Progress in the surgical management of breast cancer: Present and future

Abstract

Recognition of differing risks of locoregional recurrence (LRR) in breast cancer patients based on estrogen receptor, progesterone receptor, and HER2 status, coupled with a reduction in LRR in patients receiving adjuvant systemic therapy, offers the opportunity to tailor surgical treatment and reduce the morbidity of therapy. New guidelines for margins in breast-conserving therapy of tumor not touching ink and avoidance of axillary dissection in sentinel node positive patients undergoing breast-conserving therapy are examples of this approach which have entered practice. Increased use of neoadjuvant therapy offers the opportunity to identify which patients are responsive to chemotherapy prior to surgery, potentially allowing further tailoring of treatment, and ongoing clinical trials will address the question of the extent of axillary surgery and radiotherapy after neoadjuvant therapy in patients with and without pathologic complete response.

Integrating anatomy, radiology, pathology, and surgery: An alternative approach in resecting multifocal and multicentric breast carcinoma

“…An operative approach for MFMCBC that integrates our present understanding of the lobar anatomy of the breast, the sick lobe theory of disease and its depiction on imaging, allows a planned resection pattern with defect repair to achieve clear margins with acceptable cosmesis. This paves the way for a reductionist surgical approach to BCT, a goal consistent with objectives already laid down for the future of breast cancer treatment …”

“…This paves the way for a reductionist surgical approach to BCT, a goal consistent with objectives already laid down for the future of breast cancer treatment. 61,62…”

Should We Perform the Intraoperative Sentinel Lymph Node Biopsy in Breast Cancer?

“…The future will show us whether imaging-and clinically negative axillas in small tumors require axillary surgery or whether this technique (and with it selective SLN biopsy) 27 will become redundant, and the prognosis of the patient will depend on the biologic characteristics of the tumor instead of its axillary staging. 28 …”

Lymphoscintigraphy detecting alterations of upper limb lymphatic flow following early sentinel lymph node biopsy in breast cancer

“…The authors have introduced innovative methods in recent decades, accounting for a new standard of care for early-stage patients 17,18. These improvements enable selective, safer and less mutilating resections with satisfactory results and a substantial reduction of surgical morbidity,19,20 albeit restricted to patients with clinically negative axilla 21,22…”