Google Scholar 

  23. DiSipio T, Rye S, Newman B, Hayes S (2013) Incidence of unilateral arm lymphoedema after breast cancer: a systematic review and meta-analysis. Lancet Oncol 14(6):500–515

    Article  PubMed  Google Scholar 

  24. Hennessy BT, Hortobagyi GN, Rouzier R et al (2005) Outcome after pathologic complete eradication of cytologically proven breast cancer axillary node metastases following primary chemotherapy. J Clin Oncol 23(36):9304–9311

    Article  PubMed  Google Scholar 

  25. Xing Y, Foy M, Cox DD et al (2006) Meta-analysis of sentinel lymph node biopsy after preoperative chemotherapy in patients with breast cancer. Br J Surg 93(5):539–546

    Article  CAS  PubMed  Google Scholar 

  26. Palesty JA, Foster JM, Hurd TC et al (2006) Axillary recurrence in women with a negative sentinel lymph node and no axillary dissection in breast cancer. J Surg Oncol 93(2):129–132

    Article  PubMed  Google Scholar 

  27. Smidt ML, Janssen CM, Kuster DM et al (2005) Axillary recurrence after a negative sentinel node biopsy for breast cancer: incidence and clinical significance. Ann Surg Oncol 12(1):29–33

    Article  PubMed  Google Scholar 

  28. Veronesi U, Orecchia R, Zurrida S et al (2005) Avoiding axillary dissection in breast cancer surgery: a randomized trial to assess the role of axillary radiotherapy. Ann Oncol 16(3):383–388

    Article  CAS  PubMed  Google Scholar 

  29. Zavagno G, Carcoforo P, Franchini Z et al (2005) Axillary recurrence after negative sentinel lymph node biopsy without axillary dissection: a study on 479 breast cancer patients. Eur J Surg Oncol 31(7):715–720

    Article  CAS  PubMed  Google Scholar 

  30. Kuehn T, Bauerfeind I, Fehm T et al (2013) Sentinel-lymph-node biopsy with breast cancer before and after neoadjuvant chemotherapy (SENTINA): a prospective multi-center cohort study. Lancet Oncol 14(7):609–618

    Article  PubMed  Google Scholar 

  31. Boughey JC, Suman VJ, Mittendorf EA et al (2013) Sentinel lymph node surgery after neoadjuvant chemotherapy in patients with node positive breast cancer: the ACOSOG Z1071 (Alliance) clinical trial. JAMA 310(14):1455–1461

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  32. Lanitis S, Tekkis PP, Sgourakis G et al (2010) Comparison of skin-sparing mastectomy for breast cancer: a meta-analysis of observational studies. Ann Surg Oncol 251(4):632–639

    Article  Google Scholar 

  33. Gerber B, Krause A, Dieterich M et al (2009) The oncological safety of skin sparing mastectomy with conservation of the nipple-areola complex and autologous reconstruction: an extended follow-up study. Ann Surg 249(3):461–468

    Article  PubMed  Google Scholar 

  34. Sullivan SR, Fletcher DR, Isom CD, Isik FF (2008) True incidence of all complications following immediate and delayed breast reconstruction. Plas Reconstr Surg 122(1):19–28

    Article  CAS  Google Scholar 

  35. Marques M, Browen SA, Oliveira I et al (2010) Marques 2010 Long-term follow-up of breast capsule contracture rates in cosmetic and reconstructive cases. Plas Reconstr Surg 126(3):769–778

    Article  CAS  Google Scholar 

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Einhaltung ethischer Richtlinien

Interessenkonflikt. L. Schwentner, G. Müller-Bartusek, V. Fink und W. Janni geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Universitätsklinik für Gynäkologie und Geburtshilfe, Universität Ulm, Universitätsfrauenklinik Ulm, Prittwitzstr. 43, 89075, Ulm, Deutschland

    L. Schwentner, G. Müller-Bartusek, V. Fink & W. Janni

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  1. L. Schwentner
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  2. G. Müller-Bartusek
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  3. V. Fink
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  4. W. Janni
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Correspondence to L. Schwentner.

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Schwentner, L., Müller-Bartusek, G., Fink, V. et al. Innovationen in der operativen Therapie des Mammakarzinoms. Gynäkologe 47, 925–931 (2014). https://doi.org/10.1007/s00129-014-3370-8

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  • DOI: https://doi.org/10.1007/s00129-014-3370-8

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