Urban J A
Cancer. 1978 Oct;42(4):2066-77. doi: 10.1002/1097-0142(197810)42:4<2066::aid-cncr2820420458>3.0.co;2-v.
There is no ideal single operation for breast cancer. In planning the choice of surgery for breast cancer, one must be aware of its multicentric origin, and of the regional spread from the breast to the axillary and internal mammary lymph nodes. The scope of the surgical attack should be correlated with the clinical pathologic extent of disease in the individual patient with the aim of removing all disease present, while preserving appearance and function to the utmost. The main goal remains removal of all disease from the breast and its regional nodes. Three distinct operative procedures have been utilized--modified radical mastectomy--total mastectomy with axillary dissection, radical mastectomy, and extended radical mastectomy. In all instances, the appropriate operation is applied to the individual, with the concept of removing most efficiently all disease present in the breast and regional nodes. With this plan of therapy, a 10 year survival rate of 61% with a local recurrence rat of 7.7% has been attained in a group of 565 patients with 40% axillary node involvement. These data are crude and uncorrected for age, intercurrent disease and for those lost to follow-up. The best salvage has been attained in the so-called "minimal" breast cancers--95% well 10 years following modified radical mastectomy. The extended radical mastectomy has been superior to the radical mastectomy when axillary node disease is present. In the more complete operation, 54% 10 year survival has been attained in patients with axillary node metastases, compared with only 33% attained in those treated by the conventional radical mastectomy. Adjuvant radiation therapy is applied to the adjacent regional nodes, when indicated. Adjuvant multi-chemotherapy is in its infancy and still to be evaluated. It should be used as a supplement to adequate primary surgical treatment, and should not be used as a crutch for inadequate primary surgery.
对于乳腺癌，目前尚无理想的单一手术方式。在规划乳腺癌手术方案时，必须考虑到其多中心起源，以及从乳腺向腋窝和胸骨旁淋巴结的区域扩散。手术切除范围应与个体患者疾病的临床病理范围相关联，目标是切除所有现存病灶，同时最大程度地保留外观和功能。主要目标仍然是切除乳腺及其区域淋巴结的所有病灶。已采用三种不同的手术方式——改良根治性乳房切除术（即全乳房切除加腋窝淋巴结清扫）、根治性乳房切除术和扩大根治性乳房切除术。在所有情况下，都根据个体情况选择合适的手术方式，其理念是最有效地切除乳腺和区域淋巴结中的所有现存病灶。采用这种治疗方案，一组565例腋窝淋巴结受累率为40%的患者，10年生存率达到61%，局部复发率为7.7%。这些数据未经年龄、并存疾病及失访情况校正。在所谓的“微小”乳腺癌中，治疗效果最佳——改良根治性乳房切除术后10年，95%的患者情况良好。当存在腋窝淋巴结病变时，扩大根治性乳房切除术优于根治性乳房切除术。在更彻底的手术中，腋窝淋巴结转移患者的10年生存率达到54%，而采用传统根治性乳房切除术治疗的患者仅为33%。如有指征，辅助性放射治疗可用于邻近的区域淋巴结。辅助性多药化疗尚处于起步阶段，仍有待评估。它应作为充分的原发性手术治疗的补充，而不应被用作原发性手术不充分的依靠手段。
