Eleven-Year Follow-Up of a Randomised Study of Pectoral Fascia Preservation after Mastectomy for Early Breast Cancer.

Abstract

Abstract Background: In a previous report with 6 years follow-up a trend towards an increased risk for chest wall recurrence was seen in breast cancer patients operated with preserved pectoral fascia compared to removal of the pectoral fascia. The aim of the present study was to assess whether the preservation or removal of the pectoral fascia in the modified radical mastectomy procedure had any impact on survival or local control in breast cancer patients when followed long term.Method: The trial included 247 patients with breast cancer who underwent modified radical mastectomy in five Swedish hospitals 1993-1997. The median follow-up time was 11 years. The patients were randomised between removal (n=122) versus preservation (n=125) of the pectoral fascia.Results: The breast cancer specific survival at 10 years was 75%. Removal or preservation of the pectoral fascia had not any significant impact on the chest-wall recurrence and on breast cancer specific survival. A total of 18 patients with chest-wall recurrence were seen in the group allocated to pectoral fascia preservation versus 10 in patients allocated to pectoral fascia removal (hazard ratio=1.8, 95%CI = 0.8-4.0). The majority of the chest-wall recurrences were detected 0-5 years postoperatively. The cumulative chest-wall recurrence rates at 5 and at 10 years were 13 and 15% respectively in patients allocated to pectoral fascia preservation and 8 and 9% in patients allocated to pectoral fascia removalConclusion: Neither the chest-wall recurrence rate nor the breast cancer specific survival is significantly influenced by the preservation of the pectoral fascia when the tumor macroscopically does not involve the muscle. Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 3109.