Abstract
We performed a new type of en bloc extended radical mastectomy (EXT) as a clinical trial in 118 patients from 1980 through 1985. A variety of conventional radical mastectomies (RDL) were also undertaken in 105 patients from 1973 through 1985. In this retrospective study, univariate and multivariate analyses were performed to compare the results of EXT and RDL. The univariate analysis showed that the 10-year survival rates for the EXT and the RDL groups were 86% ± 3.3% and 77% ± 4.2%, respectively (P = 0.073 with the Cox-Mantel test). For the subgroups stratified according to the status of axillary lymph node involvement, the EXT was significantly better in patients with one to three metastatic axillary lymph nodes (P = 0.016). The adjusted Cox regression analysis revealed that the favorable results of EXT were most encouraging in the patients with one to three metastatic axillary lymph nodes (P = 0.058). Therefore, it is suggested that an EXT may be more advantageous than RDL in selected patients with resectable invasive breast cancer.
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References
Donegan W (1952) The influence of untreated internal mammary metastases upon the course of mammary cancer. Cancer 5:992–1008
Morrow M, Foster RS (1981) Staging of breast cancer. Arch Surg 116:748–751
Veronesi U, Cascinelli N, Greco M, Bufalino R, Morabito A, Galluzzo D, Conti R, Lellis RD, Donne VD, Piotti P, Sacchini V, Clemente C, Salvadori B (1985) Prognosis of breast cancer patients after mastectomy and dissection of internal mammary nodes. Ann Surg 202:702–707
Noguchi M, Koyasaki N, Ohta N, Kitagawa H, Earashi M, Thomas M, Miyazaki I, Mizukami Y (1993) Internal mammary nodal status is more reliable prognostic factor than DNA ploidy and c-erbB-2 expression in breast cancer patients. Arch Surg 128:242–246
Lacour J, Bucalossi P, Caceres E, Jacobelli G, Koszarowski T, Le M, Rumeau-Rouquette C, Veronesi U (1976) Radical mastectomy versus radical mastectomy plus internal mammary dissection: Five-year results of an international cooperative study. Cancer 37:206–214
Veronesi U, Valagussa P (1981) Inefficacy of internal mammary node dissection in breast cancer surgery. Cancer 47:170–175
Lacour J, Le GM, Caceres F, Koszarowski T, Veronesi U, Catherine H (1983) Radical mastectomy versus radical mastectomy plus internal mammary dissection. Ten-year results of an international cooperative trial in breast cancer. Cancer 51:1941–1943
Lacour J, Le GM, Hill C, Kramar A, Contesso G, Sarrazin D (1987) Is it useful to remove internal mammary nodes in operable breast cancer? Eur J Surg Oncol 13:309–314
Meier P, Ferguson DJ, Karrison T (1985) A controlled trial of extended radical mastectomy. Cancer 56:880–891
Meier P, Ferguson DJ, Karrison T (1989) A controlled trial of extended radical mastectomy. Ten-year results. Cancer 63:188–195
Noguchi M, Taniya T, Koyasaki N, Miyazaki I (1992) A multivariate analysis of en bloc extended radical mastectomy versus conventional radical mastectomy in operable breast cancer. Int Surg 77:48–54
Union Internationale Contre le Cancer (1987) Breast (ICD-0 174). In: Harmer MH (ed) TNM Classification of malignant tumours, 4th edn. Springer, Berlin Heidelberg New York, pp 93–99
Japan Breast Cancer Society (1988) General rules for clinical and pathological record of breast cancer, 9th edn. Kanehara, Tokyo, pp 21–29
The World Health Organization (1982) The World Health Organization histological typing of breast tumors. Am J Clin Pathol 78:806–816
Pickren JW (1956) Lymph node metastases in carcinoma of female mammary gland. Rosewell Park Mem Inst Bull 1:79–90
Le MG, Arriagada R, de Vathaire F, Dewar J, Fontaine F, Lacour J, Contesso G, Tubiana M (1990) Can internal mammary chain treatment decrease the risk of death for patients with medial breast cancers and positive axillary lymph nodes? Cancer 66:2313–2318
Urban JA (1952) Radical mastectomy in continuity with en bloc resection of internal mammary lymph node chain: New procedure for primary operable cancer of the breast. Cancer 5:992–1008
Noguchi M, Sakuma H, Matsuba A, Kinoshita H, Miwa K, Miyazaki I (1983) Radical mastectomy with intrapleural en bloc resection of internal mammary lymph node by sternal splitting. Jpn J Surg 13:6–15
Noguchi M, Miyazaki I (1990) The surgical management of breast cancer. Int Surg 75:8–14
Fukami A (1988) Indication of surgical management. In: Idezuki Y, Kawashima Y, Sugimachi K, Takagi H, Tobe R, Hori G, Muto T, Morioka Y (eds) New encyclopedia of surgical science, vol 18 (in Japanese). Nakayama, Tokyo, pp 115–151
Fisher B (1980) Laboratory and clinical research in breast cancer: A personal adventure: The David A. Karnofsky memorial lecture. Cancer Res 40:3863–3874
Atkins H, Hayward JL, Klugman DJ, Wayte AB (1972) Treatment of early breast cancer: A report after ten years of a clinical trial. Br Med J 2:423–429
Hayward J (1981) The surgeon's role in primary breast cancer. Breast Cancer Res Treat 1:27–32
Langlands AO, Prescott RJ, Hamilton T (1980) A clinical trial in the management of operable cancer of the breast. Br J Surg 67:170–174
Lippman ME (1985) The NIH consensus development conference on adjuvant chemotherapy for breast cancer. A commentary. Breast Cancer Res Treat 6:195–200
Noguchi M, Taniya T, Aretxabala W, Kumaki T, Tajiri K, Miyazaki I, Mura T (1989) The significance of regional lymph node dissection in the surgical management of breast cancer. Jpn J Surg 19:21–28
Kinne DW (1987) Surgical management of primary breast cancer. Cancer 51:2540–2546
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Noguchi, M., Kitagawa, H., Kinoshita, K. et al. Reappraisal of internal mammary lymph node dissection in selected patients with invasive breast cancer. Surg Today 24, 795–802 (1994). https://doi.org/10.1007/BF01636309
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DOI: https://doi.org/10.1007/BF01636309