Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Chin Clin Oncol. 2021 Dec;10(6):57. doi: 10.21037/cco-21-113.
The purpose of this review is to outline the surgical management of inflammatory breast cancer (IBC) including the clinical decision making, operative approach and current controversies.
IBC is a rare and aggressive form of breast cancer. Trimodality therapy consisting of neoadjuvant therapy, modified radical mastectomy (MRM) and radiation therapy improves survival and is the recommended course of treatment. Advancements in systemic therapy and de-escalation strategies in non-IBC have accelerated discussions regarding several aspects of care in IBC including feasibility of de-escalation of surgical care, timing of reconstruction and the role of surgery in de novo stage IV disease. We discuss the evidence to support the surgical approach and decision-making in this rare disease.
We reviewed existing literature using multiple electronic databases and clinical consensus guidelines to identify historical and current publications addressing current management recommendations and clinical controversies in IBC.
Breast conserving surgery (BCS), skin- or nipple-sparing mastectomy should not be performed in IBC as surgical resection to negative margins results in improved locoregional recurrence rates. Level I and II axillary lymph node dissection should be performed regardless of response to therapy and initial nodal status. Reconstruction should be delayed and contralateral prophylactic mastectomy (CPM) is discouraged in IBC. Surgery may be considered for de novo stage IV IBC patients who demonstrate durable response to neoadjuvant therapy to improve local-regional control.
本文旨在概述炎性乳腺癌（IBC）的手术治疗方法，包括临床决策、手术方法和当前的争议。
IBC 是一种罕见且侵袭性较强的乳腺癌。新辅助治疗、改良根治性乳房切除术（MRM）和放疗的三联疗法可提高生存率，是推荐的治疗方法。在非 IBC 中，系统治疗的进步和降级策略的发展加速了对 IBC 中几个方面的护理的讨论，包括降级手术护理的可行性、重建的时机以及手术在新诊断的 IV 期疾病中的作用。我们讨论了支持这种罕见疾病手术方法和决策的证据。
我们使用多个电子数据库和临床共识指南对现有文献进行了回顾，以确定历史和当前出版物，这些出版物涉及 IBC 中当前的管理建议和临床争议。
IBC 中不应行保乳手术（BCS）或保留皮肤或乳头的乳房切除术，因为手术切除至阴性切缘可提高局部区域复发率。应进行 I 级和 II 级腋窝淋巴结清扫术，无论对治疗的反应和初始淋巴结状态如何。应延迟重建，不鼓励 IBC 行对侧预防性乳房切除术（CPM）。对于新诊断的 IV 期 IBC 患者，如果对新辅助治疗有持久的反应，可考虑手术以改善局部区域控制。
