Radical mastectomy is a surgical procedure involving breast removal, underlying chest muscles (including major pectoralis and pectoralis minor), and axillary lymph nodes as a treatment for breast cancer. Breast cancer is the most common cancer among women today, and is primarily treated by surgery, especially during the early twentieth century when the mastectomy was developed successfully. However, with technological advances and surgical skills, the mastectomy level has been reduced. A less invasive mastectomy is used today than in the past. Currently, a combination of radiotherapy and breast conservation mastectomy is used to optimize treatment.
Video Radical mastectomy
Radical mastectomy
Halsted and Meyer were the first to achieve successful results with radical mastectomy, thus delivering on the modern era of surgical treatment for breast cancer. In 1894, William Halsted published his work with a radical mastectomy of 50 cases operated at Johns Hopkins between 1889 and 1894. Willy Meyer also published research on radical mastectomy from his interactions with New York patients in December 1894. The en bloc < The removal of breast tissue became known as Halsted's mastectomy before adopting the title of "complete surgery" and finally, "radical mastectomy" as it is known today.
Radical mastectomy is based on the medical belief that at the time breast cancer spread locally initially, invading nearby tissue and then spreading to the lymph channels where the cells were "trapped". It is estimated that the spread of tumor cells hemisial occurs at a later stage. Halsted himself believed that cancer spread in a "centrifugal spiral", reinforcing this opinion in the medical community at the time.
Radical mastectomy involves removal of the entire breast tissue, the skin above it, the pectoral muscles, and all the axillary lymph nodes. The skin is removed because it involves the skin, which is often ulcerated. Pectoralis muscle is removed not only because the chest wall is involved, but also because it is thought that transfection of lymphatic lymph transfer is necessary. At that time it was also considered anatomically impossible to perform complete axillary dissection without removing pectoralis muscle.
William Halsted achieved a 3% relapse rate of 3% and a locoregional recurrence rate of 20% without perioperative death. The five-year survival rate is 40%, which is twice that of untreated patients. However, postoperative morbidity levels are high because large lesions are allowed to heal with granulation, lymphoedema is ubiquitous, and arm motion is very limited. Thus, chronic pain becomes a common sequela. Because surgeons are confronted with such large breast cancer that seems to require drastic treatment methods, the quality of life of patients is not considered.
Nonetheless, due to the work of Halsted and Meyer, it is possible to cure some cases of breast cancer and the knowledge of the disease begins to increase. Standard treatments were created, and long-term controlled studies were conducted. Soon, it became clear that some women with advanced stages of the disease did not benefit from surgery. In 1943, Haagensen and Stout reviewed more than 500 patients who had a radical mastectomy for breast cancer and identified a group of patients who could not be cured with a radical mastectomy thus developing the concept of operability and inoperability. Nonoperable signs include skin ulceration, chest wall fixation, satellite nodules, skin edema (peau d'orange), enlarged supraclavicular lymph nodes, axillary lymph nodes greater than 2.5 cm, or tangles, lymph nodes clear. The contribution of Haagensen and his colleagues will ultimately lead to the development of a clinical staging system for breast cancer, the Clinical Classification of Columbia, which is a landmark in the study of biology and treatment of breast cancer.
Today, surgeons rarely perform radical mastectomy, as the 1977 study by the National Surgical Adjuvant Breast and Intestine Project (NSABP), led by Bernard Fisher, suggests that there is no statistical difference in survival or recurrence between radical mastectomy and inadequate invasive surgery.
Maps Radical mastectomy
Expanded radical mastectomy
According to the Halsted-Meyer theory, the main pathway for the spread of breast cancer is through the lymphatic channels. Therefore, he thinks that performing a wider and more mutilated operation that removes more lymph nodes will result in greater healing opportunities. From 1920 onwards, many surgeons performed more invasive surgeries than the original procedure by Halsted. Sampson Handley noted Halsted's observation of malignant metastases to the chest wall and breast bone through the internal mammary chains under the sternum and using an "extended" radical mastectomy that included removal of the lymph nodes located there and implantation of the radium needle into the anterior intercostal space. This study was extended by her son, Richard S. Handley, who studied the involvement of the internal mammary nodal chain in breast cancer and showed that 33% of 150 breast cancer patients had internal mamary chain involvement at the time of surgery. Radical mastectomy was then extended by a number of surgeons such as Sugarbaker and Urban to include the removal of lymph nodes of the mammary glands. Finally, this "extended" radical mastectomy was extended further to include supraclavicular lymph node removal at the time of mastectomy by Dahl-Iversen and Tobiassen. Some surgeons like Prudente even go so far as to amputate the upper arm of the en bloc with a mastectomy specimen in an attempt to cure a relatively advanced local disease. This increasingly radical development culminates in a 'super-radical' mastectomy consisting of complete excision of all breast tissue, axillary content, removal of latissimus dorsi, major and minor pectoralis muscle and lymph node lymph node dissection. After a retrospective analysis, an extended radical mastectomy was abandoned due to large and crippling operations proving to be no superior to a standard radical maslesomi.
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Source of the article : Wikipedia
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