Eleven-year follow-up of a randomized study of pectoral fascia preservation after mastectomy for early breast cancer.

BACKGROUND

The present study reports results of a randomized trial in which breast cancer patients operated with preserved pectoral fascia compared to removal of the pectoral fascia showed a trend toward an increased risk for chest wall recurrence The aim of the study was to assess whether the different procedural modes had any impact on survival or local control in breast cancer patients followed in the long term.

METHOD

The trial included 247 patients with breast cancer who underwent modified radical mastectomy in five Swedish hospitals between 1993 and 1997. The median follow-up time was 11 years. The patients were randomized between removal (n = 122) versus preservation (n = 125) of the pectoral fascia.

RESULTS

The breast-cancer-specific survival at 10 years was 73%. Removal or preservation of the pectoral fascia had no significant impact on chest-wall recurrence rate or breast-cancer-specific survival. A total of 18 patients with chest-wall recurrence were seen in the group allocated to pectoral fascia preservation versus a total of 10 in patients allocated to pectoral fascia removal (hazard ratio = 1.8, 95% confidence interval = 0.8-4.0). The majority of the chest-wall recurrences were detected 0-5 years postoperatively. The cumulative chest-wall recurrence rates at 5 and at 10 years were 13 and 15%, respectively, in patients allocated to pectoral fascia preservation and 8 and 9% in patients allocated to pectoral fascia removal.

CONCLUSIONS

With long-term follow-up neither the chest wall recurrence rate nor the breast-cancer-specific survival was significantly influenced by the preservation of the pectoral fascia. A trend toward an increased risk for chest wall recurrence was observed in patients with preserved pectoral fascia. A hazard ratio of 1.8 for a chest-wall recurrence in patients with preserved fascia indicates that fascia-sparing mastectomy may negatively affect prognosis.