Radically extended modified mastectomy of t4b-dn0-3m0 primary inflammatory breast cancer as a tool to minimize the risk of recurrence

Abstract

Introduction. Breast cancer (BC) is an important public health problem. These are BC patients in young age, hereditary (BRCA-associated) BC patients, inflammatory BC patients, synchronous cancer patients etc. In case of a large size of tumor or diffuse form of BC we often need to use extended surgery techniques in order to perform it radically and minimize a risk of recurrence. The aim of the study to evaluate the effectiveness of surgery approaches in inflammatory BC patients. Materials and research methods. Тhe first stage of our research was to evaluate extended surgical treatment using techniques by Handelhail and Beck on the risk of local recurrence. The study included 39 patients with breast cancer T4b-dN0-3M0 who in the period from 2014 to 2019 received complex treatment at National Cancer Institute of Ukraine. Besides neo- and adjuvant chemotherapy, an extended radical mastectomy using a technique by Handelhail and Beck was performed in 19 patients. In 20 patients a traditional (Madden) modified radical mastectomy was done. Results. When studying the data of a group of 20 patients we received a very high percentage of recurrence. Recurrences were classified as locoregional if they occurred in the ipsilateral breast or the axillary or supraclavicular lymph nodes, and as distant metastasis, if they occurred at any other site. Radical extended modified mastectomy consisted in the removal of the mammary gland and adjacent skin along the perimeter with subcutaneous tissue at a distance of 2-3 cm outward from the macroscopic edges of the gland, subclavian-axillary-subscapularis lymphadenectomy. The resulting defect was closed using a technique by Handelhail and Beck. The use of extended surgery made it possible to improve recurrence-free survival.