Surgery of inflammatory breast cancer
Summary. The study aims to evaluate the effectiveness of using the methods of extended surgical interventions in patients with primary inflammatory breast cancer. Materials and methods. The study included 39 patients with inflammatory breast cancer T4bN0–3M0 who during 2020 to 2023 received comprehensive treatment at National Cancer Institute of Ukraine. Besides neo- and adjuvant chemotherapy, an extended radical mastectomy using a technique by Handelheim and Beck was performed in 19 patients. In 20 patients a traditional (Madden) modified radical mastectomy was done. Results. Radical extended mastectomy allows to reduce the incidence of locoregional metastasis to 16% within 3 years compared to 34% when using traditional radical mastectomies. A total of 7 patients developed recurrence and metastatic disease, and 4 patients developed only metastatic disease. Most relapses occurred in the second or third year after diagnosis. These indicators are significantly lower compared to the indicators after traditional surgical interventions. On the other hand, the Handelheim or Beck techniques leave large scars, and we will not be able to obtain attractive cosmetic results, even after delayed breast reconstruction. Conclusion. Based on the available results of follow-up after IBC treatment, the risk of recurrence is highest in the first 2–3 years, and then it constantly decreases. Performing a surgical intervention in the scope of a radical extended modified mastectomy using the Handelheim or Beck technique in inflammatory breast cancer treatment allows to reduce the cases of locoregional recurrence to 16% within 3 years compared to 34% when using traditional radical mastectomies (p <0.001). Until the disappearance of certain clinical and radiological signs, surgical treatment is not carried out, due to the high percentage of local recurrences (preservation or increase in swelling of the entire or most part of the gland, regional metastases in the parasternal or supraclavicular lymph nodes, or an increase in the affected axillary lymph nodes). The presence of any signs of inoperability was associated with a 3-year recovery rate equal to 0% (relapse-free survival). Handelheim or Beck technique can be used to close the chest wall defect. The choice of a skin flap depends on the shape and length of the defect in the zone of maximum tension of the fused edges of the wound, which are determined by the volume of removed tissue and the anthropometric characteristics of the patient. Wider implementation of the Handelheim and Beck method in everyday practice will reliably lead to a decrease of inflammatory breast cancer recurrence.
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