Primary tumor resection in de novo stage IV breast cancer patients

Breast and axillary surgery in Stage IV disease is outside current national guidelines but has been a topic of ongoing debate. A single institution retrospective study identified women with de novo stage IV BC from 2011‐2016 to evaluate the rate and goals of primary site surgery. Only 10.2% (n = 27/265patients) had primary site surgery. The goal of surgery was most often treatment intent (n = 23, 85.1%) not palliation (n = 4, 14.8%). There was no 30‐day mortality and low (n = 1, 3.7%) 30‐day morbidity. Multi‐disciplinary patient care pathways based on modern evidence may help identify patients potentially suitable for primary site surgery.     

Impact of Surgery on Survival in Stage IV Breast Cancer

We aimed to assess retrospectively the survival outcome in patients with stage IV breast cancer who underwent surgery. In a retrospective, nonrandomized study of stage IV breast cancer patients diagnosed in a single institution between 2000 and 2012, we assessed patient's survival in the context of baseline characteristics. A total 678 patients with metastatic breast cancer were included; 412 (60.77%) underwent surgery for the primary tumor (Surgery group), and 266 (39%) did not underwent surgery for the primary tumor (Nonsurgery group), with a median follow‐up of 41 months. Patients in the Surgery group had longer survival (41 versus 27 months, p < 0.0029). The 5‐year survival rate for Surgery group was 34% compared with 14% for the Nonsurgery group. A multivariate analysis revealed surgery (p = 0.0003), large tumor size (p = 0.0195), ER‐positive (p < 0.0001), and metastasis at presentation (p = 0.0032) were prognostic variables. Loco‐regional surgery does confer a survival advantage in stage IV breast cancer, however, selection bias cannot be excluded, a well‐designed and powerful randomized, controlled trial would be valuable to answer whether surgery can improve survival.     

Effect of primary tumor resection on overall survival in patients with stage IV breast cancer

We aimed to evaluate the effect of primary tumor resection on overall survival in stage IV breast cancer patients. In total, 284 breast cancer patients presenting with breast cancer at stage IV at initial diagnosis, between 2001 and 2014, were enrolled in the study. Patients were divided into two groups based on surgical resection of the primary tumor. Overall survival (OS) between the two groups was analyzed. Patients in the surgery group (n = 92) had smaller tumors than those in the no‐surgery group (n = 192, T0‐1:17.7% vs 34.8%, P < 0.001). The surgery group more often had negative nodal status (5.7% vs 33.7%, P < 0.001). Multiple metastatic organ sites were more common in the no‐surgery group than in the surgery group (55.7% vs 15.2%, P < 0.001). The surgery group showed a better OS than the no‐surgery group (P = 0.01). Multivariate analysis showed that surgical resection of primary tumors tended to be associated with improved OS (HR = 0.67, P = 0.055). T stage, ER, HER2 and metastatic organ sites were independent prognostic factors for OS in multivariate analysis. Surgical resection of the primary tumor may be a treatment option for patients with stage IV disease and may not have a negative effect on overall survival.     

Radical resection of rectal cancer primary tumor provides effective local therapy in patients with stage IV disease

Background The optimal use of radical surgery to palliate primary rectal cancers presenting with synchronous distant metastases is poorly defined. We have reviewed stage IV rectal cancer patients to evaluate the effectiveness of radical surgery without radiation as local therapy. Methods Eighty stage IV patients with resectable primary rectal tumors treated with radical rectal surgery without radiotherapy were identified. Sixty-one (76%) patients received chemotherapy; response information was available for 34 patients. Results Radical resection was accomplished by low anterior resection (n=65), abdominoperineal resection (n=11), and Hartmann’s resection (n=4). Surgical complications were seen in 12 patients (15%), with 1 death and 4 reoperations. The local recurrence rate was 6% (n=5), with a median time to local recurrence of 14 months. Only one patient received pelvic radiotherapy as salvage treatment. One patient required subsequent diverting colostomy. Median survival was 25 months. On multivariate analysis, the extent of metastasis and response to chemotherapy were determinants of prolonged survival. Conclusions For patients who present with distant metastases and resectable primary rectal cancers, radical surgery without radiotherapy can provide durable local control with acceptable morbidity. The extent of metastatic disease and the response to chemotherapy are the major determinants of survival. Effective systemic chemotherapy should be given high priority in the treatment of stage IV rectal cancer.     

