The prospect of breast cancer surgery

1. The evolution of breast cancer surgery stems from the change and renewal of treatment concept. The progress of basic theoretical research has deepened people's understanding of the biological characteristics of breast cancer, a new concept: breast cancer is a systemic disease, replacing the concept that breast cancer is a local disease. The emergence of a large number of representative clinical randomized experimental results, the application of mammography and B-ultrasound, the popularization of tumor knowledge, the perfection and maturity of radiotherapy equipment and technology, the advent of new chemotherapy and endocrine drugs and the application of optimized schemes, as well as the strengthening of people's demand for quality of life and physical beauty after breast cancer surgery, have promoted the improvement of breast cancer treatment level, and the new concept of holistic comprehensive treatment, chemotherapy and quality of life has replaced the old concept of "local radical cure". Medical practice has proved that comprehensive treatment can reduce the scope of operation, improve limb effect, maintain upper limb function and improve the quality of life without affecting the survival rate and recurrence rate.

2. Comprehensive treatment is the direction of breast cancer treatment, and the situation of "fighting alone" in surgery has become a thing of the past. It is wrong to unilaterally publicize the role of surgery and blindly worship the idea of "one-knife doctrine". Clinical experiments show that postoperative adjuvant therapy for breast cancer can reduce the recurrence of 1/3 cases and the annual mortality of 10//6 ~1/5. The comprehensive treatment of breast-conserving surgery plus radiotherapy and chemotherapy for early breast cancer is the same as radical surgery and improved surgery in local and regional control rate and long-term survival rate, but it improves the quality of life of patients. In comprehensive treatment, it is necessary to avoid doctors' old concept of "going their own way". Surgeons, radiotherapy, chemotherapy and pathologists should pay attention to the rational design of the overall treatment scheme and the organic cooperation between various treatment methods, and unite and cooperate to ensure the success of comprehensive treatment.

3. Standardized chemotherapy is the key to the success or failure of breast cancer treatment, which should be strongly advocated and strengthened in China. European and American countries have corresponding guidelines (Guid line) for comprehensive treatment of breast cancer at all stages. The standardization scheme is based on "evidence-based medicine". The treatment level of breast cancer in China lags behind that in Europe and America, and one of the reasons is that it is not standardized. The treatment methods are extremely inconsistent, and the treatment effect is also very different. Surgery abandoned abroad is still being done in China, and the technology popularized abroad is only carried out in a few hospitals in China. The norms of breast cancer treatment are closely related to socio-economic conditions, national medical facilities, race and other factors. Breast-conserving surgery is the first choice for early breast cancer in Europe and America, but in rural America, because some patients can't complete all routine treatments, surgeons don't follow the principle of breast-conserving treatment proposed by NSABP, but prefer total mastectomy. Paik et al. reported at the 2 1 San Antonio International Breast Cancer Conference and the 3rd Asian Breast Cancer Conference that the curative effect of breast-conserving treatment for female breast cancer in Korea is better than that in Europe and America. Whether Asian women's breast cancer has different characteristics from western women needs to be studied. Breast-conserving surgery requires high medical technology, radiotherapy equipment and treatment costs, so it is not appropriate to carry it out reluctantly in some hospitals that do not have the conditions in China. In a word, the standardization of breast cancer treatment can't completely copy the treatment model of European and American countries, but should formulate corresponding treatment norms in combination with China's medical resources and needs. So far, no operation can be applied to all stages and sites of breast cancer. Therefore, while emphasizing standardized treatment, we should also follow the principle of individualized treatment. Under the guidance of surgeons, patients with breast cancer choose the most ideal treatment scheme from different treatment schemes, and multidisciplinary comprehensive treatment group will play an important role in individualized treatment of breast cancer.

4. It is predicted that in the future, there will be an individualized comprehensive treatment model with multiple operations coexisting and taking care of the cure and quality of life. Breast-conserving surgery plus sentinel lymph node biopsy has become the first choice for the treatment of early breast cancer in Europe and America. In China, radiotherapy equipment and technology have not been popularized, and are only carried out in a few hospitals, but it will become the future development trend. Modified radical surgery is still dominant in China, but it will eventually be replaced by breast-conserving surgery. The integrity of immediate breast reconstruction has been affirmed, which will not affect the prognosis and follow-up of breast cancer patients, and there will be room for development under the condition of conditional hospital patients' needs. Surgery can improve the local and regional control rate of breast cancer treatment and reduce the recurrence rate. Neoadjuvant chemotherapy, radiotherapy, consolidation chemotherapy, endocrine therapy and biotherapy can further reduce recurrence and death and improve survival rate. Breast cancer surgery will continue to seek its position and value in comprehensive treatment and keep pace with the times. The detection of clinical prognostic indicators and tumor markers is helpful to determine the intensity of adjuvant therapy.

5. Japan is studying more humanized minimally invasive breast surgery, that is, reducing large cancerous tumors through radiotherapy and chemotherapy, and then breast-conserving surgery or smaller surgery. These minimally invasive treatments will improve people's quality of life, and the case of breast cancer resection with fiberscope has also been reported in Britain, which has brought us great excitement and encouragement. The continuous development of minimally invasive surgery is bound to trigger a vigorous technological revolution.