Surgical Controversies in Management of Advanced and Metastatic Breast Cancer

Purpose of Review: To review the role of surgery for contralateral axillary metastases (CAM), de novo (dn) metastatic breast cancer (MBC), and resection of primary or metastatic lesions in excellent responders. Recent Findings: Multiple studies report improved survival for CAM compared to traditional MBC with outcomes similar to locoregional recurrences. However, others consider CAM most like oligo-MBC. Surgical management remains controversial. For dnMBC, two well-balanced randomized trials found that primary tumor resection did not increase survival. Most data supporting surgical interventions are retrospective analyses, generally pointing to survival improvements in selected subgroups. Better prognostic staging is needed to delineate potential benefits. Resection for excellent responders with metastatic disease shows some promise in retrospective studies. Larger cohorts of metastasectomies are now published, but it is unclear as to what extent tumor biology or surgery drive the prolonged survival. Summary: Surgical resection remains controversial in MBC. Patient selection and heterogeneity add complexity, and confounders cannot be fully controlled in retrospective data.

Duke Scholars

Author Astrid Botty Surgical Oncology