Central quadrantectomy with resection of the nipple-areola complex compared with mastectomy in patients with retroareolar breast cancer

Appropriate surgery in women with retroareolar breast cancer should allow resection of the cancer with wide free margins and an acceptable cosmetic result. The aim of this study was to compare breast conservation surgery (BCS) to mastectomy for treatment of retroareolar breast cancer. In a prospective nonrandomized study, 69 women with retroareolar breast cancers underwent either central quadrantectomy (n=33) with complete removal of the nipple-areola complex or mastectomy (n=36). Two of 33 (6%) patients scheduled for BCS had a secondary mastectomy and immediate reconstruction due to involved margins. After a median follow-up of 42 month (range 17-99 months) in the BCS group and 43 months (range 16-118 months) in the mastectomy group local and regional recurrences as well as systemic disease were comparable between both groups. The postoperative cosmetic result after BCS as evaluated by the patients was rated as excellent in 80% and good in 20% with no poor result. BCS followed by radiation therapy is a feasible alternative to mastectomy in patients with retroareolar breast cancer.     

The role of primary tumour resection in patients with stage IV colorectal cancer

OBJECTIVE: The management of stage IV colorectal cancer is controversial. Resection of the primary tumour to prevent obstruction, bleeding or perforation is the traditional approach, although survival benefit is undetermined. Management consisting of diverting ostomy, enteric bypass, laser recanalization or endoscopic stenting is an alternative to radical resection. The purpose of this study was to determine the role of resection of the primary tumour in patients with stage IV colorectal cancer, with specific attention paid to survival benefit and safety. METHOD: This was a retrospective review of all stage IV colon and rectal cancer patients in our tumour registry between 1991 and 2002. Data collected included patient demographics, presenting symptoms, detail from the hospital course including diagnostic data and operative management, complications and survival time (days). Survival analysis was performed to assess the effect of primary tumour resection on long-term survival. RESULTS: 109 patients were studied. Sixty-two (57%) patients (group I) underwent resection of the primary tumour, whereas 47 (43%) patients (group II) were managed without resection. Median survival times for groups I and II were 375 (IQR: 179-759) and 138 (IQR: 35-262) days respectively (P < 0.0001). After controlling for age, sex, tumour location and level of liver involvement as well as liver function, patients who underwent resection still survived longer (HR = 0.34, 95% CI: 0.21-0.55). CONCLUSION: Palliative resection of the primary tumour plays an essential role in the management of stage IV colorectal cancer. Resection can offer increased survival and is indicated in certain patients with incurable disease. Limited metastatic tumour burden of the liver was associated with better survival in such patients.     

乳腺癌前哨淋巴结活检手术经验总结

【摘要】目的总结早期乳腺癌前哨淋巴结活检的手术经验。方法回顾性分析2012年1月至2016年6月在我院乳腺外科行乳腺癌腋窝前哨淋巴结活检手术的78例早期乳腺癌病人的临床资料。结果中位年龄54岁（范围32~75岁）,其中48例（62%）患者为右乳癌,30例（38%）为左乳癌。同时,46例（59%）患者肿物位于外上象限,13例（17%）肿物位于外下象限,11例（14%）位于内上象限,8例（10%）位于内下象限。55例（70%）患者为浸润性导管癌（IDC）,16例（21%）为导管原位癌（DCIS）,5例（6%）为浸润性小叶癌（ILC）,2例（3%）为其他类型浸润性癌。前哨淋巴结检出率为90%（70/78）,其中前哨淋巴结阳性率为34%（24/70）,前哨淋巴结阴性率为66%（46/70）。前哨淋巴结准确率为93%（65/70）,假阴性率为11%（5/46）。中位随访时间为12个月,腋窝淋巴结复发1例,余均未见复发事件。结论当前结果符合文献报道,早期乳腺癌腋窝淋巴结活检是一种安全的肿瘤腋窝淋巴结状态评估手段,但需要一定经验的外科医生实施。     

