Annual Report 2023

Department of Breast Surgery

Tatsuya Onishi, Chisako Yamauchi, Yuji Yamashita, Rurina Watanuki, Risa Otani

Introduction

 We treat patients with operable malignant mammary glands. Our main professional practices include diagnosing breast disease, providing surgical treatment and conducting follow-up for breast cancer patients. The Department of Breast Surgery is committed to providing the latest and most comprehensive breast treatments for our patients. A multidisciplinary approach to the cancer diagnosis and treatment is performed using the cooperation of related specialists.

 Our department focuses on “minimally invasive surgery” and performs thorough investigations for oncologically safe approaches, with lower morbidity and good cosmesis. For example, although sentinel lymph node (SLN) biopsy has been established as the standard care for clinical node negative patients, omitting axillary lymph node dissection (ALND) for positive SLNs has been included in clinical practice as an expanded indication. Preoperative systemic therapy provides the opportunity for a curative operation or breast-conserving surgery to avoid mastectomy. Moreover, breast reconstructive surgery is performed in collaboration with the Department of Plastic and Reconstructive Surgery. These procedures will contribute to a better quality of life for patients with breast cancer.

The Team and What We Do

 For regular activities of our department, a daily morning round is scheduled for inpatients by all staff. Moreover, our weekly preoperative diagnostic imaging conference is conducted to discuss each patient's surgical treatment planning. A clinical conference to decide on treatment courses by multidisciplinary breast care team members is held twice a month. A monthly pathological conference on breast cancer is also conducted. At these conferences, individual cases are presented to a team of highly trained cancer specialists, including radiologists, breast surgeons, pathologists, radiation oncologists, and medical oncologists. Our multidisciplinary team approach to breast cancer treatment provides superior-quality care to patients.

 Table 1 shows changes in the annual number of patients with breast cancer who underwent surgery.

 Surgeries were performed on 527 patients with primary breast cancer and 84 patients with recurrent or other breast cancer.

Hospital East

 The types and number of operative procedures performed in 2023 are shown in Table 2. The rate of breast-conserving surgery was 48% (253/527). Sentinel node biopsy was performed on 434 patients, and 415 patients were spared from ALND. We have performed nipple-sparing mastectomy (NSM) endoscopically on 37 patients. Sixteen immediate breast reconstruction surgeries were performed (Table 3).

Research Activities

 We contribute to establishing new standard treatments for breast cancer patients by actively enrolling participants in clinical trials. We have collaborated on a multicenter, retrospective cohort study of local recurrence and prognosis (real-world data) after breast-conserving therapy in Japan and the United States, which is scheduled to be presented at the 2025 Japanese Breast Cancer Society. In addition, the clinical trials we are currently conducting are as follows.

Clinical Trials

1) Single-arm confirmatory trial of endocrine therapy alone for estrogen receptor-positive, low-risk ductal carcinoma of the breast in situ (JCO1505, LORETTA Trial): This is a single-arm interventional study to confirm whether endocrine therapy alone for ER-positive low-risk DCIS is safe and effective compared with the current standard treatment.

2) Study for avoiding mastectomy using trastuzumab, pertuzumab and radiation for breast cancer (JCOG1806, AMATERAS-BC): This is a single-arm study to confirm the efficacy of avoiding surgical treatment for HER2-positive breast cancer patients who received neoadjuvant chemotherapy and achieved complete response.

3) Radiofrequency ablation (RFA) using a Cool-tip electrode system: A phase II study of RFA without resection was performed for T=<1.5 cm, N0 breast cancer patients using a Cool-tip electrode system (RAFAELO study); patients were offered RFA therapy for early breast cancer (PO-RAFAELO study).

4) Effectiveness of primary tumor resection for metastatic breast cancer (JCOG 1017): In this clinical trial, a primary tumor resection plus systemic therapy arm is compared with a systemic therapy alone arm in metastatic breast cancer.

