Relevance of indications for adjuvant and/or palliative surgical procedures in cancer of the breast

Metastatic lesions of breast cancer represent rare indications for operatio n in thoracic surgery. Only in case of persistent malignant pleural effusio ns or in case of tumour progress despite all other available therapy modali ties thoracic surgery can be indicated. Over a period of 5 years between 19 93 and 1997 53 patients with metastatic breast cancer were treated in our i nstitution. 36 pts. suffered from persistent pleural effusions, 13 pts. had pulmonary metastases and 4 pts. had metastases involving the chest wall. I n all these patients the disease could not be controlled by conservative me asures. Our experiences are the following: Thoracoscopy is the diagnostic m ethod of choice for pleural effusions in patients with malignant tumors. If a malignant pleural effusion is confirmed, a talc poudrage represents the most reliable treatment to palliate the dyspnea. The resection of a single solitary pulmonary metastasis can be indicated to confirm the histologic ty pe of the nodule. Resections for centrally localized lesions causing hemopt ysis or atelectasis represent rare occasions. Metastatic lesions of breast cancer involving the ribs or the sternum are resected in order to confirm t he histologic diagnosis. According to the literature these procedures, with a 5-year survival rate of 50 % and without perioperative mortality, can be beneficial.