Advertisement

Die Mastektomie — Indikationen und Operative Technik aus Heutiger Sicht

  • P. Dubsky
  • D. Kandioler
Chapter
  • 848 Downloads

Auszug

Die radikale Mastektomie nach Rotter-Halsted galt bis Mitte der 1960er Jahre als Standardoperation des Mammakarzinoms in jedem Stadium. Der Eingriffbeinhaltet die Entfernung des gesamten Drüsenkörpers mit Brustmuskeln gemeinsam mit axillärer Dissektion en bloc, und ist heute als obsolet zu bewerten. Um die klinischen Kontroversen zu beenden, welche sich aus anekdotenhaften Berichten einzelner Chirurgen speisten, entwarf die Arbeitsgruppe des National Surgical Adjuvant Breast and Bowel Project (NSABP) 1971 die erste prospektiv randomisierte Studie zum Vergleich der Halsted-Mastektomie mit weniger extensiven chirurgischen Verfahren (NSABP B-04; Fischer et al., 2002 a): Patientinnen mit klinisch negativer Axilla wurden zu je einem Drittel randomisiert in die Behandlungsgruppen
  • Halsted-Mastektomie,

  • Mastektomie ohne axilläre Dissektion, aber mit regionaler Bestrahlung, und

  • Mastektomie ohne weitere Therapie.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

