[Full thickness chest wall resection for recurrent breast cancer with reference to prognostic factors]

Full thickness chest wall resection surgery has been carried out in 16 patients with local recurrence after previous mastectomy. Seven of 16 patients had isolated chest wall recurrence, but 9 had mediastinal invasion and/or distant metastasis of carcinoma. Recurrent breast carcinoma involving the bony chest wall was resected, and the chest wall defects were reconstructed with myocutaneous flaps using rectus abdominis or latissimus dorsi, or breast flap. Marlex mesh was utilized under the flap in 10 patients. The 3 year survival probability was 79% and the 5 year one was 57% with mean follow-up period of 43 month. Local recurrence was classified into 3 types according to cancer infiltration; i.e., demarcated, scattered and diffuse types. The patients with demarcated type showed better prognosis than those with diffuse type. Patients who received curative surgery showed better prognosis than those receiving palliative surgery. A disease free interval (DFI) after mastectomy longer than 5 years correlated well with a long survival rate after chest wall resection. Thus, local recurrence presenting demarcated tumor with possible curative surgery as well as a longer DFI after mastectomy is a favorable prognostic factor for full thickness chest wall resection.