Heil Joerg, Fuchs Valerie, Golatta Michael, Schott Sarah, Wallwiener Markus, Domschke Christoph, Sinn Peter, Lux Michael P, Sohn Christof, Schütz Florian
Universitäts-Frauenklinik, Universitätsklinikum Heidelberg, Germany.
Institut für Pathologie, Universität Heidelberg, Germany.
Breast Care (Basel). 2012 Oct;7(5):364-9. doi: 10.1159/000343976.
Surgery is still a main therapeutic option in breast cancer treatment. Nowadays, methods of resection and reconstruction vary according to different tumors and patients. This review presents and discusses standards of care and arising questions on how radical primary breast cancer surgery should be according to different clinical situations. In most early breast cancer patients, breast conservation is the method of choice. The discussion on resection margins is still controversial as different studies show conflicting results. Modified radical mastectomy is the standard in locally advanced breast cancer patients, although there are different promising approaches to spare skin or even the nipple-areola complex. A sentinel node biopsy is the standard of care in clinically node-negative invasive breast cancer patients, whereas the significance of axillary lymphonodectomy seems to be questioned through a number of different findings. Although there are interesting findings to modify surgical approaches in very young or elderly breast cancer patients, it will always be an individualized approach if we do not adhere to current guidelines. Up to date, there are no special surgical procedures in BRCA mutation carriers or patients of high-risk families.
手术仍然是乳腺癌治疗的主要治疗选择。如今，根据不同的肿瘤和患者情况，切除和重建方法各不相同。本综述介绍并讨论了护理标准以及关于根据不同临床情况原发性乳腺癌手术应达到何种根治程度所引发的问题。在大多数早期乳腺癌患者中，保乳是首选方法。关于切缘的讨论仍存在争议，因为不同研究显示出相互矛盾的结果。改良根治性乳房切除术是局部晚期乳腺癌患者的标准术式，尽管有不同的有前景的方法来保留皮肤甚至乳头乳晕复合体。前哨淋巴结活检是临床腋窝淋巴结阴性的浸润性乳腺癌患者的护理标准，而腋窝淋巴结清扫术的意义似乎因一些不同的研究结果而受到质疑。尽管在非常年轻或老年乳腺癌患者中修改手术方法有一些有趣的研究结果，但如果我们不遵循当前指南，手术方法将始终是个体化的。到目前为止，BRCA突变携带者或高危家族患者没有特殊的手术程序。
