A new surgical strategy for breast conservation in locally advanced breastcancer that achieves a good locoregional control rate: preliminary report

The scope of breast conserving surgery has recently expanded to include loc ally advanced breast cancer (LABC) patients who are downstaged following ne oadjuvant chemotherapy (NACT). However, the efficacy of this approach in ac hieving adequate locoregional control of disease is in doubt. Some reports have attributed the failure to the association of NACT-induced tumour downs taging which call leave multifocal in situ and invasive lesions around the main tumour mass. In the present study, in order to eradicate all possible tumour satellites, a very wide local excision that included the whole origi nal tumour-bearing area was performed regardless of the expected wide defec t. This defect was then immediately reconstructed by an ipsilateral pedicle d latissimus dorsi myocutaneous (LDM) flap. The study included 26 patients with LABC without evidence of primary tumour -multicentricity. Tumours were downstaged following NACT. The early cosmeti c outcome was good in the majority of cases. Early complications were minim al. Twenty-two patients had a mean follow up period of 30.2 (range 7-50) mo nths. In those evaluable cases, locoregional control of the disease was exc ellent (100%) but distant metastases occurred in seven cases (31.8%). (C) 2 001 Harcourt Publishers Ltd.