CA: A Cancer Journal for Clinicians, Vol 8, 20-26, Copyright
© 1958 by American Cancer Society
Radical Mastectomy with en Bloc in Continuity Resection of the Internal Mammary Lymph-Node Chain
Jerome A. Urban M.D.1
1 Breast Service, Memorial Hospital, New York, New York.
1. We are convinced that a combination of early diagnosis and early more thorough surgical treatment will result in an increased salvage of patients with primary, operable breast cancer. [See Table 3 source pdf.]
2. Radical mastectomy with en bloc in continuity resection of the internal mammary lymph-node chain extends the clasical radical mastectomy procedure to include the other primary lymphatic drainage depot of the breast—the internal mammary chain. In our hands it has proved a practical procedure with no increased postoperative mortality (less than 1 per cent).
3. At present 285 patients with breast cancer have undergone this procedure. In the first 270 cases evaluated 35.5 per cent had internal mammary lymph-node metastases and 48.2 per cent showed axillary-node involvement. Of the cases with clear axillas, 15 per cent had internal mammary metastases.
4. An increased (60 per cent) five-year survival rate clinically free of disease has been obtained in the first 55 primary operable breast cancers undergoing this procedure as compared with the salvage rate of similar patients treated by radical mastectomy (48.5 per cent). Of 22 patients with positive internal mammary nodes eight are now free of disease between five and six years postoperatively. Only four local recurrences, as the first sign of recurrent disease, have been noted in the first 285 patients.
5. This procedure is indicated for Stage I and early Stage II cases, particularly when the primary tumor arises in the central and medial sectors of the breast. It cannot be expected to help the advanced case of breast cancer with subclinical systemic disease.
