Disease-related surgery in patients with distant metastatic breast cancer

Introduction: This study evaluates the frequency of and indications for disease-related surgical procedures in the palliative breast cancer (BC) situation. Patients & methods: Based on a cohort of women who were treated for newly diagnosed BC during a 20-year period (1990e2009), we analyzed 340 patients who developed distant metastatic disease (DMD) until 2011 and died (i.e. still ongoing palliative disease courses were not included). Results: One hundred and twenty-seven surgical procedures were performed in 100 patients (29.4% of all patients with metastatic disease). The most common site for surgery was breast (n ¼ 60, 47.2%). The primary tumor was removed at first diagnosis of DMD in 43 patients (33.9%); sixteen operations (12.6%) were performed for local recurrence. In 37 patients, 50 surgical procedures (39.4%) were necessary to stabilize osseous structures due to metastases. Procedures were rarely performed on other common metastatic sites: lung: n ¼ 1 (0.8%); liver: n ¼ 1 (0.8%), brain: n ¼ 4 (3.1%). When excluding surgery for primary breast tumors at initial diagnosis of DMD from analysis, 34 of 84 surgeries (40.4%) were performed in the first third of survival follow-up (i.e. period of metastatic disease survival); operations in the last two-thirds each totaled 29.8% (n ¼ 25). The median survival after surgery was 16 months (range: 0.5e89 months). Conclusions: In a cohort of BC patients who had primary or developed secondary DMD, nearly one third of the patients received diseaserelated surgical procedures during their palliative disease course. This high rate of operations shows that surgery has a clearly established role in the palliative therapy concept. 2013 Elsevier Ltd. All rights reserved.