Khuyến nghị của AGO về liệu pháp phẫu thuật ung thư vú: Cập nhật 2022
Tóm tắt
Khuyến nghị của Ủy ban Ung thư Vú AGO về liệu pháp phẫu thuật cho ung thư vú đã được cập nhật lần cuối vào tháng 3 năm 2022 (www.ago-online.de). Do liệu pháp phẫu thuật là một trong nhiều bước trong điều trị ung thư vú, nên kinh nghiệm chẩn đoán và ung thư học phong phú của bác sĩ phẫu thuật vú và sự hợp tác liên ngành tốt với các bác sĩ chẩn đoán hình ảnh là rất quan trọng. Những thay đổi quan trọng nhất liên quan đến các kỹ thuật định vị, rìa cắt, quản lý nách trong bối cảnh điều trị tiền phẫu và đánh giá các lưới trong phẫu thuật tái tạo. Dựa trên các phân tích tổng hợp từ các nghiên cứu ngẫu nhiên, mức độ khuyến nghị cho siêu âm vú trong phẫu thuật để định vị các tổn thương không sờ thấy đã được nâng lên thành “++”. Do đó, kỹ thuật này được coi là tương đương với việc định vị bằng dây, miễn là đó là một tổn thương có thể được thể hiện tốt bằng siêu âm, bác sĩ phẫu thuật có kinh nghiệm phong phú trong siêu âm vú và có quyền truy cập vào thiết bị siêu âm phù hợp trong quá trình phẫu thuật. Đối với ung thư vú xâm lấn, mục tiêu là đạt được rìa cắt âm tính (“không có khối u trên mực mực”), bất kể liệu có thành phần nội nhú rộng hay không. Các ca phẫu thuật oncoplastic cũng có thể thay thế cho phẫu thuật cắt bỏ vú trong các trường hợp được chọn nhờ vào số lượng kỹ thuật hiện có, và tương đương với phẫu thuật cắt khối trong việc đảm bảo ung thư với tỷ lệ biến chứng tương đương. Phẫu thuật cắt hạch bạch huyết chẩn đoán được khuyến nghị cho bệnh nhân có tình trạng cN0 nhận hóa trị liệu neoadjuvant sau khi hoàn thành hóa trị. Sinh thiết xâm lấn tối thiểu được khuyến nghị cho các hạch bạch huyết nghi ngờ ban đầu. Sau khi hóa trị neoadjuvant, những bệnh nhân có 1 – 3 hạch bạch huyết nghi ngờ ban đầu và có đáp ứng tốt (ycN0) có thể nhận cắt bỏ hạch nách có mục tiêu và cắt bỏ hạch nách như các tùy chọn tương đương.
Từ khóa
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