请输入您要查询的百科知识：

　

词条 Breast-conserving surgery
释义

  1. History

  2. Decision Making

  3. Patient Considerations

     Indications  Absolute Contraindications   Relative Contraindications  

  4. Oncoplastic surgery

  5. External links

{{multiple issues|{{lead too short|date=June 2010}}{{more citations needed|date=July 2012}}
}}{{Infobox interventions |
 Name        = Breast-conserving surgery | Image       = Lumpectomy 02.jpg | Caption     = Breast-conserving surgery avoids removing the entire breast | ICD10       = | ICD9        = {{ICD9proc|85.21}}-{{ICD9proc|85.23}} | MeshID      = D015412 | OPS301      = | OtherCodes  = | HCPCSlevel2 = |

}}

Breast-conserving surgery (BCS), refers to an operation that aims to remove breast cancer while avoiding a mastectomy. Other terms for this operation include: lumpectomy, wide local excision, segmental resection, tylectomy, and quadrantectomy. BCS has been increasingly accepted as an alternative to mastectomy in specific patients, as it provides tumor removal while maintaining an acceptable cosmetic outcome. This page reviews the history of this operation, important considerations in decision making and patient selection, and the emerging field of oncoplastic breast conservation surgery.

History

Prior to 1981, there existed limited evidence that breast-conserving surgery was an acceptable alternative to radical mastectomy for treatment of early stage breast cancer. Dr. Umberto Veronesi, an Italian oncologist, challenged this notion and led a clinical trial comparing the radical mastectomy with breast-conserving surgery (which was termed quadrantectomy at the time). This landmark trial showed no differences in overall survival, disease-free survival, and local recurrence for patients with breast cancer of less than 2 cm and no palpable axillary nodes.[1][2] He was widely celebrated for this landmark study, so much so that some began referring to this operation as the Veronesi Quadrantectomy.[1][3]

Decision Making

Shared decision-making is an important consideration in breast-conserving surgery. It is estimated that between 50% and 70% of patients are active participants in the decision making of breast cancer surgery.[4][5] The time following a cancer diagnosis may be filled with fear, vulnerability, and a sense of being overwhelmed at the amount of information being provided by physicians as well as accessed on the internet.[6] Each patient has their own set of unique characteristics, which may make it challenging to read information online and apply that information to a specific individual circumstance. In addition, there are several important misconceptions regarding breast-conservation surgery for patients and clinicians to keep in mind.[7]
  1. In appropriately selected patients, mastectomy and breast-conserving surgery have equivalent survival rates.
  2. Undergoing mastectomy does not eliminate the risk for recurrent or new cancer.
  3. Radiation therapy may still be needed following breast-conservation surgery.
  4. The decision regarding the need for chemotherapy is independent from the surgical options.

A close partnership between the surgeon and patient is important in the decision making process for whether or not to pursue breast-conservation surgery.

Patient Considerations

Breast-conserving surgery is not appropriate for all patient with breast cancer. Proper patient selection involves a careful consideration of the indications and contraindications for surgery.

Indications

BCS is indicated in cases of biopsy-proven invasive breast cancer or biopsy-proven ductal carcinoma in situ (DCIS). In the assessment of the tumor, the surgeon should assess the ability to resect the tumor with clear margins while providing a cosmetic result that is acceptable to the patient. [8]

Absolute Contraindications

Absolute contraindications, which are reasons why the procedure absolutely cannot be done, include:[9]

  1. Pregnancy is an absolute contraindication to the use of breast irradiation. In some cases, it may be possible to perform breast-conserving surgery in the third trimester and treat the patient with radiation after delivery.
  2. Two or more primary tumors in separate quadrants of the breast or with diffuse malignant-appearing microcalcifications.
  3. A history of prior therapeutic irradiation to the breast that would require re-treatment to an excessively high total dose.
  4. Persistent positive margins after reasonable surgical attempts: the importance of a single focally positive microscopic margin needs further study and may not be an absolute contraindication.
  5. Inflammatory breast cancer
  6. Diffuse or indeterminate micro-calcifications on mammography

Relative Contraindications

Relative contraindications encompass situations of higher risk of complications to the patient that may be outweighed by other considerations, such as the benefit to the patient. Relative contraindications include:[8]
  1. Previous breast radiation therapy
  2. Connective tissue disease such as Scleroderma, Sjogren Syndrome, Lupus, and Rheumatoid arthritis may result in an increased risk of radiation toxicity.&91;10&93;
  3. Very large tumor size relative to breast volume.

