Breast Surgery

Introduction

The Breast Surgery Division is responsible for the treatment and management of operable breast cancers. In recent years, the number of breast cancer patients has increased, especially those with early stage cancer. To achieve cure, surgical management of breast cancer is indispensable. Primary breast cancer patients are treated using the multidisciplinary approach. Preoperative chemotherapy or endocrine therapy provides the opportunity for curative operation or breast-conserving surgery to avoid mastectomy. On the other hand, sentinel node biopsy can be a reasonable alternative to unnecessary axillary lymph node dissection. These procedures will contribute to better quality of life of breast cancer patients.

Routine Activities

Until March 2008, the Breast Surgery Division had only one staff surgeon. From April 2008, a new staff surgeon joined the division.
For the regular activities of the division, a daily routine round is scheduled for inpatients every morning by all staff and residents. Moreover, a film conference on breast cancer is conducted every Monday evenings to discuss the diagnosis and operation strategies for each patient. Multidisciplinary case conferences with surgeons, medical oncologists, radiologists, psycho-oncologists and nurses are held twice a month. A monthly pathological conference on breast cancer is also conducted on the last Friday of each month and is participated in by surgeons, pathologists, medical oncologists, radiologists, and technicians.
Changes in the annual number of operated breast cancer patients are shown in Table 1. In 2008, 227 patients with primary breast cancer and 33 patients with recurrence or other breast neoplasms were operated. Of the primary breast cancer patients, 59 (26%) underwent primary chemotherapy or endocrine therapy. The types and number of operative procedures performed in 2008 are shown in Table 2. The rate of breast-conserving surgeries was 79% (179/227). Sentinel node biopsy was performed in 172 patients, and 121 patients were spared from axillary lymph node dissection.

● N. Wada ●

Table 1. Number of cases of breast cancer operated during 1998-2008
Clinical stage 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
Stage 0 11 3 4 9 8 18 14 29 34 27 23
Stage I 30 47 67 77 73 97 100 89 79 94 84
Stage II 98 96 96 95 110 104 97 94 103 87 87
Stage III 19 10 14 8 24 33 24 35 34 25 33
Stage IV, unknown 6 4 3 1 1 1 2 2 1 4 0

Table 2. Types of operative procedures performed in 2008
Operation No. of cases （％）
Modified radical mastectomy 36 （16）
PM+ALND 56 （25）
SM + SNB 12 （5）
PM + SNB 109 （48）
Other 14 （6）
ALND, axillary lymph node dissection; PM, partial mastectomy;
SM, simple mastectomy; SNB, sentinel node biopsy

Table of Contents