Theories and technologies in surgical treatment of breast cancer： development and challenge

doi:10.3877/cma.j.issn.1674-0807.2025.01.001

Abstract

Abstract:

The concepts and techniques of surgical treatment for breast cancer have been innovated for more than 100 years and the development can be divided into four stages： radical resection， function preservation， organ reconstruction and minimally invasive treatment. Currently， clinical treatment of breast cancer is a process in which these four stages overlap and continuously progress. This evolution not only embodies the deepening of the treatment concept， shifting from radical disease elimination to organ and function protection in breast cancer surgery， but also mirrors the continuous progress in physiological and psychological care for patients. With the help of advanced technical equipment，clinical problems are constantly being solved，highlighting the specialty features of breast surgery. However， the following issues still impede the further development of breast surgery： lack of breakthroughs in the etiology of major breast diseases， few updates on guiding theories for breast surgery， slow development of key surgical techniques in breast cancer and limited successful cases using modern technology in clinical practice and few techniques related to sensory restoration during breast reconstruction. Among these， a major theoretical breakthrough of surgical techniques in breast cancer is a key point at present. This article put forward，for the first time，the treatment concept of non-radical breast cancer surgery， aiming to construct the theoretical and technical system of non-radical breast cancer surgery and analyze its theoretical basis and clinical feasibility. Moreover， it systematically summarized the current development of non-radical breast cancer surgery and its potentials as an alternative to classic radical surgery， and explored the research directions and related topics required to establish a new clinical treatment theory in breast cancer， hoping to draw the attention and spark discussions among the academic community.

Key words: Breast neoplasms, Surgical procedures，operative, Non-radical resection

Zhaoyu Wang, Jun Jiang. Theories and technologies in surgical treatment of breast cancer： development and challenge[J]. Chinese Journal of Breast Disease(Electronic Edition), 2025, 19(01): 1-5.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhrxbzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-0807.2025.01.001