Literatur

  1. Abner AL, Recht A, Eberlein T et al. (1993) Prognosis following salvage mastectomy for recurrence in the breast after conservative surgery and radiation therapy for early-stage breast cancer. J Clin Oncol 11: 44–48PubMedGoogle Scholar
  2. Alpert TE, Kuerer HM, Arthur DW, Lannin DR, Haffty BG. (2005) Ipsilateral breast tumor recurrence after breast conservation therapy: outcomes of salvage mastectomy vs. salvage breast-conserving surgery and prognostic factors for salvage breast preservation. Int J Radiat Oncol Biol Phys 63: 845–851PubMedCrossRefGoogle Scholar
  3. Beer GM, Varga Z, Budi S, Seifert B, Meyer VE (2002) Incidence of the superficial fascia and its relevance in skin-sparing mastectomy. Cancer 94: 1619–1625PubMedCrossRefGoogle Scholar
  4. Blichert-Toft M, Rose C, Anderson JA, Overgaard M, Axelsson CK, Andersen KW, Mouridsen HT, Danish Breast Cancer Cooperative Group (1992) Danish randomized trial comparing breast conservation therapy with mastectomy: six years of life-table analysis. J Natl Cancer Inst Monogr 11: 19–25PubMedGoogle Scholar
  5. Chen AM, Meric-Bernstam F, Hunt KK et al. (2004) Breast conservation after neoadjuvant chemotherapy: the MD Anderson cancer center experience. J Clin Oncol 22: 2303–2312PubMedCrossRefGoogle Scholar
  6. Chen AM, Meric-Bernstam F, Hunt KK et al. (2005) Breast conservation after neoadjuvant chemotherapy. Cancer 103: 689–695PubMedCrossRefGoogle Scholar
  7. Clarke M, Collins R, Darby S et al. (2005) Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of the randomised trials. Lancet 366: 2087–2106PubMedGoogle Scholar
  8. Dalberg K, Mattson A, Sandelin K, Rutqvist LE. (1998) Outcome of treatment for ipsilateral breast tumor recurrence in early-stage breast cancer. Breast Cancer Res Treat 49: 69–78PubMedCrossRefGoogle Scholar
  9. Early Breast Cancer Trialist’s Collaborative Group (1995) Effects of radiotherapy and surgery in early breast cancer. An overview of the randomized trials. N Engl J Med 333: 1444–1455CrossRefGoogle Scholar
  10. Early Breast Cancer Trialist’s Collaborative Group (2000) Favourable and unfavourable effects on long-term survival of radiotherapy for early breast cancer: an overview of the randomized trials. Lancet 355: 1757–1770CrossRefGoogle Scholar
  11. Fisher B, Jeong JH, Anderson S, Bryant J, Fisher ER, Wolmark N (2002 a) Twenty-five-year follow-up of a randomized trial comparing radical mastectomy, total mastectomy, and total mastectomy followed by irradiation. N Engl J Med 347: 567–575PubMedCrossRefGoogle Scholar
  12. Fisher B, Anderson S, Bryant J et al. (2002 b) Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med 347: 1233–1241PubMedCrossRefGoogle Scholar
  13. Gerber B, Krause A, Reimer T et al. (2003) Skin-sparing mastectomy with conservation of the nipple-areola complex and autologous reconstruction is an oncologically safe procedure. Ann Surg 238: 120–127PubMedCrossRefGoogle Scholar
  14. Giordano SH, Hortobagyi GN (2003) Inflammatory breast cancer: clinical progress and the main problems that must be addressed. Breast Cancer Res 5: 284–288PubMedCrossRefGoogle Scholar
  15. Goldhirsch A, Glick JH, Gelber RD, Coates AS, Thurlimann B, Senn HJ (2005) Meeting highlights: international expert consensus on the primary therapy of early breast cancer 2005. Ann Oncol 16: 1569–1583PubMedCrossRefGoogle Scholar
  16. Jacobson JA, Danforth DN, Cowan KH et al. (1995) Ten-year results of a comparison of conservation with mastectomy in the treatment of stage I and II breast cancer. N Engl J Med 332: 907–911PubMedCrossRefGoogle Scholar
  17. Jakesz R, Samonigg H, Gnant M et al. (2003) Significant increase in breast conservation in 16 years of trials conducted by the Austrian Breast and Colorectal Cancer Study Group. Ann Surg 237: 556–564PubMedCrossRefGoogle Scholar
  18. Khanna MM, Mark RJ, Silverstein MJ, Juillard G, Lewinsky B, Giuliano AE (1992) Breast conservation management of breast tumors 4 cm or larger. Arch Surg 127: 1038–1041; discussion 1041–1043PubMedGoogle Scholar
  19. Kuerer HM, Arthur DW, Haffty BG (2004) Repeat breast-conserving surgery for in-breast local breast carcinoma recurrence: the potential role of partial breast irradiation. Cancer 100: 2269–2280PubMedCrossRefGoogle Scholar
  20. Kurtz JM, Jacquemier J, Amalric R et al. (1991) Is breast conservation after local recurrence feasible? Eur J Cancer 27: 240–244PubMedCrossRefGoogle Scholar
  21. Morrow M (2005) Limiting breast surgery to the proper minimum. Breast 14: 523–526PubMedCrossRefGoogle Scholar
  22. Robson M, Svahn T, McCormick B, Borgen P, Hudis CA, Norton L, Offit K (2005) Appropriatenenss of breast-conserving treatment of breast carcinoma in women with germline mutations in BRCA1 or BRCA2: a clinic-based series. Cancer 103: 44–51PubMedCrossRefGoogle Scholar
  23. Sarrazin D, Le MG, Arriagada R et al. (1989) Ten-year results of a randomized trial comparing a conservative treatment to mastectomy in early breast cancer. Radiother Oncol 14: 177–184PubMedCrossRefGoogle Scholar
  24. Silverstein MJ, Lagios MD, Craig PH, Waisman JR, Lewinsky BS, Colburn WJ, Poller DN (1996) A prognostic index for ductal carcinoma in situ of the breast. Cancer 77: 2267–2274PubMedCrossRefGoogle Scholar
  25. Skinner KA, Silverstein MH (2001) The management of ductal carcinoma in situ of the breast. Endocr Relat Cancer 8: 33–45PubMedCrossRefGoogle Scholar
  26. Van Dongen JA, Voogd AC, Fentiman IS et al. (2000) Long-term results of a randomized trial comparing breast-conserving therapy with mastectomy: European Organization for Research and Treastment of Cancer 10801 trial. J Natl Cancer Inst 92: 1143–1150PubMedCrossRefGoogle Scholar
  27. Veronesi U, Saccozzi R, Del Vecchio M et al. (1981) Comparing radical mastectomy with quadrantectomy, axillary dissection, and radiotherapy in patients with small cancers of the breast. N Engl J Med 305: 6–11PubMedCrossRefGoogle Scholar
  28. Veronesi U, Cascinelli N, Mariani L et al. (2002) Twenty-year follow-up of a randomized study comparing breast conservation surgery with radical mastectomy for early breast cancer. N Engl J Med 347: 1227–1232PubMedCrossRefGoogle Scholar
  29. Voogd AC, van Tienhoven G, Peterse HL et al. (1999) Local recurrence after breast conservation therapy for early stage breast carcinoma: detection, treatment, and outcome in 266 patients. Dutch Study Group on Local Recurrence after Breast Conservation (BORST). Cancer 85: 437–446PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag / Wien 2007

Authors and Affiliations

  • P. Dubsky
    • 1
  • D. Kandioler
    • 1
  1. 1.Brustambulanz AKH Wien, Universitätsklinik für ChirurgieMedizinische Universität WienWien

Personalised recommendations