Abstract:

Centennial review and enlightenment of breast cancer surgery        DUAN Xue-ning.Breast Disease Center,Peking University First Hospital,Beijing 100034,China
Abstract    The treatment of breast cancer is mainly based on local therapy since its record. In particular, since 1894  Halsted pioneered radical mastectomy, surgery has always been at the heart of breast cancer treatment. From the attempt of extended radical resection to the advent of modified radical mastectomy, all patients were treated on the basis of tumor free resection, with the prognosis of patients who did not deteriorate. After the Fisher team put forward the concept of breast cancer as a systemic disease, local treatment of breast cancer is developing towards a narrower operation. Local excision and radiotherapy for breast conserving became feasible. Depending on status of sentinel lymph node to determine whether to carry out axillary clearance has also been recognized in this century. Over the past hundred years, surgical treatment has not significantly improved the prognosis of breast cancer, but has improved the quality of life. With the rapid development of systemic therapy, the trend of breast cancer treatment has been reversed. The importance of operation to local control seems to be shaken. The enhancement of endocrine therapy and target therapy, the further optimization of cytotoxic drugs make the prognosis of breast cancer more dependent on the whole body treatment, and the progress of radiotherapy also affects the status of the partial operation control, especially the presence of positive axillary nodes. In the age of group medical treatment to individualized medical treatment and the pursuit of precision medical treatment, molecular subtypes guidance systematic therapy is feasible, and the guidance of surgical treatment has not been supported by evidence. Therefore, the idea of tumor free resection cannot be changed. It is necessary to recommend the best way of operation to improve survival, and to find a better combination of surgery and systematic therapy.

Key words: breast cancer, breast-conserving therapy, endocrine therapy, sentinel lymph node , axillary lymph node

摘要：

自有记载以来，乳腺癌的治疗就是以局部治疗为主，特别是自1894年Halsted首创乳腺癌根治术后，该手术一直是乳腺癌治疗的核心术式，之后从扩大根治术到改良根治术，临床医生均遵循在无瘤切除的基础上以未恶化为标准的操作。Fisher团队提出乳腺癌为全身性疾病的概念后，乳腺癌的局部治疗向更小的操作范围发展，保留乳房的肿瘤局部切除加放疗成为可能，并延续至今。目前，以前哨淋巴结活检来判定是否行腋窝淋巴清扫的方法亦获得业内认可。经历百余年的发展，虽然乳腺外科手术治疗仍未能明显改善乳腺癌病人的预后，但对改善病人生活质量意义重大。随着全身系统治疗的迅速发展，乳腺癌的治疗趋势出现逆转。手术对局部控制的重要地位似乎被动摇，内分泌治疗与靶向治疗的强化，细胞毒药物的进一步优化，使乳腺癌的预后更依赖于全身治疗，放疗的进展亦影响手术的局部控制，特别是对腋窝淋巴结阳性的病人。在群体化医疗向个体化医疗转化，追求精准医疗的时代，分子分型指导系统治疗成为可能，然而其指导手术治疗尚未获得证据支持。因此，无瘤切除的理念尚不能改变，推荐最优生存结果的手术方式，发掘更优化的手术与系统治疗的组合势在必行。

关键词: 乳腺癌, 保乳手术, 内分泌治疗, 放疗, 前哨淋巴结, 腋窝淋巴结