Lumpectomy

Lumpectomy, also called wide excision, is the name for the breast-conserving surgical removal of a small tumor from a patient's chest. The lumpectomy is a method selected from the group of breast-conserving therapy ( BET).

In most cases, it is malignant tumors ( breast cancer) that are removed. In lumpectomy, only the tumor, as well as the adjacent tissue is removed at him. In comparison, the whole breast is removed at a mastectomy. Therefore often spoken in the lumpectomy also of breast-conserving surgery. But this also includes the quadrantectomy, in which an entire quadrant of the chest, with the overlying skin spindle away.

Is found especially in older publications, the term Thylektomie, or Tylektomie (Greek = Tylos, lump ',' node '), for the lumpectomy.

Application

A lumpectomy can be applied to both ductal carcinoma in situ ( ductal carcinoma in situ, DCIS), as well as an invasive ductal carcinoma ( invasive ductal carcinoma, IDC) and other cancers of the breast gland. In contrast, a contraindication represents the inflammatory breast cancer ( inflammatory breast cancer, IBC), which accounts for 1-4 percent of all breast cancers. Also multicentric carcinomas, tumors with multifocal herds, as well as an extensive involvement of the lymphatic system ( lymphangitis carcinomatosis ) argue against a lumpectomy. The tumor diameter should be less than 30 mm and not inflitrieren skin.

In a study published in 2002 study of over 1800 patients had survival rates of the cohort with lumpectomy followed by radiation therapy compared with the group in which the affected breast was removed by mastectomy. The authors of the study conclude that the lumpectomy with radiation is adequate treatment for women with breast cancer when the tumor is completely removed and the cosmetic result is satisfactory. A second study with over 700 patients from the same year comes to similar results and explains the breast-conserving therapy for treatment of choice for relatively small tumors.

Several studies have come to the conclusion that the radical nature of the methods used to remove the tumor surgery has no influence on local recurrence. There are therefore in principle not caused by the tumor size a contraindication regarding a lumpectomy. However, since tumors with a diameter larger than 30 mm are usually treated neoadjuvant, are rarely larger tumors removed by lumpectomy. A major factor is the ratio of tumor size to breast size, especially as regards the cosmetic result. Tumors of the class T3 and T4 are rarely removed by lumpectomy.

Taking into account the contraindications lumpectomy can be applied at about 50 to 65 percent of all women with breast cancer.

Execution

In lumpectomy typically a semi-circular incision is made above the tumor. In cases where the tumor is located directly under the skin, and the main spindle is mostly removed. The section is elliptical rather in such cases. After the incision, the tumor is identified by palpation with two fingers and cut out with scissors with a margin of healthy tissue. The hem is approximately from 10 to 20 mm

Some authors advise against the use of electrocautery in the dissection, as this may complicate the assessment of the tumor in the peripheral area in pathology.

After lumpectomy is usually radiotherapy. There are no study that has shown that radiotherapy can be safely omitted. The likelihood of a recurrence is reduced significantly with radiation; The survival rate is unchanged.

Complications

The most common complication of a lumpectomy is a hematoma ( bruising). Careful hemostasis after excision, for example by thermocoagulation, therefore, is particularly important.

Lumpectomy

Application

Execution

Complications

Further Reading