Abdallah Ahmed, Abdelwahab Khaled, Awny Shadi, Zuhdy Mohammad, Hamdy Omar, Atallah Khalid, Elfeky Abeer, Hegazy Mohammed A F, Metwally Islam H
Surgical Oncology Department, Oncology Center, Mansoura University (OCMU), Mansoura, 35516 Egypt.
Indian J Surg Oncol. 2023 Mar;14(1):93-105. doi: 10.1007/s13193-022-01602-x. Epub 2022 Aug 27.
Fungating breast cancer severely affects patients' daily lives, and patient management poses major oncology challenges. To present 10-year outcomes of unique tumor presentation, suggesting a focused algorithm for surgical management and providing deep analysis for factors affecting survival and surgical outcomes. Eighty-two patients with fungating breast cancer were enrolled in the period from January 2010 to February 2020 in the Mansoura University Oncology Center database. Epidemiological and pathological characteristics, risk factors, different surgical treatment techniques, and surgical and oncological outcomes were reviewed. Preoperative systemic therapy was used in 41 patients, with the majority (77.8%) showing progressive response. Mastectomy was performed in 81 (98.8%) patients, with primary wound closure in 71 (86.6%), and wide local excision in a single patient (1.2%). Different reconstructive techniques in non-primary closure operations were used. Complications were reported in 33 (40.7%) patients, of which 16 (48.5%) were of Clavien-Dindo grade II category. Loco-regional recurrence occurred in 20.7% of patients. The mortality rate during follow-up was 31.7% ( = 26). Estimated mean overall survival (with 95% CI) was 55.96 (41.98-69.9) months; estimated mean loco-regional recurrence-free survival (with 95% CI) was 38.01 (24.6-51.4) months. Surgery is a cornerstone fungating breast cancer treatment option, but at the expense of high morbidity. Sophisticated reconstructive procedures may be indicated for wound closure. A suggested algorithm based on the center's experience of wound management in difficult mastectomy cases is displayed.
乳腺外生型癌严重影响患者的日常生活，患者管理给肿瘤学带来了重大挑战。为了呈现独特肿瘤表现的10年结果，提出一种针对手术管理的重点算法，并对影响生存和手术结果的因素进行深入分析。2010年1月至2020年2月期间，曼苏拉大学肿瘤中心数据库纳入了82例乳腺外生型癌患者。回顾了其流行病学和病理特征、危险因素、不同的手术治疗技术以及手术和肿瘤学结果。41例患者接受了术前全身治疗，大多数（77.8%）显示病情进展。81例（98.8%）患者接受了乳房切除术，71例（86.6%）进行了一期伤口缝合，1例（1.2%）患者进行了广泛局部切除。非一期缝合手术采用了不同的重建技术。33例（40.7%）患者报告了并发症，其中16例（48.5%）为Clavien-Dindo II级。20.7%的患者发生了局部区域复发。随访期间的死亡率为31.7%（n = 26）。估计平均总生存期（95%置信区间）为55.96（41.98 - 69.9）个月；估计平均局部区域无复发生存期（95%置信区间）为38.01（24.6 - 51.4）个月。手术是乳腺外生型癌治疗的基石，但代价是高发病率。对于伤口闭合可能需要复杂的重建手术。展示了一种基于该中心在困难乳房切除病例伤口管理经验的建议算法。
