Abstract
The results of an analysis done on the regional lymph node metastases of 300 patients with operable breast cancer, who were treated in the Department of Surgery (II), Kanazawa University Hospital from 1973 to early 1988 are reported herein. It was found that the metastases of the axillary and internal mammary lymph nodes were closely related to the survival of patients, but they were hardly diagnosed before the operation. Only the dissection of these lymph nodes proved useful for providing the prognostic information. Moreover, in a retrospective study comparing theen bloc extended radical mastectomyversus the other types of mastectomy, the extended radical mastectomy was seen to greatly improve the survival of patients with 3 or less than 3 metastatic axillary lymph nodes. Thus, the extended radical mastectomy provides the maximum diagnostic and prognostic information, and gives the best chance of loco-regional control of the disease. The anterior chest deformity created by the extended radical mastectomy, however, should be avoided in those patients without internal mammary involvement. We therefore propose the modified extended mastectomy as a staging operation.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Donegan WL. Surgical clinical trial. Cancer 1984; 53: 691–699.
Montague ED, Ames FC, Shell SR, Romsdahl MN. Conservative surgery and irradiation as an alternative to mastectomy in the treatment of clinically favorable breast cancer. Cancer 1984; 54: 2668–2672.
Mueller CB. Lumpectomy; Who is eligible? Surgery 1986; 100: 584–585.
Japan Mammary Cancer Society. General rules for clinical and histological records of mammary cancer. Tokyo: Kanehara Co. 1984; 22. (in Japanese)
Noguchi M, Sakuma H, Matsuda A, Kinoshita H, Miwa K, Miyazaki I. Radical mastectomy with intrapleuralen bloc resection of internal mammary lymph node by sternal splitting. Jpn J Surg 1983; 13: 6–15.
Noguchi M, Tajiri K, Fujii H, Miwa K, Miyazaki I. The modified extended mastectomy using the trapdoor method as a staging operation. Int Surg 1987; 72: 38–41.
Kaplan EL, Meier P. Non-parametric estimation from incomplete observation. J Am Stat Assoc 1958; 53: 457–481.
Cox DR, Regression models and life-tables. J R Stat Soc [B] 1972; 34: 187–220.
Lacour J, Becalossi P, Caceres E, Jacobelli G, Koszarowski T, Le M, Rumeau-Rouquette C, Veronesi U. Radical mastectomyversus radical mastectomy plus internal mammary dissection: Five-year results of an international cooperative study. Cancer 1976; 37: 206–214.
Veronesi U, Valagussa P. Inefficacy of internal mammary nodes dissection in breast cancer surgery. Cancer 1981; 47: 170–175.
Lacour J, Le M, Caceres E, Koszarowski T, Veronsi U, Catherine H. Radical mastectomyversus radical mastectomy plus internal mammary dissection. Ten year results of an internal cooperative trial in breast cancer. Cancer 1983; 51: 1941–1943.
Meier P, Ferguson DJ, Karrison T. A controlled trial of extended radical mastectomy. Cancer 1985; 55: 880–891.
Turner L, Bell WGT, Hartly RC, Tasker JH, Wilson WW, Alderson MR, Leck IM. Radicalversus modified radical mastectomy for breast cancer. Ann R Coll Surg Engl 1981; 63: 239–243.
Fisher B, Montague E, Redmond C, Barton B, Borland D, Fisher E, Deutsch M, Schwarz G, Margolese R, Donegan W, Volk H, Konvolinka C, Gardner B, Cohn I, Lesnick G, Cruz AB, Lawrence W, Nealon T, Butcher H, Lawton R. Comparison of radical mastectomy with alternative treatments for primary breast cancer: A first report of results from apropective randomized clinical trial. Cancer 1977; 39: 2827–2839.
Fisher B, Redmond C, Fisher ER, Bauer M, Volmark N, Wickerham L, Deutsch M, Montague E, Margolese R, Foster R. Ten-year results of a randomized clinical trial comparing radical mastectomy and total mastectomy with or without radiation. N Engl J Med 1985; 312: 674–681.
Veronesi U, Saccozzi R, Vecchio MD, Banfi A, Clemente C, Lena MD, Gallus G, Greco M, Luini A, Marubini E, Muscolino G, Rilke F, Salvadori B, Zecchini A, Zucali R. Comparing radical mastectomy with quadrantectomy, axillary dissection, and radiotherapy in patients with small cancers of the breast. N Engl J Med 1981; 305: 6–11.
Fisher B, Bauer M, Margolese R, Poisson R, Pilch Y, Redmond C, Fisher E, Wolmark N, Deutsch M, Montague E, Saffer E, Wickerham L, Lerner H, Glass A, Shibata H, Deckers P, Ketcham A, Oishi R, Russell I. Five-year results of a randomized clinical trial comparing total mastectomy and segmental mastectomy with or without radiation in the treatment of breast cancer. N Engl J Med 1985; 312: 665–673.
Noguchi M, Yabushita K, Tajiri K, Fujii H, Miyazaki I. Five-year results of radical mastectomy for breast cancer, by a sternal splitting, intrapleuralen bloc resection of the internal mammary lymph nodes. Jpn J Surg 1987; 17: 63–71.
Hayward J. The principles of breast cancer surgery. Breast Cancer Research and Treatment 1984; 4: 61–68.
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. Prognosis of breast cancer patients after mastectomy and dissection of internal mammary nodes. Ann Surg 1985; 202: 702–707.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Noguchi, M., Taniya, T., de Aretxabala, X. et al. The significance of regional lymph node dissection in the surgical management of breast cancer. The Japanese Journal of Surgery 19, 21–28 (1989). https://doi.org/10.1007/BF02471562
Received:
Issue Date:
DOI: https://doi.org/10.1007/BF02471562