https://zhrxbzz.cma-cmc.com.cn/EN/Y2025/V19/I01/1

References 32

［1］	Braile D. The surgeon［J］. Rev Bras Cir Cardiovasc， 2011， 26（1）：VI-VII.
［2］	黄志强. 传统外科与消失中的外科传统——外科学的历史发展观［J］. 消化外科， 2005， 4（2）： 77-83.
［3］	Atul G. Two hundred years of surgery［J］. N Engl J Med， 2012，366（18）： 1716-1723.
［4］	Halsted WS. Theresults of operations for the cure of cancer of the breast performed at the Johns Hopkins Hospital from June， 1889， to January，1894［J］. Ann Surg， 1894， 20 （5）： 497-555.
［5］	张保宁. 乳腺癌外科100 年［J］. 中华肿瘤杂志，2003，25（6）：102-105.
［6］	Risal D，Isis S，Rebecca K，et al.Neurotization of thenipple-areola complex during implant-based reconstruction： evaluation of early sensation recovery［J］. Plast Reconstr Surg， 2020， 146（2）： 250-254.
［7］	Mathew A，Davidson NE. Adjuvant endocrine therapy for premenopausal women with hormone-responsive breast cancer［J］. Breast， 2015， 24：S120-S125.
［8］	Jacobson JA， Danforth DN， Cowan KH， et al. Ten-year results of a comparison of conservation with mastectomy in the treatment of stage I and Ⅱbreast cancer［J］. N Engl J Med， 1995， 332（14）： 907-911.
［9］	张彦收，刘运江. 乳腺癌手术治疗回顾和进展［J］. 现代肿瘤医学，2015， 23（5）： 719-723.
［10］	Kronowitz SJ， Hunt KK， Kuerer HM， et al. Practicalguidelines for repair of partial mastectomy defects using the breast reduction technique in patients undergoing breast conservation therapy［J］. Plast Reconstr Surg， 2008， 120（7）： 1755-1768.
［11］	Hang-Fu L， Snyderman RK. State-of-the-art breast reconstruction ［J］.Cancer， 1991， 68（5）： 1148-1156.
［12］	O’Connell LR，Stevens JR， Harris AP， et al. Review of threedimensional （3D） surface imaging for oncoplastic， reconstructive and aesthetic breast surgery［J］. Breast， 2015， 24（4）： 331-342.
［13］	Hung WK， Ying M， Chan CM， et al. Minimally invasive technology in the management of breast disease［J］. Breast Cancer， 2009， 16（1）：23-29.
［14］	Yu G， Qingqiu C， Shichao L， et al. Safety and feasibility of minimally invasive （laparoscopic/robotic-assisted） nipple-sparing mastectomy combined with prosthesis breast reconstruction in breast cancer： a single-center retrospective study［J］. Ann Surg Oncol， 2022，29（7）：4057-4065.
［15］	Angeliki A， Des F，Anthony CR，et al. The microbiology and treatment of human mastitis［J］. Med Microbiol Immunol，2018，207（2）：83-94.
［16］	Wyld L， Audisio RA， Poston GJ. The evolution of cancer surgery and future perspectives［J］. Nat Rev Clin Oncol， 2015， 12（2）： 115-124.
［17］	Bernard F， Jong-Hyeon J， Stewart A， et al. Twenty-five-year follow-up of a randomized trial comparing radical mastectomy， total mastectomy，and total mastectomy followed by irradiation［J］. N Engl J Med， 2002，347（8）： 567-575.
［18］	Konstantinos MT，Byoel HL，Wei Y，et al. Accuracy ofpost-neoadjuvant chemotherapy image-guided breast biopsy to predict residual cancer［J］.JAMA Surg， 2020， 155（12）： e204103-e204103.
［19］	Loevezijn VAA，Noordaa DVEM，Werkhoven VDE，et al. Minimallyinvasive complete response assessment of the breast after neoadjuvant systemic therapy for early breast cancer （MICRA trial）： interim analysis of a multicenter observational cohort study［J］. Ann Surg Oncol， 2020，28（6）： 1-11.
［20］	Jiang B，Bao L， He S， et al. Deep learning applications in breast cancer histopathological imaging： diagnosis， treatment， and prognosis［J］. Breast Cancer Res， 2024， 26（1）： 137.
［21］	Asselain B，Barlow W，Bartlett J，et al.Long-term outcomes for neoadjuvant versus adjuvant chemotherapy in early breast cancer： meta-analysis of individual patient data from ten randomised trials［J］. Lancet Oncol，2018， 19（1）： 27-39.
［22］	桂余，陈莉. 达芬奇机器人在乳腺外科中的应用及进展［J］. 临床外科杂志， 2021， 29（3）： 292-294.
［23］	Kaufman CS. Increasingrole of oncoplastic surgery for breast cancer［J］.Curr Oncol Rep， 2019， 21（12）： 111.
［24］	Risal D， Isis S， Rebecca K， et al. Neurotization of thenipple-areola complex during implant-based reconstruction： evaluation of early sensation recovery［J］. Plast Reconstr Surg， 2020， 146（2）： 250-254.
［25］	Veronesi U， Boyle P， Goldhirsch A， et al. Breast cancer［J］. Lancet，2005， 365（9472）： 1727-1741.
［26］	Hughes KS， Schnaper LA， Bellon JR，et al. Lumpectomy plus tamoxifen with or without irradiation in women age 70 years or older with early breast cancer： long-term follow-up of CALGB 9343［J］. J Clin Oncol，2013， 31（19）： 2382-2387.
［27］	Boniface DJ， Tvedskov FT， Rydén L， et al. Omittingaxillary dissection in breast cancer with sentinel-node metastases［J］. N Engl J Med，2024， 390（13）： 1163-1175.
［28］	万安弟，周于钦，张聪，等. 腔镜与开放保留乳房手术治疗早期乳腺癌的近期疗效比较［J］. 中国普通外科杂志， 2023， 32（11）：1743-1751.
［29］	Heil J， Kuerer HM，Pfob A，et al. Eliminating the breast cancer surgery paradigm after neoadjuvant systemic therapy： current evidence and futurechallenges［J］. Ann Oncol，2020， 31（1）： 61-71.
［30］	Topolion SL， Toube JM， Anders RA， et al. Mechanism-driven biomarkers to guide immune checkpoint blockade in cancer therapy［J］.Nat Rev Endocrinol， 2016， 16（5）： 275-287.
［31］	Wenbin Z，Muxin Y， Xinrui M， et al. Landscape of theperipheral immune response induced by local microwave ablation in patients with breast cancer［J］. Adv Sci （Weinh）， 2022， 9（17）： e2200033.
［32］	Wang L， Lynch C， Pitroda PS， et al. Radiotherapy and immunology［J］. J Exp Med， 2024， 221（7）： e20232101.

