Curative use of forequarter amputation for recurrent breast cancer over an axillary area: a case report and literature review

Abstract

Axillary recurrence of breast cancer that involves the brachial neurovascular bundle is uncommon. However, for many patients with such recurrence, forequarter amputation can play a palliative role in relieving excruciating pain and paralysis of the upper limb. Further, for those patients who do not have distant metastasis or other local-regional recurrence, forequarter amputation provides a chance for a cure. Only a few case reports of curative amputations for recurrent breast cancer are present in the literature. Here, we report a case of forequarter amputation for curative treatment of axillary recurrent breast cancer, together with a literature review. To date, we have followed the patient for three years after amputation, during which there has been no evidence of recurrence or metastasis. Although radical resection is feasible, it can be accompanied by surgical wound complications and psychosocial stress. Therefore, an organized multidisciplinary approach is needed to ensure the success of radical resection.

Forequarter Amputation Following Pre-Operative Embolization to Treat Two Upper Extremity Malignancies in a Previously Irradiated Tissue Bed: A Case Report

“…Although forequarter amputations are performed for curative management [15,17], this type of procedure has typically been described in the context of palliative surgery with a post-operative survival of less than 2 years [15,18,19]. Extended forequarter amputation with or without chest wall resection and/or pneumonectomy has been described for lesions extending into the chest wall [15] however, we did not think the additional risk of such a dissection was justified in this particular case. Pre-operative embolization has been described as an important adjunct in neurosurgery, general surgery, urology, head and neck surgery, oral surgery and orthopedics to minimize intraoperative bleeding [20][21][22][23] and although complications such as nerve injury [24], arterial infarction [25], local hemorrhage and ischemic events [26] and embolization of improper structure have been described, the majority are performed successfully.…”

“…Forequarter amputation is an uncommon procedure that is typically performed to treat aggressive primary soft tissue sarcomas and their recurrences [1,[11][12][13]. Although significant improvement in quality of life can be observed [1,13], post-operative complications are frequent and include bleeding, wound dehiscence and necrosis [13] phantom pain [2,14,15] high rates of early local and distant recurrences and high post-operative mortality rates [16]. Although forequarter amputations are performed for curative management [15,17], this type of procedure has typically been described in the context of palliative surgery with a post-operative survival of less than 2 years [15,18,19].…”

“…Although significant improvement in quality of life can be observed [1,13], post-operative complications are frequent and include bleeding, wound dehiscence and necrosis [13] phantom pain [2,14,15] high rates of early local and distant recurrences and high post-operative mortality rates [16]. Although forequarter amputations are performed for curative management [15,17], this type of procedure has typically been described in the context of palliative surgery with a post-operative survival of less than 2 years [15,18,19]. Extended forequarter amputation with or without chest wall resection and/or pneumonectomy has been described for lesions extending into the chest wall [15] however, we did not think the additional risk of such a dissection was justified in this particular case.…”