A trend has been emerging in the surgical treatment of cancer during the past several decades: Less surgery is often better than radical surgery, or at least just as good. This trend has also been the case in the surgical treatment of breast cancer after the National Surgical Adjuvant Breast and Bowel Project B-06 trial, lead by Bernard Fisher, demonstrated that lumpectomy and radiation, and even lumpectomy with no radiation, had survival rates equivalent to mastectomy.
1This was true even though the less radical operations had greater local recurrence rates, which were as great as 43% at 5 years in the group treated with lumpectomy alone. Another great example was the landmark trial spearheaded by Steven Rosenberg, Sir Murray Brennan, Paul Sugarbaker, and others comparing limb-sparing resection plus radiation to radical amputation for soft-tissue sarcomas of the extremities.
- Fisher B
- Anderson S
- Bryant J
- et al.
Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for treatment of invasive breast cancer.
N Engl J Med. 2002; 347: 1233-1241
2Similar to the B-06 trial results, the less radical operations were associated with greater local recurrence rates than amputations, but the survival rates were again equivalent. In both examples, these seemingly paradoxial results are attributable to the fact that the survival is ultimately determined—not by the local control of the primary tumor—but rather by the distant metastases, which are likely already preordained by the time the primary tumor is discovered.
- Rosenberg SA
- Tepper J
- Glatstein E
- et al.
The treatment of soft-tissue sarcomas of the extremities: prospective randomized evaluations of (1) limb-sparing surgery plus radiation therapy compared with amputation and (2) the role of adjuvant chemotherapy.
Ann Surg. 1982; 196: 305-315
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- Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for treatment of invasive breast cancer.N Engl J Med. 2002; 347: 1233-1241
- The treatment of soft-tissue sarcomas of the extremities: prospective randomized evaluations of (1) limb-sparing surgery plus radiation therapy compared with amputation and (2) the role of adjuvant chemotherapy.Ann Surg. 1982; 196: 305-315
- Operative resection of primary carcinoid neoplasms in patients with liver metastases yields significantly better survival.Surgery. 2006; 140: 891-897
- Palliative resection of the primary tumor in 442 metastasized neuroendocrine tumors of the pancreas: a population-based, propensity score-matched survival analysis.Langenbecks Arch Surg. 2015; 400: 715-723
- Resection of the Primary Gastrointestinal Neuroendocrine Tumor Improves Survival with or without Liver Treatment.Ann Surg. 2018; ([Epub ahead of print])https://doi.org/10.1097/SLA.0000000000002809
Published online: December 17, 2018
Accepted: November 6, 2018
Received: November 6, 2018
© 2018 Published by Elsevier Inc.