[1]	Yang Li, Jinyu Cai, Xiaozhi Dang, Wanying Chang, Yan Ju, Yi Gao, Hongping Song. Application value of a deep learning-based model for generating strain elastography images using breast grayscale ultrasound images [J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2024, 21(06): 563-570.
[2]	Collaboration Group，Breast Cancer Specialty Committee，Hebei Anti-Cancer Association Nursing. Expert consensus on nursing management of central venous access in breast cancer patients [J]. Chinese Journal of Breast Disease(Electronic Edition), 2024, 18(06): 321-329.
[3]	Chenlu Liu, Jie Liu, Fan Zhang, Caiying Yan, Qian Chen, Shuangqing Chen. Habitat analysis based on enhanced MRI radiomic features in predicting HER-2 expression in breast cancer [J]. Chinese Journal of Breast Disease(Electronic Edition), 2024, 18(06): 339-345.
[4]	Xiaoyu Zhang, Yulai Yin, Yinxu Zhang. Efficacy and prognostic analysis of apatinib combined with neoadjuvant chemotherapy in triple negative breast cancer [J]. Chinese Journal of Breast Disease(Electronic Edition), 2024, 18(06): 346-352.
[5]	Lin Qiu, Jinhui Liu, Tuerhong Zumureti, Yuexin Ma, Xiaoling Leng. Diagnostic value of ultrasound radiomics in non-mass breast cancer in dense breasts [J]. Chinese Journal of Breast Disease(Electronic Edition), 2024, 18(06): 353-360.
[6]	Rui Ge, Fei Chen, Jie Li, Juanjuan Li, Han Chen. Application of multi-gene panel testing in adjuvant therapy for early breast cancer [J]. Chinese Journal of Breast Disease(Electronic Edition), 2024, 18(05): 257-263.
[7]	Liu Yang, Zhenchuan Song, Xinle Wang. Clinical efficacy evaluation of modified radical mastectomy combined with latissimus dorsi muscle repositioning [J]. Chinese Journal of Breast Disease(Electronic Edition), 2024, 18(05): 269-273.
[8]	Ming Su, Danping Tang, Ping Wang, Qian He. Research progress on method selection of immediate breast reconstruction after modified radical mastectomy for breast cancer [J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2025, 19(02): 231-234.
[9]	Mengmeng Han, Xueyuan Feng, Ning Ma. A case of radial nerve injury after modified radical surgery for breast cancer [J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2025, 19(01): 117-118.
[10]	Jiehong Gao, Pingping Li, Jing Qi, Yinhai Dai. Study on the relationship between the expression of ETFA gene and clinicopathological parameters and prognosis in breast cancer [J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2025, 19(01): 64-67.
[11]	Zhizhao Zhang, Rui Wang, Pingping Gao, Chengfang Wang, Cheng Wang, Xiaowei Qi. Relationship between DNMT3B and prognosis of breast cancer and its biological mechanism [J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2024, 18(06): 624-629.
[12]	Lingyan Wang, Chunhui Gao, Xueyuan Feng, Xinmiao Cui, Huan Liu, Wenming Zhao, Jinku Zhang. Application of circulating tumor cells in neoadjuvant and postoperative adjuvant therapy for breast cancer [J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2024, 18(06): 630-633.
[13]	Linjuan Zhao, Jie Lv, Wensheng Wang, Demao Ma, Tao Hou. Study on the effect of ultrasound guided resection of stellate and cylindrical lactation preserving areas with staining marks [J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2024, 18(06): 634-637.
[14]	Zongjie Chen, Tiansong Hu. Analysis of influencing factors of bile leakage after treatment in patients with liver trauma and rupture [J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2024, 13(06): 836-840.
[15]	Zhuo Liu, Zongming Zhang, Chong Zhang, Limin Liu, Yue Zhao, Hui Qi. Safety and surgical technique selection of laparoscopic surgery for elderly patients with acute obstructive suppurative cholangitis [J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2024, 13(06): 795-800.

Please choose a citation manager

Content to export