5) Intensive vs. standard post-operative surveillance in high-risk breast cancer patients (JCOG1204, INSPIRE Trial): This is a randomized phase III trial to confirm the superiority of intensive follow-up to standard follow-up in terms of overall survival in high-risk breast cancer patients.

6) A prospective observational study to explore the impact of risk-reducing mastectomy and surveillance on mental and psychological status and quality of life in patients with hereditary breast cancer or ovarian cancer

7) Prospective observational study to evaluate Lemborexant Utility in iNsomniA women with bReast cancer; LUNAR (WJOG14921B)

8) Research and development of underwear for patients who have experienced breast cancer.

Education

 Our goal is to train residents to become leaders in breast cancer treatment from clinical and research perspectives. On the clinical side, we improve the understanding of breast diseases through various conferences and provide surgical guidance. We also provide guidance for conference presentations and writing papers, along with support for obtaining medical specialties and degrees.

Future Prospects

 We will deliver appropriate postoperative follow-up care, which has been a long-term concern in breast cancer medical care. We also aim to further develop surgical approaches with minimally invasive procedures such as endoscopic nipple-sparing mastectomy and cosmetic surgery. Moreover, we will construct a treatment system that is conscious of fertility preservation, hereditary cancers and appearance with an awareness of the patients' viewpoint.

List of papers published in 2023

Journal

1. Akechi T, Furukawa TA, Noma H, Iwata H, Toyama T, Higaki K, Matsuoka H, Zenda S, Iwatani T, Akahane K, Inoue A, Sagara Y, Uchida M, Imai F, Momino K, Imaizumi G, Yamaguchi T, Mashiko T, Miyaji T, Horikoshi M, Sakurai N, Onishi T, Kanemitsu Y, Murata T, Wanifuchi-Endo Y, Kuroda H, Nishikawa R, Miyashita M, Abe M, Uchitomi Y. Optimizing smartphone psychotherapy for depressive symptoms in patients with cancer: Multiphase optimization strategy using a decentralized multicenter randomized clinical trial (J-SUPPORT 2001 Study). Psychiatry and clinical neurosciences, 78:353-361, 2024

2. Miyazaki N, Iwasaki T, Sakai H, Watanuki R, Tanizawa Y, Cai Z, Kawaguchi T, Tsurutani J, Nagashima K. Risk factors for recurrence in patients with hormone receptor-positive/human epidermal growth factor receptor 2-negative early breast cancer in Japan: a systematic literature review and meta-analysis. Current medical research and opinion, 40:827-837, 2024

3. Takayama S, Kinoshita T, Shiino S, Jimbo K, Watanabe KI, Fujisawa T, Yamamoto N, Onishi T, Shien T, Ito M, Takahashi M, Futamura M, Aruga T, Kaneko K, Suto A. Patients Offer Radiofrequency Ablation Therapy for Early Breast Cancer as Local Therapy (PO-RAFAELO) Study under the Patient-proposed Health Services. JMA journal, 6:505-512, 2023

4. Yoshida M, Numajiri S, Notani N, Nomoto K, Urabe H, Sato JI, Yamashita Y, Hirao T. Novel double staining of the stratum corneum with fluorescent ε-poly-l-lysine and anionic dextran. International journal of cosmetic science, 45:400-412, 2023

5. Mizumoto S, Inubushi S, Miki M, Nakamura H, Baba M, Yamashita Y, Yamamoto M, Inoue S, Tanino H, Kunihisa T. Target-Oriented Classification of Triple-negative Breast Cancer. Anticancer research, 43:5067-5072, 2023

6. Yabe N, Watanuki R, Harada Y, Kondo A, Yanagisawa T, Maeda H, Kishi M, Yoshikawa T, Osumi K, Kamiya N, Sotome K, Ishii Y, Jinno H, Ikeda T, Watanabe M. [A Case of Triple Negative Breast Cancer with Successful Control of Recurrent Disease Activity for More than Ten Years]. Gan to kagaku ryoho. Cancer & chemotherapy, 50:1759-1761, 2023