Oncoplastic surgery

Oncoplastic surgery is an important consideration in breast-conserving surgery that integrates plastic surgery principles into breast cancer surgery in order to preserve aesthetic outcomes and quality of life, without compromising local control of the cancer. It is based on three surgical principles: ideal breast cancer surgery with free tumor margins, immediate breast reconstruction, and immediate symmetry with the other breast.[11] Oncoplastic approaches to breast-conserving surgery may require a close partnership among surgeons who specialize in surgical oncology and plastic surgery. Oncoplastic surgery is not only limited to breast-conserving surgery, as the techniques and principles of plastic surgery can be applied to mastectomy as well.[12]

As of 2017, there had been no randomized controlled trials to compare oncoplastic breast-conserving surgery to traditional breast conserving surgery techniques.[13] However, there is increasingly more evidence to support the oncoplastic breast-conserving surgery is safe from the cancer recurrence perspective while providing optimal cosmetic outcomes.[13][14][15][16]

References

1. ^1 {{cite journal | vauthors = Corso G, Veronesi P, Sacchini V, Galimberti V, Luini A | title = The Veronesi quadrantectomy: an historical overview | journal = Ecancermedicalscience | volume = 11 | pages = 743 | date = 2017-06-08 | pmid = 28690674 | pmc = 5481191 | doi = 10.3332/ecancer.2017.743 }}
2. ^{{cite journal | vauthors = Veronesi U, Saccozzi R, Del Vecchio M, Banfi A, Clemente C, De Lena M, Gallus G, Greco M, Luini A, Marubini E, Muscolino G, Rilke F, Salvadori B, Zecchini A, Zucali R | title = Comparing radical mastectomy with quadrantectomy, axillary dissection, and radiotherapy in patients with small cancers of the breast | journal = The New England Journal of Medicine | volume = 305 | issue = 1 | pages = 6–11 | date = July 1981 | pmid = 7015141 | doi = 10.1056/NEJM198107023050102 }}
3. ^{{cite journal | vauthors = Zurrida S, Costa A, Luini A, Galimberti V, Sacchini V, Intra M | title = The Veronesi quadrantectomy: an established procedure for the conservative treatment of early breast cancer | journal = International Journal of Surgical Investigation | volume = 2 | issue = 6 | pages = 423–31 | date = 2001 | pmid = 12678123 }}
4. ^{{cite journal | vauthors = Katz SJ, Lantz PM, Janz NK, Fagerlin A, Schwartz K, Liu L, Deapen D, Salem B, Lakhani I, Morrow M | title = Patient involvement in surgery treatment decisions for breast cancer | journal = Journal of Clinical Oncology | volume = 23 | issue = 24 | pages = 5526–33 | date = August 2005 | pmid = 16110013 | doi = 10.1200/JCO.2005.06.217 }}
5. ^{{cite journal | vauthors = Keating NL, Guadagnoli E, Landrum MB, Borbas C, Weeks JC | title = Treatment decision making in early-stage breast cancer: should surgeons match patients' desired level of involvement? | journal = Journal of Clinical Oncology | volume = 20 | issue = 6 | pages = 1473–9 | date = March 2002 | pmid = 11896094 | doi = 10.1200/JCO.2002.20.6.1473 }}
6. ^{{cite journal | vauthors = Tsaras K, Papathanasiou IV, Mitsi D, Veneti A, Kelesi M, Zyga S, Fradelos EC | title = Assessment of Depression and Anxiety in Breast Cancer Patients: Prevalence and Associated Factors | journal = Asian Pacific Journal of Cancer Prevention | volume = 19 | issue = 6 | pages = 1661–1669 | date = June 2018 | pmid = 29938451 | pmc = 6103579 | doi = 10.22034/APJCP.2018.19.6.1661 }}
7. ^{{cite journal | vauthors = Newman LA | title = Decision Making in the Surgical Management of Invasive Breast Cancer-Part 1: Lumpectomy, Mastectomy, and Contralateral Prophylactic Mastectomy | journal = Oncology | volume = 31 | issue = 5 | pages = 359–68 | date = May 2017 | pmid = 28512732 }}
8. ^1 {{Cite web|url=https://www.breastsurgeons.org/statements/guidelines/PerformancePracticeGuidelines_Breast-ConservingSurgery-PartialMastectomy.pdf|title=American Society of Breast Surgeons Performance and Practice Guidelines for Breast-Conserving Surgery/Partial Mastectomy|last=|first=|date=February 2015|website=www.breastsurgeons.org|archive-url=https://www.breastsurgeons.org/statements/guidelines/PerformancePracticeGuidelines_Breast-ConservingSurgery-PartialMastectomy.pdf|archive-date=February 2015|dead-url=|access-date=March 23, 2019}}
