A multivariate analysis of en bloc extended radical mastectomy versus conventional radical mastectomy in operable breast cancer.

We made clinical trials of en bloc extended radical mastectomy (EXT) of a new type in 118 patients from 1980 through 1985. A variety of conventional radical mastectomies (RDL) were also performed in 105 patients from 1973 through 1985. A multivariate analysis was performed of the results to compare EXT and RDL. The result showed the 5-year survival rates of 91 +/- 2.6% and 83 +/- 3.7% were achieved for the EXT and RDL groups, respectively (Cox P value for comparison of survival curves = 0.16). Adjusted Cox regression analysis revealed a significantly favourable result of EXT (P = 0.05). This difference was most remarkable in patients with one to three metastatic axillary lymph nodes, although it was not statistically significant because of too small a number of patients available (P = 0.18). The results are thus not definite, but suggest that EXT may be advantageous over RDL especially in patients with a few metastatic axillary lymph nodes.     

Five-year results of a randomized clinical trial comparing modified radical mastectomy and extended radical mastectomy for stage II breast cancer

A controlled cooperative study was carried out to assess the value of modified radical mastectomy for patients with stage II breast cancer. The data was analyzed from 11 institutions in the Shikoku District participating in a prospective clinical trial in which patients were randomly assigned either to a modified radical mastectomy group or an extended radical mastectomy group. These two groups of patients were similar to each other in terms of such background factors as age distribution, menopausal status, TNM classification, tumor size, location of the primary tumor, axillary nodal involvement, histological type, and estrogen receptor status. The median follow-up times in the modified and extended radical mastectomy groups were 4.7 and 4.5 years, respectively. The cumulative curves indicated no difference between the two groups in either disease-free survival or overall survival. The survival rates were classified according to the presence or absence of axillary nodal metastases. However, no significant difference was found between the two groups. These findings thus suggest that the routine removal of the grossly uninvolved major pectoral muscle and parasternal lymph nodes is not necessary in patients with stage II breast cancer.     

A multivariate analysis of en bloc extended radical mastectomy versus conventional radical mastectomy in operable breast cancer

We made clinical trials of en bloc extended radical mastectomy (EXT) of a new type in 118 patients from 1980 through 1985. Conventional radical mastectomies (RDL) were also performed in 105 patients from 1973 through 1985. A multivariate analysis was performed to compare the results of EXT and RDL. As the result, the 5-year survival rates of 91 +/- 2.6% and 83 +/- 3.7% were achieved for the EXT and RDL groups, respectively (Cox P value for comparison of survival curves = 0.16). Adjusted Cox regression analysis revealed a significantly favorable result of EXT (P = 0.03). This difference was most remarkable in patients with one to three metastatic axillary lymph nodes, although it was not statistically significant because of too small number of patients available (P = 0.18). The results are thus not definite, but suggest that EXT may be advantageous over RDL especially in patients with a few metastatic axillary lymph nodes.     

Modified radical mastectomy.

The recent history of operations for breast cancer indicates a growing trend toward conservatism. The modified radical mastectomy achieves the goal of removing all evidence of cancer in the breast involved and removes the regional lymph nodes for accurate staging of the disease. In addition, it provides a cosmetic result superior to that of the standard radical mastectomy. Breast reconstruction may be undertaken at a later time with excellent result. The 5 and 10 year survival rates of comparable groups of patients after modified radical mastectomy and standard radical mastectomy appear to be almost identical.     

II,III期乳腺癌行根治术与扩大根治术的疗效评价:附691例报告

目的　探讨乳腺癌根治术与扩大根治术治疗II ,III期乳腺癌的疗效。方法　回顾性分析691例II ,III期乳腺癌的两种手术方法治疗后的 5年和 10年生存率。 691例乳腺癌中II期行根治术 2 0 6例 ,行扩大根治术 14 2例 ;III期行根治术 193例 ,行扩大根治术 15 0例。结果　癌灶位于中央区及内乳区行扩大根治术的II ,III期患者的 5年生存率和III期的 10年生存率显著高于根治术患者 (均P <0 .0 1)。癌灶位于外上象限行扩大根治术的II ,III期患者 10年生存率和III期患者的 5年生存率亦显著高于根治术患者 (均 P <0 .0 5 )。结论　提示II ,III期乳腺癌病灶位于中央区及内乳区的患者、位于外上象限的III期患者应考虑行扩大根治术。     

乳腺癌术后即刻乳房重建的适应证及手术方法的选择

近年来,各种乳腺疾病特别是乳腺癌的发病率逐年增高,是女性最常见的恶性肿瘤。乳房不仅是哺乳器官,也是体现女性形象美的重要因素。传统的乳腺癌根治手术,使患者胸壁严重毁损、乳房缺失、腋窝凹陷、姿势变形等,彻底摧毁了女性优美的性征和曲线美,随着生存期的延长,对于大多数术后患者,癌的威胁会逐步破乳房畸形、缺失所引起的烦恼与痛苦所替代,乳腺癌患者需要面对更大更复杂的心理压力,乳房重建已成为乳腺癌患者术后的迫切需要。随着对乳腺癌诊断技术的不断提高,早期乳腺癌的诊断率也在提升,在肿瘤根治的同时,     

