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Surgical treatment of primary breast cancer evolution of surgical procedures



Surgical treatment of primary breast cancer evolution of surgical procedures



Japanese Journal of Plastic & Reconstructive Surgery 34(10): 1007-1013



The first true paradigm for primary breast cancer therapy was conceived by Halsted who, in 1880's, synthesized the "Halstedian" hypothesis for cancer management, and his surgical procedure was called a radical mastectomy. According to Halstedian concepts, tumor cells spread along lymphatic pathways by direct extension rather than by embolization, and regional lymph nodes served as effective filters. Halsted's procedures for breast cancer endured for nearly three-quarters of a century. Based on this Halstedian hypothesis, extended radical operations were being performed from the 1950's to 1960's. However, despite the large number of patients given this surgery in many of the studies reported, the evaluations were inadequate to test the worth of this extended radical operation. based on new principles advocated by Fisher et al. in 1960's, i.e., that operable breast cancer is a systemic disease and that the regional lymph nodes are ineffective as barriers to tumor cell spread, operations that are less extensive started to become accepted. As for the present surgical procedure for a primary breast cancer, breast-conserving therapy is generally accepted in Europe and U.S.A. as well as a major pectoral muscle-conserving radical mastectomy. In Japan, the evoluation of surgical procedures for a primary breast cancer has followed an almost similar pattern as that of Europe and U.S.A. As for breast-conserving therapy, however, only now are several hospitals and institutes trying the procedure as a pilot study.

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