Breast Surgery

Introduction

The Breast Surgery Division deals with operable breast cancers. The multidisciplinary approach (surgery, chemoendocrine therapy, and radiation therapy) has become the standard treatment for primary breast cancer patients. Primary chemotherapy (or endocrine therapy) is highly recommended for patients with positive nodes or those with a main tumor of diameter ≧3 cm. This provides an opportunity for breast preservation. Sentinel node biopsy is a standard procedure for clinically node-negative patients. These procedures will contribute to better quality of life of such patients.

Routine Activities

The Breast Surgery Division had 2 staff surgeons and 1 chief resident until March 2007. One of the staff surgeons was promoted to the post of Professor at the University School of Medicine. A film conference on breast cancers is conducted on Monday evenings to discuss the diagnosis and treatment strategies for each patient. A monthly pathological conference on breast cancers is conducted on the last Friday of each month and is attended by surgeons, pathologists, medical oncologists, radiologists, and technicians.
The change in the annual number of operated breast cancer patients is shown in Table 1. In 2007, 233 cases of primary breast cancer and 21 cases of recurrence or other breast neoplasms were operated. Of the primary breast cancer cases, 58 (24%) cases underwent primary chemo or endocrine therapy. Table 2 shows the number of operative procedures performed in 2007. The rate of breast-conserving surgeries was 74% (176/237). Sentinel node biopsy was performed in 174 cases, and 130 cases were spared axillary lymph node dissection.
Whether the operated patients require adjuvant systemic therapy or not will be determined by a target-oriented approach and by examining the prognostic factors. Patients with positivity for steroid hormone receptors and HER-2 positivity have been used as effective targets for endocrine therapy and trastuzumab, respectively. In order to accomplish the best medical care for patients, medical oncologists work in collaboration with us.

● N. Wada ●

Table 1. Number of cases of breast cancer operated during 1997-2007
Clinical stage 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007
Stage 0 8 11 3 4 9 8 18 14 29 34 27
Stage I 23 30 47 67 77 73 97 100 89 79 94
Stage II 118 98 96 96 95 110 104 97 94 103 87
Stage III 20 19 10 14 8 24 33 24 35 34 25
Stage IV, unknown 5 6 4 3 1 1 1 2 2 1 4

Table 2. Types of operative procedures performed in 2007
Operation No. of cases （％）
Modified radical mastectomy 41 （17）
PM+ALND 54 （23）
SM + SNB 18 （8）
PM + SNB 112 （47）
Other 12 （5）
ALND, axillary lymph node dissection; PM, partial mastectomy;
SM, simple mastectomy; SNB, sentinel node biopsy

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