乳腺痛术后即刻乳房重建的适应证及手术方法的选择

近年来,各种乳腺疾病特别是乳腺癌的发病率逐年增高,是女性最常见的恶性肿瘤.乳房不仅是哺乳器官,也是体现女性形象美的重要凶素.传统的乳腺癌根治手术,使患者胸壁严重毁损、乳房缺失、腋窝凹陷、姿势变形等[1],彻底摧毁了女性优美的性征和曲线美,随着生存期的延长,对于大多数术后患者,癌的威胁会逐步被乳房畸形、缺失所引起的烦恼与痛苦所替代,乳腺痛患者需要面对更大更复杂的心理压力[2],乳房重建已成为乳腺癌患者术后的迫切需要.随着对乳腺癌诊断技术的不断提高,早期乳腺癌的诊断率也在提升,在肿瘤根治的同时,乳房重建已成为乳腺癌综合治疗中的一部分.     

Ⅱ,Ⅲ期乳腺癌行根治术与扩大根治术的疗效评价:附691例报告

目的探讨乳腺癌根治术与扩大根治术治疗Ⅱ,Ⅲ期乳腺癌的疗效.方法回顾性分析691例Ⅱ,Ⅲ期乳腺癌的两种手术方法治疗后的5年和10年生存率.691例乳腺癌中II期行根治术206例,行扩大根治术142例;Ⅲ期行根治术193例,行扩大根治术150例.结果癌灶位于中央区及内乳区行扩大根治术的Ⅱ,Ⅲ期患者的5年生存率和Ⅲ期的10年生存率显著高于根治术患者(均P<0.01).癌灶位于外上象限行扩大根治术的Ⅱ,Ⅲ期患者10年生存率和III期患者的5年生存率亦显著高于根治术患者(均P<0.05).结论提示Ⅱ,Ⅲ期乳腺癌病灶位于中央区及内乳区的患者、位于外上象限的Ⅲ期患者应考虑行扩大根治术.     

The usefulness of extended radical mastectomy in patients with breast carcinoma]

Extended radical mastectomy (EXT) in 1, 137 patients with breast carcinoma was devised to eradicate all possible sites of local nodal metastases including internal mammary chain during the years 1962 through 1990. The tumors had to be mainly any T located in medial-half, central (excluding less 1.0 cm or histologic type with good prognosis) and T size measuring 3.0 cm or more in lateral-half. Prognostic outcomes were analysed by the presence or absence of nodes involved. The 10-year relapse free survival in patients with internal mammary node (IMN) only invaded and both axillary (AX) & IMN invaded were 47.8% and 40.1%, respectively. The incidence of relapse free survival at 10 years in relation to the number of positive AX and IMN indicated virtually favorable--1 positive: 71.4%, 2 or 3 positive: 61.3% and 4-9 positive: 53.7%. In our study, the frequency of IMN involvement calculated 24.1% from all quadrants of the breast. In comparison of nonrandomized series with medial-half and lateral-half tumors which involved positive IMN, comprising 95 and 28 patients of the total (n = 495), relapse free survivals at 15 years were 36.5% and 17.5%, respectively. It was presumed that the benefit of EXT would be found in medial-central tumors.     

Modified radical mastectomy

Surgical management in the treatment of potentially curable breast cancer has changed from a radical to a more conservative approach. The most common procedure used at the present time is the modified mastectomy, which is discussed in detail in this article.     

乳腺癌改良根治术

乳腺癌改良根治术:距肿瘤边缘约5 cm做梭形切口,在皮肤与浅筋膜间做皮瓣分离,上界为锁骨下缘,下界达肋弓处,内侧界近胸骨,外侧界为背阔肌前缘,将乳腺从胸大肌表面分离。打开胸锁筋膜,将胸大小肌向内上牵拉,显露腋窝。腋淋巴结整块切除后,保留胸大肌、胸小肌、胸前神经分支以及胸长和胸背神经。放置负压引流管。仔细伤口创面止血,缝合皮肤。     

One-day hospitalization following modified radical mastectomy.

Postoperative management of patients following modified radical mastectomy has changed dramatically in recent years. Historically, patients usually remained in the hospital with closed suction drainage until the amount of drainage had decreased sufficiently for them to be removed. The feasibility of early discharge on the day following surgery was studied in a prospective manner in 29 consecutive breast cancer patients; 27 underwent unilateral modified radical mastectomy and 2 bilateral mastectomies by a single surgeon. All patients were instructed before surgery about planned early discharge and drain care. Twenty-seven of 29 patients (93.3%) were discharged the day following surgery. However, 2 patients refused discharge and were discharged on postoperative Day Two, and one patient was readmitted for confusion. Drains were removed in the office an average of 5.07 days after surgery. Forty-five per cent of patients developed a seroma that required aspiration at least once. No significant long-term sequela were experienced as a result of early discharge. The average hospital cost was reduced by $2,474.00 or 36 per cent (P less than 0.001) as compared to other surgeons in the same medical center who held to traditional postoperative care. The authors conclude that discharge on the day following surgery for patients undergoing a modified radical mastectomy is safe and cost effective.