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Fungating and Ulcerating Breast Cancer: Wound Closure Algorithm, Complications, and Survival Trends

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Abstract

Fungating breast cancer severely affects patients’ daily lives, and patient management poses major oncology challenges. To present 10-year outcomes of unique tumor presentation, suggesting a focused algorithm for surgical management and providing deep analysis for factors affecting survival and surgical outcomes. Eighty-two patients with fungating breast cancer were enrolled in the period from January 2010 to February 2020 in the Mansoura University Oncology Center database. Epidemiological and pathological characteristics, risk factors, different surgical treatment techniques, and surgical and oncological outcomes were reviewed. Preoperative systemic therapy was used in 41 patients, with the majority (77.8%) showing progressive response. Mastectomy was performed in 81 (98.8%) patients, with primary wound closure in 71 (86.6%), and wide local excision in a single patient (1.2%). Different reconstructive techniques in non-primary closure operations were used. Complications were reported in 33 (40.7%) patients, of which 16 (48.5%) were of Clavien-Dindo grade II category. Loco-regional recurrence occurred in 20.7% of patients. The mortality rate during follow-up was 31.7% (n = 26). Estimated mean overall survival (with 95% CI) was 55.96 (41.98–69.9) months; estimated mean loco-regional recurrence-free survival (with 95% CI) was 38.01 (24.6–51.4) months. Surgery is a cornerstone fungating breast cancer treatment option, but at the expense of high morbidity. Sophisticated reconstructive procedures may be indicated for wound closure. A suggested algorithm based on the center’s experience of wound management in difficult mastectomy cases is displayed.

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Data Availability

All the clinical, radiological, and pathological data used in this manuscript is available on Mansoura University medical system (Ibn Sina Hospital Management System). http://srv137.mans.edu.eg/mus/newSystem/

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Authors and Affiliations

  1. Surgical Oncology Department, Oncology Center, Mansoura University (OCMU), Mansoura, 35516, Egypt

    Ahmed Abdallah, Khaled Abdelwahab, Shadi Awny, Mohammad Zuhdy, Omar Hamdy, Khalid Atallah, Abeer Elfeky, Mohammed A. F. Hegazy & Islam H. Metwally

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  1. Ahmed Abdallah
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  2. Khaled Abdelwahab
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  3. Shadi Awny
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  4. Mohammad Zuhdy
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  5. Omar Hamdy
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Contributions

All authors have read and approved the manuscript. Data collection and revision: AA, AE, KA, KAW, SA, MZ, OH. Conceptualization, writing: AA. Supervision and revision: MA, KAW, IH, MZ, OH. Statistical analysis: IH. Editing: OH.

Corresponding author

Correspondence to Omar Hamdy.

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Ethics Approval and Consent to Participate

All procedures performed in the study involving human participants followed the ethical standards of the institutional research committee and the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. All the patients signed written consent for the surgical maneuvers for resection and reconstruction. This is a retrospective study. Consent for participation in the study itself is not applicable. Approval was obtained from the Institutional Review Board of the Faculty of Medicine, Mansoura University (MFM-IRB), under code number R.20.10.1040.

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Abdallah, A., Abdelwahab, K., Awny, S. et al. Fungating and Ulcerating Breast Cancer: Wound Closure Algorithm, Complications, and Survival Trends. Indian J Surg Oncol 14, 93–105 (2023). https://doi.org/10.1007/s13193-022-01602-x

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