Postoperative long-term cancer chemotherapy (PLCC) extends life-span of non-curatively resected patients with stage IV gastric cancer

Postoperative long-term cancer chemotherapy (PLCC) with a combination of Mitomycin-C, Tegafur and PSK (an immunostimulant) was applied to non-curatively resected cases with stage IV gastric cancer (invading the adjacent organs and/or with metastasis to the liver, peritoneum, and/or distant lymph nodes). This approach has a significant life-prolongation effect. The two-year survival rate was 16.8 per cent in the PLCC group, such being higher than 6.7 per cent and 1.7 per cent in MMC and no chemotherapy groups (p<0.05). 50 per cent survival periods in those with liver metastasis were 8.3 months in the PLCC group, such being longer than 5.2 and 2.8 months in MMC and no chemotherapy groups (p<0.002) respectively. Combination therapy of PLCC and intra-arterial infusion of 5-FU through the proper hepatic artery prescribed for 8 patients with liver metastasis resulted in a 3-month prolongation of 50 per cent survival periods, compared with PLCC alone (p<0.05). In those with peritoneal dissemination the rate was 10.5 months in the PLCC group, that is longer than 6.5 months in the MMC group (p<0.02). In cases of invasion to other organs plus distant lymph node metastasis, the time was 11.0 in PLCC and 7.0 months in MMC groups (p<0.05). Thus, PLCC is a palliative approach for non-curatively resected carcinoma of the stomach.     

Disease-free survival for 9 years after liver resection for stage IV gallbladder cancer: Report of a case

We report herein the case of a 66-year-old woman who has survived for more than 9 years without recurrence since undergoing a right trisegmentectomy of the liver with biliary reconstruction using the jejunum for stage IV (T1, N1a, M0, UICC) gallbladder cancer. The resected tumor, which was histologically diagnosed as moderately to poorly differentiated adenocarcinoma, was approximately 8cm in diameter and infiltrated from the gallbladder to the medial, anterior, and posterior segments of the liver, involving the right hepatic and common hepatic ducts and the right hepatic artery; no intrahepatic distant metastasis was found. Although preoperative imaging diagnosis showed swollen lymph nodes at the hepatoduodenal ligament and paraaortic region, histological analysis of the resected lymph nodes revealed only one metastasis, located at the cystic duct which was involved in the tumor. This case demonstrates that curative resection may be the appropriate surgical intervention for patients with a stage IV tumor and direct infiltration to the liver and surrounding organs but no distant metastases.     

初治Ⅳ期乳腺癌患者外科治疗对生存影响的meta分析

目的探讨Ⅳ期乳腺癌患者原发肿瘤的切除是否可以改善其总体生存情况。方法全面检索PubMed、Medline、Cochrane Library、Embase、中国知网、万方、CBM、维普等数据库中关于Ⅳ期乳腺癌治疗的相关文献,由两名作者独立筛选文献并提取数据(包括总生存期和无进展生存期及肿瘤特征)后,采用RevMan 5.3及SPSS 21.0统计软件对数据进行meta分析。结果本研究共纳入21篇文献,其中回顾性队列研究17篇,随机对照试验研究4篇。共纳入5250例Ⅳ期乳腺癌患者,其中接受局部肿瘤手术切除+全身治疗2686例(手术组),仅接受全身治疗2564例(非手术组)。meta分析结果显示,手术组的总生存期明显优于非手术组[HR=0.64,95%CI(0.59,0.69),P<0.00001];亚组分析结果显示,非RCT研究中手术组的总生存期明显优于非手术组[HR=0.60,95%CI(0.55,0.65),P<0.00001],但RCT研究中未发现2组的总生存期比较差异有统计学意义[HR=0.89,95%CI(0.73,1.09),P=0.27]。2组间无进展生存期比较差异无统计学意义[HR=0.43,95%CI(0.17,1.11),P=0.08]。进一步对2组患者的临床病理特征进行了分析发现,与非手术组比较,手术组患者呈现的特点是更年轻(P<0.05),T2分期及以下、存在骨转移、ER阴性、接受放疗、转移数目<3枚患者的比例更高(P<0.05)。结论适当选择初治Ⅳ期乳腺癌患者采用局部切除手术可以改善其总体生存情况,应进行个体化治疗。     

