J Korean Surg Soc.
2000 Jun;58(6):780-788.
Clinical Significance of Scanlon's Procedure in a Modified Radical Mastectomy for Patients with Infiltrating Breast Cancer
- Affiliations
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- 1Department of Surgery, College of Medicine, Inje University, Pusan Paik Hospital.
Abstract
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PURPOSE: Modified radical mastectomy is the most commonly performed operative treatment because
of extensive microcalcifications, multicentric tumors, early pregnancy, and patient preference, despite of
the eligibility of many women for breast-conserving surgery. Various modifications of this operation have
been described, including preservation of the pectoralis minor, resection of the pectoralis minor, and
division of the origin of the pectoralis minor. The purpose of this study was to identify the indications
of Scanlon's technique by evaluating the benefit of complete axillary dissection and the cosmetic results
of chest walls in patients who had undergone a modified radical mastectomy (MRM) for breast cancer.
METHODS
In fifty nine patients who had undergone MRM for infiltrating breast cancer from January
1992 to December 1997 and performed follow-up study of CT of chest walls, we examined operative
techniques, dissected & involved axillary lymph nodes (ALNs) retrospectively and atrophy of pectoralis
muscles by clinical examination and CT findings of chest walls. RESULTS: We analyzed all the
results
of aforementioned study, based on various operative techniques. The largest groups
were Auchincloss of 63.6% in stage IIA, Scanlon of 50% in stage IIB and Patey of 28.6% in
stage IIIA. The mean numbers of harvested ALNs were 20.4 in Scanlon, 20 in Patey and 15
in Auchincloss. The largest groups were Auchincloss of 77.3% in the harvested ALNs of 10-19,
Scanlon of 40% in the harvested ALNs of 20-29 and Patey of 14.3% in the harvested ALNs
of 30-39. The mean numbers of involved ALNs were 4.4 in Patey, 2.6 in Scanlon and 0.9 in
Auchincloss. The largest groups were Auchincloss of 63.6% in the non-involved ALNs,
Auchincloss of 31.8% in the involved ALNs of 1-3, Scanlon of 20% in the involved ALNs
of 4-9 and Patey of 28.6% in the involved ALNs of 10 or more. Through the clinical
examinations and CT studies of chest wall, such changes of chest walls were found, as
suggestive of injury of medial pectoral nerve of 2 cases (9.1%) and of lateral pectoral nerve
of 1 case (4.5%) inAuchincloss, of injury of medial pectoral nerve of 1 case (3.3%) in Scanlon
and of injuries of medial pectoral nerve of 3 cases (42.9%) and of lateral pectoral nerve of 1
case (14.3%) in Patey. Postoperative complications were arm lymphedema of 1 case in each
technique and anemia of 4 cases (13.3%) in Scanlon. CONCLUSION: We conclude that in the MRM
for patients with resectable breast cancer, Scanlon's technique is superior to Auchincloss or
Patey in preventing axillary recurrence and atrophies of pectoralis muscles by successful
complete axillary dissection with preservation of medial and lateral pectoral nerve in cases of
more advanced stage over stage IIB with involved ALNs of one to nine. However Patey's
technique seems to be necessary in cases of metastasis of the interpectoral node or the
subclavicular node regardless of poor results of cosmesis.