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J Thorac Cardiovasc Surg 2000;119:420-428
© 2000 Mosby, Inc.

GENERAL THORACIC SURGERY

CHEST WALL RESECTION FOR LOCALLY RECURRENT BREAST CANCER: IS IT WORTHWHILE?

From the Divisions of Thoracic Surgery^a and Breast Surgery,^c Department of Surgery, and the Biostatistics Service, Department of Epidemiology and Biostatistics,^b Memorial Sloan-Kettering Cancer Center, New York, NY.
*Ms F. Ida Hsu is a medical student at the College of Physicians and Surgeons, Columbia University, and her work was supported by a Research Fellowship from Cornell University Medical College.

Address for reprints: Robert J. Downey, MD, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10021 (E-mail: downeyr{at}mskcc.org ).

Objective: The effectiveness of chest wall resection for locally recurrent breast cancer as cancer treatment remains poorly defined, possibly because of the general impression that locally recurrent disease is a harbinger of rapidly progressive metastatic disease and that extensive surgical treatment in these patients is inappropriate. Reports to date have focused on technical feasibility, not long-term outcome.
Methods: We reviewed our experience with 38 women who underwent chest wall resection for locally recurrent breast cancer between October 1987 and May 1997. Overall survival was calculated by the Kaplan-Meier method and the significance of prognostic variables evaluated by log-rank and Cox regression analyses.
Results: The operative mortality rate was 0%. Overall survival at 1, 3, and 5 years after chest wall resection was 74%, 41%, and 18%, respectively, and the proportion of patients free of local recurrence at 1, 3, and 5 years was 59%, 42%, and 13%, respectively. Regional nodal disease and size of largest tumor nodule (>4 cm) were significant predictors of local re-recurrence (P < .01, P = .04); lymph node metastasis was the only predictor of long-term survival (P < .01). Patients with and without synchronous sites of metastatic disease had near-identical 3-year survivals.
Conclusions: Chest wall resection for locally recurrent breast cancer has a low mortality. However, a significant number of patients have the development of local re-recurrence or metastases, and 5-year survival is limited. It is unlikely that complete resection of all locally recurrent disease improves survival. Future studies should focus on the quality of palliation achieved.

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