乳腺癌保乳手术38例临床分析

目的 总结保乳手术治疗早期乳腺癌的临床经验及疗效观察.方法 回顾性分析2005年1月至2010年2月新疆石河子人民医院收治的38例临床0～IIa期、非乳晕区单发肿瘤的乳腺癌患者的临床资料.分析其近期疗效,并按Rose标准,对接受保乳手术的患者进行美容效果评价.结果 所有病例术后恢复良好,无1例出现并发症,随访未见局部复发及远处转移,患者对术后乳房外形及生活质量满意.结论 早期乳腺癌患者接受保乳手术治疗可取得满意的临床和美容效果.     

早期乳腺癌的保乳综合治疗疗效分析

目的　评价早期乳腺癌保乳综合治疗的疗效。方法　保乳组 92例 ,行保留乳房的肿瘤切除加腋窝淋巴结清扫术 ;对照组 60例 ,行乳癌改良根治术。术后给予放疗、全身化疗和 /或内分泌治疗。结果　平均随访 5 7个月 ,保乳组中无局部复发病例 ,3年生存率为 97.2 % ,5年生存率为 89.3 % ,远隔脏器转移率为 6.5 % ;对照组局部复发 2例 ,3年生存率为 97.5 % ,5年生存率为90 .1% ,远隔脏器转移率为 5 .0 % ,两组各指标对比无明显差异 (P >0 .0 5 )。结论　早期乳腺癌采用保乳综合疗法 ,可以达到与根治术相似的治疗效果 ,可作为首选方法     

Conservative treatment of breast cancer: Milan experience

Summary Background The conservative treatment of operable breast cancer has gradually become well-established during the last 20 years as it offers adequate loco-regional control of the disease and saves the brest. Moreover, larger, demolishing operations have not shown to decrease the risk of distant metastases. Methods Four prospective, randomized trials (Milan Trials I to IV) have been conducted at the Department of Surgical Oncology of the Istituto Nazionale Tumori Milan since 1973 comparing the radical Halsted approach in operable breast cancer to conservative treatments combining extensive breast resection and various radiotherapies. Results Data analysis lends force to the conservative treatment concept, showing that an extensive breast resection, defined as quadrantectomy, together with radiotherapy are a safe procedure that results in a long term survival comparable to that after Halsted's mastectomy. Furthermore, the studies reveal that too limited a resection (lumpectomy) and withdrawal of radiotherapy increase the risk of local recurrence. In women older than 55 years, however, quadrantectomy without radiotherapy yields good results. Young age and the presence of an extensive intraductal component are further, signficant and important risk factors of local recurrence. Conclusions If attention is paid to the defined risk factors and adjuvant therapeutic regimes the conservative surgical treatment of breast cancer yields excellent long term results.      

组织学早期乳腺癌的临床诊断

目的探讨组织学早期乳腺癌的临床特点和诊断方法.方法对我院1999～2001年共收治的25例组织学早期乳腺癌结合其临床表现、诊断方法和病理结果进行回顾性分析.结果临床表现以乳头溢液最为多见(52%),其次是局限性腺体增厚(28%),再次是乳房肿块(24%).辅助检查以乳管内视镜的诊断符合率最高,达84.6%,高频X线摄影仅为40.0%.结论组织学早期乳腺癌有一定的临床特征,对乳头溢液和腺体增厚患者要用多重诊断方法联合才能提高组织学早期乳腺癌的诊断率.