Quadrantectomy

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Quadrantectomy is the term used to describe the surgical removal ( excision ) of a tumor from a patient's breast while conserving the breast . Quadrantectomy is a procedure from the group of breast-conserving therapies (BET). Some authors also call the quadrantectomy partial mastectomy or segmental mastectomy .

Description and differentiation

The four quadrants of the chest.

Most of the cases are malignant tumors ( breast cancer ) that are removed by quadrantectomy. The part (the “quarter”, “quadrant”) of the breast, including the overlying skin spindle , is excised in which the tumor is located. If the quadrant is in the laterocranial position, the lymph nodes in the armpit area (axillary dissection) or the sentinel lymph nodes can be removed at the same time . In comparison, a mastectomy removes the entire breast and a lumpectomy only removes the tumor and 1 to 2 cm of surrounding healthy tissue.

The combination of Qu adrantektomie, A xilladissektion and R adio t herapie has the acronym Quart .

Effects

With the exception of central quadrantectomy, the area of ​​the nipple and the areola, as well as most of the healthy breast tissue, are preserved during quadrantectomy. Nevertheless, an asymmetry or deformation of the breast can arise after the procedure. A number of different reconstruction methods can largely compensate for these cosmetic deficits. One possible variant is the use of an autologous transplant , such as a myocutaneous flap ( skin-muscle transplant ) of the latissimus dorsi (large back muscle). This can be done - which is usually advantageous for the patient - immediately after the tumor has been removed during the same procedure.

In a long-term study over 20 years, the long-term survival rate of two patient groups was compared. In one group of patients the tumor was removed by mastectomy, in the other group the procedure was performed by quadrantectomy with subsequent radiation therapy of the affected breast. The survival rates were the same in both groups. The authors of the study therefore see breast-conserving tumor removal as the method of choice if the tumor has not exceeded a certain size.

Medical history

Quadrantectomy was developed by the Italian surgeon Umberto Veronesi (1925-2016) in the 1970s. He also originated the concept quadrantectomy ( Engl. Quadrantectomy ).

further reading

Web links

Individual evidence

  1. ↑ a b 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
  2. ↑ OE Silva and S. Zurrida: Breast Cancer: Diagnosis and Treatment. Elsevier, Urban & Fischer Verlag, 2007 ISBN 3-437-24260-1 limited preview in the Google book search
  3. ↑ M. Hamdi et al .: Partial mastectomy reconstruction. In: Clin Plast Surg 34, 2007, pp. 51-62. PMID 17307071 (Review)
  4. ↑ V. Naraynsingh et al .: Immediate breast reconstruction following segmentectomy using a latissimus dorsi 'myoadipose' flap through a single axillary incision: a case series. In: Cases Journal 2, 2009, 8116. PMID 19830050 ( Open Access , under CC-by-3.0 license)
  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: NEJM 347, 2002, pp. 1227-1232. PMID 12393819
  6. ↑ U. Veronesi: Surgical treatment of primary breast cancer according to disease extent. In: Prog Clin Biol Res 12, 1977, pp. 347-357. PMID 335400
  7. ↑ S. Zurrida include: The Veronesi quadrantectomy: an established procedure for the conservative treatment of early breast cancer. In: Int J Surg Investig 2, 2001, pp. 423-431. PMID 12678123 (Review)