No abstract

In one out of four cases of operable breast cancer internal mammary metastases are present. The internal mammary involvement of tumors of the outer quadrants is also considerable (18%), being especially frequent in cases with axillary metastases (41%). The 5‐ and 10‐year survival rates show that the prognosis of cases with involvement of both axillary and internal mammary nodes is very poor; whereas, cases with internal mammary metastases only have an unexpectedly good prognosis. The removal of the internal mammary chain is essential for better prognostic evaluation and also seems justified by the radicality additionally given to the Halstead operation. However, only the results of a coordinated clinical trial will give a reliable evaluation of the true value of the procedure. A new technique of super‐radical operation is described. The operation is safe, without considerable functional or cosmetic impairment. However, only long‐term results will allow evaluation of its effectiveness.

Desmoid tumors are easily diagnosed when located within the muscles of the abdominal wall. On the contrary, extra-abdominal desmoids, because of their various sites and lack of pathognomonic signs, can be very difficult to diagnose. A review of 21 cases of the Istituto Nazionale Tumori of Milan confirms that these tumors primarily affect young, multiparous women and that even extra-abdominal desmoids are prevalent in women. All patients were treated by radical surgery consisting of wide exicision in 18 cases, hemimandibulectomy in 1 case, and amputation of the lower limb in 2 cases. Radical surgery resulted in no recurrences in all cases but one. Our results are in contrast with the relatively high recurrence rates reported in the literature.

Description of the technique of super-radical mastectomy with removal of axillary, internal mammary, supraclavicular and mediastinal lymph nodes developed at the National Cancer Institute of Milan and previously reported (1). The thoracic defect due to thoracectomy with removal of the clavicle, the medial portion of the first and second ribs and the corresponding half of the sternum is now avoided by sternal replacement and suture. Thus radicality is maintained and cosmetic impairment is confined to breast removal.

In 1080 patients operated on at the National Cancer Institute of Milan from 1937 to 1964, 84 recurrences appeared on the operative field after radical neck dissection for oropharyngeal cancer. There was no evidence of the primary tumor almost 2 years after treatment. 78 recurrences concerned 930 determined cases (8.9%): 7 appeared among 407 dissections in which no microscopic involvement of lymph nodes was demonstrated (1.72%); 77 among 673 operations for histologically positive nodes. Most recurrences (75/84) were localized in the upper regions of the operative field (upper carotid, retromandibular, submastoid area). In all but 3 cases they occurred in the region nearest to the primary. Clinically, recurrences appeared as isolated or multiple tumor nodes adherent to the skin or to deep structures or both; only in 7 cases they were movable, and among these 5 were external to the operative field. Histological examination of the node was performed in 35 cases; residual lymph node tissue was found only in the movable ones. In nearly all cases isolated « foci» were found, and these findings suggest a sowing of cancer cells. Pathogenesis of recurrences is discussed, and the conclusions are that: — In 50% of cases cancer cells spread out actively from the walls of the lymph node by an invasive mechanism; — In 40% of cases sowing was due to the surgical section of lymph vessels or, rarely, of the lymph node capsule; — In 2.7% of cases the recurrence was localized in lymph nodes not removed at surgery; — In 4.7% of cases the typical dissection was not sufficiently extensive, and recurrences can appear outside the operative field, often in the parotid gland, very seldom in the spinal chain. Since the therapy of cervical recurrences is very deceptive prognosis can be improved only by preventing them, and this can be attained by earlier operations (prophylactic dissections) and surgical refinements in technique and tactics.