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Historically, women who present with stage IV metastatic breast cancer (MBC), even those with an intact primary tumor, are not offered surgical treatment. Instead, the recommended primary treatment approach is systemic therapy. However, improved breast cancer screening and imaging technology have presented a different dilemma: patients with MBC may have oligometastatic or stable metastatic disease with an operable intact primary tumor, suggesting that surgery may be effective. Furthermore, over the past 25 years, multimodality treatments for new and advanced breast cancers have resulted in improved median survival times for patients with MBC.1 Therefore, for patients with MBC, it is time to reevaluate the role of resection of the intact primary tumor and the role of metastasectomy in patients without an intact primary tumor.

It is generally accepted that mastectomy does not confer a survival advantage after metastases have developed.2 Surgical treatment of intact primary tumors in patients with MBC has generally been reserved for palliation, such as treatment of bleeding, tumor ulceration, infection, or hygienic conditions. A salvage, or "toilet," mastectomy is generally performed as a last resort, with no intent for cure. However, multiple national databases and single-institution studies in the past 8 years have reexamined the role of resection of intact primary tumors for patients with MBC to clarify its role in the care of breast cancer patients (Table 72-1).3-8

Table 72-1 Retrospective Studies on Resection of the Intact Primary Tumor in Patients with Metastatic Breast Cancer

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