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Long-Term Oncologic Outcomes of Omitting Axillary Surgery in Breast Cancer Patients with Chest Wall Recurrence after Mastectomy
by
, , , , ,
Geok Hoon Lim
1,2,3,*,
Veronica Siton Alcantara
1,3,
John Carson Allen, Jr.
4,
Seyed Ehsan Saffari
4,
Veronique Kiak Mien Tan
3,5,6,
Kiat Tee Benita Tan
3,5,6,7,
Sabrina Ngaserin
3,7,
Su-Ming Tan
3,8,
Lester Chee Hao Leong
9 and
Fuh Yong Wong
10 1
Breast Department, KK Women’s and Children’s Hospital, Singapore 229899, Singapore
2
Duke-NUS Medical School, National University of Singapore, Singapore 169857, Singapore
3
SingHealth Duke-NUS Breast Centre, Singapore 168582, Singapore
4
Centre for Quantitative Medicine, Duke-NUS Medical School, National University of Singapore, Singapore 169857, Singapore
5
Department of Breast Surgery, Singapore General Hospital, Singapore 544886, Singapore
6
Division of Surgery and Surgical Oncology, National Cancer Centre Singapore 168583, Singapore
7
Breast Service, Department of Surgery, Sengkang General Hospital, Singapore 544886, Singapore
8
Division of Breast Surgery, Changi General Hospital, Singapore 529889, Singapore
9
Department of Diagnostic Radiology, Singapore General Hospital, Singapore 169608, Singapore
10
Division of Radiation Oncology, National Cancer Centre, Singapore 168583, Singapore
*
Author to whom correspondence should be addressed.
Cancers 2024, 16(15), 2699; https://doi.org/10.3390/cancers16152699
Submission received: 7 June 2024
/
Revised: 22 July 2024
/
Accepted: 23 July 2024
/
Published: 29 July 2024
(This article belongs to the Section Methods and Technologies Development)
Simple Summary
The management of the axilla for post-mastectomy breast cancer patients who develop a chest wall recurrence (CWR) remains to be established. This study aimed to determine if omitting axillary staging surgery for these patients resulted in an increased risk of second recurrence. A total of 194 patients with CWR, with a median follow-up of 59.5 (IQR 27.3–105) months, were analysed. There was no statistically significant difference in second recurrences between patients with or without axillary surgery during the excision of the CWR.
Abstract
Background: The management of the axilla in breast cancer patients with isolated chest wall recurrence (CWR) after mastectomy remains controversial. Although sentinel lymph node biopsy (SLNB) for restaging is feasible, its role is unclear. We aimed to determine if the omission of axillary restaging surgery in female patients with operable presumably isolated CWRs could result in an increased risk of second recurrences. Methods: In this retrospective multicentre study, patients who developed CWRs were reviewed. We excluded patients with suspected or concomitant regional/distant metastases, bilateral cancers and patients without CWR surgery. Patients’ demographics, pathological data and subsequent recurrences were collected from a prospective database and were compared between patients with axillary lymph node dissection (ALND) and/or SLNB versus no axillary operation at CWR. Findings: A total of 194 patients with CWRs were eligible. The median age at CWR was 56.0 (IQR 47.0–67.0) years old. At recurrence, 8 (4.1%), 5(2.6%) and 181 (93.3%) patients had ALND, SLNB and no axillary operation, respectively. Patients with no axillary surgery during CWR were associated with, at primary cancer, a lower incidence of ductal carcinoma in situ as diagnosis (p = 0.007) and older age (p = 0.022). Subsequent ipsilateral axillary (p = 0.768) and second recurrences (p = 0.061) were not statistically different between patients with and without axillary surgery at CWR on median follow-up of 59.5 (IQR 27.3–105) months. Interpretation: In patients without evidence of concomitant regional or distant metastasis at CWR diagnosis, omission of axillary restaging surgery was not associated with an increased ipsilateral axillary or second recurrences on long-term follow-up.