9. ^{{cite book | vauthors = DeVita VT, Lawrence TS, Rosenberg SA | title = Cancer: Principles & Practice of Oncology | edition = 8th | date = 2008 | pages = 1624–1625 | publisher = Lippincott | location = Phila }}
10. ^{{Cite journal|last=Dilaveri|first=Christina A.|last2=Sandhu|first2=Nicole P.|last3=Neal|first3=Lonzetta|last4=Neben-Wittich|first4=Michelle A.|last5=Hieken|first5=Tina J.|last6=Mac Bride|first6=Maire Brid|last7=Wahner-Roedler|first7=Dietlind L.|last8=Ghosh|first8=Karthik|date=2014|title=Medical factors influencing decision making regarding radiation therapy for breast cancer|url=https://www.ncbi.nlm.nih.gov/pubmed/25429241|journal=International Journal of Women's Health|volume=6|pages=945–954|doi=10.2147/IJWH.S71591|issn=1179-1411|pmc=4242405|pmid=25429241|via=}}
11. ^{{cite journal | vauthors = Bertozzi N, Pesce M, Santi PL, Raposio E | title = Oncoplastic breast surgery: comprehensive review | journal = European Review for Medical and Pharmacological Sciences | volume = 21 | issue = 11 | pages = 2572–2585 | date = June 2017 | pmid = 28678328 }} {{open access}}
12. ^{{cite journal | vauthors = Macmillan RD, McCulley SJ | title = Oncoplastic Breast Surgery: What, When and for Whom? | journal = Current Breast Cancer Reports | volume = 8 | issue = 2 | pages = 112–117 | date = June 2016 | pmid = 27330677 | pmc = 4886147 | doi = 10.1007/s12609-016-0212-9 }}
13. ^1 {{Cite journal|last=Weber|first=Walter P.|last2=Soysal|first2=Savas D.|last3=Zeindler|first3=Jasmin|last4=Kappos|first4=Elisabeth A.|last5=Babst|first5=Doris|last6=Schwab|first6=Fabienne|last7=Kurzeder|first7=Christian|last8=Haug|first8=Martin|date=Summer 2017|title=Current standards in oncoplastic breast conserving surgery|url=https://linkinghub.elsevier.com/retrieve/pii/S0960977617305052|journal=The Breast|language=en|volume=34|pages=S78–S81|doi=10.1016/j.breast.2017.06.033|via=}}
14. ^{{Cite journal|last=Chang|first=Edward I.|last2=Peled|first2=Anne Warren|last3=Foster|first3=Robert D.|last4=Lin|first4=Cheryl|last5=Zeidler|first5=Kamakshi R.|last6=Ewing|first6=Cheryl A.|last7=Alvarado|first7=Michael|last8=Hwang|first8=E. Shelley|last9=Esserman|first9=Laura J.|date=June 2012|title=Evaluating the feasibility of extended partial mastectomy and immediate reduction mammoplasty reconstruction as an alternative to mastectomy|url=https://www.ncbi.nlm.nih.gov/pubmed/22470069|journal=Annals of Surgery|volume=255|issue=6|pages=1151–1157|doi=10.1097/SLA.0b013e31824f9769|issn=1528-1140|pmid=22470069|via=}}
15. ^{{Cite journal|last=Clough|first=Krishna B.|last2=Gouveia|first2=Pedro F.|last3=Benyahi|first3=Djazia|last4=Massey|first4=Eleanore J. D.|last5=Russ|first5=Elisabeth|last6=Sarfati|first6=Isabelle|last7=Nos|first7=Claude|date=December 2015|title=Positive Margins After Oncoplastic Surgery for Breast Cancer|url=https://www.ncbi.nlm.nih.gov/pubmed/25893409|journal=Annals of Surgical Oncology|volume=22|issue=13|pages=4247–4253|doi=10.1245/s10434-015-4514-3|issn=1534-4681|pmid=25893409|via=}}
16. ^{{Cite journal|last=Khan|first=J.|last2=Kahn|first2=J.|last3=Barrett|first3=S.|last4=Forte|first4=C.|last5=Stallard|first5=S.|last6=Weiler-Mithoff|first6=E.|last7=Doughty|first7=J. C.|last8=Romics|first8=L.|date=July 2013|title=Oncoplastic breast conservation does not lead to a delay in the commencement of adjuvant chemotherapy in breast cancer patients|url=https://www.ncbi.nlm.nih.gov/pubmed/23746877|journal=European Journal of Surgical Oncology: The Journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology|volume=39|issue=8|pages=887–891|doi=10.1016/j.ejso.2013.05.005|issn=1532-2157|pmid=23746877|via=}}

External links

  • American Academy of Family Physicians, Breast-Conserving Surgery, What is breast-conserving surgery?
  • Breast conserving surgery at National Breast and Ovarian Cancer Centre www.nbocc.org
{{Operations and other procedures of the integumentary system}}

1 : Breast surgery
随便看

　

开放百科全书收录14589846条英语、德语、日语等多语种百科知识，基本涵盖了大多数领域的百科知识，是一部内容自由、开放的电子版国际百科全书。

　

Copyright © 2023 OENC.NET All Rights Reserved
京ICP备2021023879号 更新时间：2024/11/11 19:47:57