Department of Surgery, Maxima Medical Centre, Veldhoven, The Netherlands.
Eur J Cancer. 2011 Sep;47 Suppl 3:S6-22. doi: 10.1016/S0959-8049(11)70142-3.
Some of the patients who present with breast cancer already have distant metastatic disease. According to recent literature, these patients may benefit from resection of the breast tumour. One explanation for the effect of this resection is that reducing the tumour load influences metastatic growth. Results of future randomised controlled trials should indicate whether surgery of the breast tumour truly improves survival. Selected patients could even benefit from metastasectomy of liver and lung metastases; survival seems to improve and these procedures seldom lead to major complications. When metastasectomy is not possible, minimally invasive techniques can be used in selected patients for the treatment of breast cancer liver metastases, radiofrequency ablation (RFA) being discussed most in the literature. Patients with locally advanced breast cancer are treated multidisciplinarily and with curative intent. Part of the treatment is surgery to reduce tumour load. Regarding treatment of the axilla, in a clinically negative axilla sentinel node biopsy is advised before neoadjuvant treatment; an axillary lymph node dissection is not warranted. In local recurrence, surgery is the primary treatment. Axillary staging can be done in patients with a previous negative sentinel node biopsy. Regional recurrence after breast-conserving surgery or mastectomy is treated with surgery followed by radiotherapy.
一些患有乳腺癌的患者已经出现远处转移。根据最近的文献，这些患者可能受益于乳房肿瘤切除术。这种切除术效果的一个解释是，减少肿瘤负荷会影响转移生长。未来随机对照试验的结果应该表明，乳房肿瘤切除术是否真的能提高生存率。一些选择的患者甚至可能受益于肝和肺转移灶切除术；生存似乎有所改善，而且这些手术很少导致严重并发症。当无法进行转移灶切除术时，微创技术可用于治疗乳腺癌肝转移，文献中讨论最多的是射频消融术。局部晚期乳腺癌患者接受多学科治疗，旨在治愈。治疗的一部分是手术以减少肿瘤负荷。关于腋窝的治疗，在新辅助治疗前，临床阴性腋窝的前哨淋巴结活检是建议的；不需要腋窝淋巴结清扫术。在局部复发时，手术是主要的治疗方法。对于以前有阴性前哨淋巴结活检的患者，可以进行腋窝分期。保乳手术后或乳房切除术后的区域复发采用手术加放疗治疗。
