Die subkutane Mastektomie

Zusammenfassung

Wir berichten über 278 Patientinnen, die an der UFK Heidelberg zwischen 1980 und 1996 eine subkutane Mastektomie (SCM) erhielten. Indikationen waren: diagnostische Probleme (n = 104), DCIS (n = 64), CLIS (n = 33), invasive Karzinome (n = 36), Rezidiverkrankungen (n = 8) und kontralateraler Herd (n = 33). In 20 % der Patientinnen mit DCIS und in 6 % mit CLIS wurde in der histologischen Aufarbeitung ein invasives Karzinom gefunden. 16 % der CLIS und 5 % der DCIS traten beidseitig auf. In der Gruppe der schwer kontrollierbaren Risikobrüste fanden wir in 16 % okkulte Karzinome. In den jeweiligen kontralateralen Brüsten diagnostizierten wir in 27 % okkulte Karzinome. Nach einem medianen Follow-up von 16,6 Jahren lag die Lokalrezidivrate beim invasiven Karzinom bei 19 %, beim DCIS bei 3 % und beim CLIS bei 10 %. Die 10-Jahres-rezidivfreie-Überlebensrate liegt beim DCIS und beim CLIS bei 91 %, beim invasiven Karzinom bei 86 %. Die 10-Jahres-Gesamtüberlebensrate liegt beim CLIS bei 97 %, beim DCIS bei 95 % und beim invasiven Karzinom bei 90 %. Die Inzidenz des Mammakarzinoms nach prophylaktischer SCM lag bei 1 %. Unsere Daten zur SCM sind vergleichbar mit den derzeitigen Standardoperationsmethoden hinsichtlich der Rezidiv- und Gesamtüberlebensraten. Die SCM stellt eine Bereicherung der operativen Möglichkeiten in der Therapie des Mammakarzinoms dar und kann als Option angeboten werden.

Abstract

This is a report on 278 patients who underwent subcutaneous mastectomy (SCM) at the Gynaecological Department of the University Hospital Heidelberg between 1980 and 1996. These operations were indicated either because of diagnostic problems (n = 104), a carcinoma of the contralateral breast (n = 33), non-invasive lobular carcinoma (n = 33), non-invasive ductal carcinoma (n = 64), recurrent disease (n = 8) or invasive carcinoma (n = 36). In the group of patients with diagnostic problems occult lesions were found in 16 %. In women with a previously known contralateral carcinoma occult carcinomata were diagnosed in 27 %. In cases with a preoperative lobular carcinoma in situ we found ipsilaterally 6 % occult invasive carcinoma and in 20 % with a preoperatively diagnosed ductal carcinoma in situ. After a median follow up of 16.6 years the local recurrence rate for the invasive carcinoma was 19 %, for LCIS was 10 % and for DCIS was 3 %. The recurrence free survival after 10 years was 91 % for DCIS and LCIS and 86 % for invasive carcinoma. The overall survival after ten years was 97 % for DCIS, 95 % for LCIS and 90 % for invasive carcinoma. The incidence of invasive breast cancer after prophylactic subcutaneous mastectomy was 1 %. The findings of this study support the use of SCM because of comparable results in local recurrence rates and overall survival with breast conserving therapy and mastectomy, therefore SCM is a further therapeutic option.

Schlüsselwörter

Subkutane Mastektomie - Carcinoma ductale in situ - Carcinoma lobulare in situ - Risikobrust

Key words

Subcutaneous mastectomy - ductal carcinoma in situ - lobular carcinoma in situ - diagnostic problems

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