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Attualità nella chirurgia del carcinoma della mammella.

Per quasi un secolo la mastectomia radicale messa a punto da Halsted nel 1894 e le sue successive modifiche hanno rappresentato il trattamento di elezione del carcinoma della mammella, con indiscutibili e comprovati risultati sulla sopravvivenza delle pazienti.

Nella prima metà degli anni “80 il concetto di radicalità oncologica introdotto da Halsted subì la prima importante rivoluzione. Il trial Milano I, condotto in Italia da Veronesi, ed il trial NSABP-04, condotto negli USA da Fisher, dimostrarono che nel carcinoma mammario di piccole dimensioni l’asportazione del solo quadrante sede del tumore, associato alla linfadenectomia ascellare e seguito dalla radioterapia sulla mammella operata garantiva gli stessi risultati della mastectomia radicale. La chirurgia conservativa iniziava così ad imporsi prepotentemente come gold standard nel trattamento del carcinoma della mammella, estendendo progressivamente le sue indicazioni anche a tumori di maggiori dimensioni, grazie alla chemioterapia neoadiuvante. Rimaneva però concettualmente ben saldo il ruolo della linfadenectomia ascellare con la sua duplice funzione di cura e di stadiazione.

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