Lumpectomy

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A 35-year-old patient with a fibroadenoma (a benign breast tumor).
The lumpectomy and axillary dissection are performed sequentially through an incision.
The retracted pectoralis minor muscle allows a view of the level III lymph nodes in the armpit.
The isolated fibroadenoma. (all pictures)

Lumpectomy , also known as wide excision , is the name for the surgical removal of a small tumor from a patient's breast while preserving the breast . Lumpectomy is a procedure from the group of breast-conserving therapies (BET).

In most cases it is malignant tumors ( breast cancer ) that are removed. In a lumpectomy, only the tumor and the tissue adjacent to it are removed. In comparison, a mastectomy removes the entire breast. A lumpectomy is therefore often referred to as a breast-conserving operation . But this also includes the quadrantectomy , in which an entire quadrant of the breast with the skin spindle above it is removed.

The term thylectomy , or tylectomy (Greek: tylos = 'lump', 'knot'), for lumpectomy can also be found in older publications .

application

A lumpectomy can be used both for a ductal carcinoma in situ ( ductal carcinoma in situ , DCIS), as well as for an invasive ductal carcinoma ( invasive ductal carcinoma , IDC) and other cancers of the mammary gland to be applied. A contraindication on the other hand provides the inflammatory breast cancer ( inflammatory breast cancer is, IBC), which accounts for 1 to 4 percent of all breast cancers. Multicenter carcinomas, tumors with multifocal foci, and extensive involvement of the lymphatic system ( lymphangiosis carcinomatosa ) also speak against lumpectomy. The tumor diameter should be less than 30 mm and not infiltrate the skin.

In a study published in 2002 with over 1,800 patients, the survival rates of the cohort with lumpectomy and subsequent radiation therapy were comparable to the group in which the affected breast was removed by mastectomy. The study's authors conclude that lumpectomy with radiation therapy is an adequate therapy for women with breast cancer if the tumor is completely removed and the cosmetic result is satisfactory. A second study with over 700 patients from the same year came to similar results and declared breast-conserving therapy to be the treatment of choice for relatively small tumors.

Several studies have come to the conclusion that the radical nature of the surgery used to remove the tumor has no effect on local recurrence . There is therefore in principle no contraindication to a lumpectomy due to the size of the tumor. However, since tumors with a diameter larger than 30 mm are usually treated neoadjuvantly , larger tumors are rarely removed using lumpectomy. A key factor is the ratio of tumor size to breast size, especially when it comes to the cosmetic result. Class T3 and T4 tumors are rarely removed by lumpectomy.

Taking the contraindications into account, lumpectomy can be used in around 50 to 65 percent of all women with breast cancer.

execution

In a lumpectomy, a semicircular skin incision is usually made above the tumor. In cases where the tumor is just below the skin, the skin spindle is usually also removed. In such cases, the cut is more elliptical. After the incision, the tumor is identified with two fingers by palpation and cut out with a scissors with a border of healthy tissue. The hem is about 10 to 20 mm.

Some authors advise against the use of an electrocautery during dissection, as this can make it more difficult to assess the tumor in the marginal area in pathology .

Radiation therapy is usually performed after the lumpectomy. To date, there is no study that has shown that radiation therapy can be safely omitted. The likelihood of a relapse decreases significantly with radiation therapy; the survival rate, however, is unchanged.

Complications

The most common complication of a lumpectomy is a hematoma (bruise). Careful hemostasis after the excision , for example by thermocoagulation, is therefore particularly important.

further reading

Web links

Individual evidence

  1. ↑ Chintamani et al: Carcinoma developing in a fibroadenoma in a woman with a family history of breast cancer: a case report and review of literature. In: Cases Journal 2, 2009, 9348. doi : 10.1186 / 1757-1626-2-9348 ( Open Access )
  2. ↑ a b c d e M. Gnant and PM Schlag: Surgical Oncology: Strategies and Standards for Practice. Verlag Springer, 2008, ISBN 3-211-48612-7 , p. 98. Restricted preview in the Google book search
  3. ↑ a b c A. Hirner and K. Weise: Surgery: cut for cut. Georg Thieme Verlag, 2004, ISBN 3-131-30841-9 , p. 407. Restricted preview in the Google book search
  4. ↑ B. Fisher et al .: Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. In: N Engl J Med 347, 2002, pp. 1233-1241. PMID 12393820
  5. ↑ U. Veronesi et al .: Twenty-Year Follow-up of a Randomized Study Comparing Breast-Conserving Surgery with Radical Mastectomy for Early Breast Cancer. In: N Engl J Med 347, 2002, pp. 1227-1232. PMID 12393819
  6. ↑ a b M. Kaufmann et al. (Editor): Atlas of breast surgery. Verlag Springer, 2007, ISBN 3-540-48881-2 restricted preview in the Google book search
  7. ↑ OE Silva and S. Zurrida (Editor): Breast cancer: diagnosis and treatment. Verlag Elsevier, Urban & Fischer, 2007, ISBN 3-437-24260-1 , p. 194. Restricted preview in Google book search
  8. ^ IE Smith and GM Ross: Breast Radiotherapy after Lumpectomy - No Longer Always Necessary. In: N Engl J Med 351, 2004, pp. 1021-1023. PMID 15342811