Review Article| Volume 103, ISSUE 1, P93-106, February 2023

Operative Management in Stage IV Breast Cancer

Published:October 17, 2022DOI:


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribers receive full online access to your subscription and archive of back issues up to and including 2002.

      Content published before 2002 is available via pay-per-view purchase only.


      Subscribe to Surgical Clinics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Giuliano A.E.
        • Edge S.B.
        • Hortobagyi G.N.
        Eighth edition of the AJCC cancer staging manual: breast cancer.
        Ann Surg Oncol. 2018; 25: 1783-1785
        • Mariotto A.B.
        • Etzioni R.
        • Hurlbert M.
        • et al.
        Estimation of the number of women living with metastatic breast cancer in the united states.
        Cancer Epidemiol Biomarkers Prev. 2017; 26: 809-815
        • American Cancer Society
        Breast Cancer Facts & Figures 2019-2020.
        • Thomas A.
        • Khan S.A.
        • Chrischilles E.A.
        • et al.
        Initial surgery and survival in stage IV Breast cancer in the united states, 1988-2011.
        JAMA Surg. 2016; 151: 424-431
        • Teshome M.
        Role of operative management in stage IV breast cancer.
        Surg Clin North Am. 2018; 98: 859-868
        • Flanigan R.C.
        • Salmon S.E.
        • Blumenstein B.A.
        • et al.
        Nephrectomy followed by interferon Alfa-2b compared with interferon Alfa-2b alone for metastatic renal-cell cancer.
        N Engl J Med. 2001; 345: 1655-1659
        • Mickisch G.H.J.
        • Garin A.
        • van Poppel H.
        • et al.
        Radical nephrectomy plus interferon-alfa-based immunotherapy compared with interferon alfa alone in metastatic renal-cell carcinoma: a randomised trial.
        Lancet. 2001; 358: 966-970
        • National Comprehensive Cancer Network
        NCCN clinical practice guidelines in oncology: breast cancer, Version 1.2022.
        (Available at:)
        • Freedman R.A.
        • Keating N.L.
        • Lin N.U.
        • et al.
        Breast cancer-specific survival by age: worse outcomes for the oldest patients.
        Cancer. 2018; 124: 2184-2191
        • Chitapanarux I.
        • Sripan P.
        • Somwangprasert A.
        • et al.
        Stage-specific survival rate of breast cancer patients in northern thailand in accordance with two different staging systems.
        Asian Pac J Cancer Prev. 2019; 20: 2699-2706
        • Rashid O.M.
        • Takabe K.
        Does removal of the primary tumor in metastatic breast cancer improve survival?.
        J Womens Health (Larchmt). 2014; 23: 184-188
        • Folkman J.
        New perspectives in clinical oncology from angiogenesis research.
        Eur J Cancer. 1996; 32: 2534-2539
        • Fisher E.R.
        • Fisher B.
        Experimental studies of factors influencing the development of hepatic metastases: XIII. Effect of hepatic trauma in parabiotic pairs.
        Cancer Res. 1963; 23: 896-900
        • Al-Sahaf O.
        • Wang J.H.
        • Browne T.J.
        • et al.
        Surgical injury enhances the expression of genes that mediate breast cancer metastasis to the lung.
        Ann Surg. 2010; 252: 1037-1043
        • Ferrand F.
        • Malka D.
        • Bourredjem A.
        • et al.
        Impact of primary tumour resection on survival of patients with colorectal cancer and synchronous metastases treated by chemotherapy: Results from the multicenter, randomised trial Fédération Francophone de Cancérologie Digestive 9601.
        Eur J Cancer. 2013; 49: 90-97
        • Khan S.A.
        • Stewart A.K.
        • Morrow M.
        Does aggressive local therapy improve survival in metastatic breast cancer? Surgery.
        . 2002; 132 ([discussion: 626-7]): 620-626
        • Rapiti E.
        • Verkooijen H.M.
        • Vlastos G.
        • et al.
        Complete excision of primary breast tumor improves survival of patients with metastatic breast cancer at diagnosis.
        J Clin Oncol. 2006; 24: 2743-2749
        • Gnerlich J.
        • Jeffe D.B.
        • Deshpande A.D.
        • et al.
        Surgical removal of the primary tumor increases overall survival in patients with metastatic breast cancer: analysis of the 1988–2003 SEER data.
        Ann Surg Oncol. 2007; 14: 2187-2194
        • Babiera G.V.
        • Rao R.
        • Feng L.
        • et al.
        Effect of primary tumor extirpation in breast cancer patients who present with stage IV disease and an intact primary tumor.
        Ann Surg Oncol. 2006; 13: 776-782
        • Lang J.E.
        • Tereffe W.
        • Mitchell M.P.
        • et al.
        Primary Tumor extirpation in breast cancer patients who present with stage IV disease is associated with improved survival.
        Ann Surg Oncol. 2013; 20: 1893-1899
        • Fields R.C.
        • Jeffe D.B.
        • Trinkaus K.
        • et al.
        Surgical resection of the primary tumor is associated with increased long-term survival in patients with stage IV breast cancer after controlling for site of metastasis.
        Ann Surg Oncol. 2007; 14: 3345-3351
        • Blanchard D.K.
        • Shetty P.B.
        • Hilsenbeck S.G.
        • et al.
        Association of surgery with improved survival in stage IV breast cancer patients.
        Ann Surg. 2008; 247: 732-738
        • Bafford A.C.
        • Burstein H.J.
        • Barkley C.R.
        • et al.
        Breast surgery in stage IV breast cancer: impact of staging and patient selection on overall survival.
        Breast Cancer Res Treat. 2009; 115: 7-12
        • Ruiterkamp J.
        • Ernst M.F.
        • van de Poll-Franse L.V.
        • et al.
        Surgical resection of the primary tumour is associated with improved survival in patients with distant metastatic breast cancer at diagnosis.
        Eur J Surg Oncol (EJSO). 2009; 35: 1146-1151
        • Vohra N.A.
        • Brinkley J.
        • Kachare S.
        • et al.
        Primary tumor resection in metastatic breast cancer: a propensity-matched analysis, 1988-2011 SEER data base.
        Breast J. 2018; 24: 549-554
        • Stahl K.
        • Wong W.
        • Dodge D.
        • et al.
        Benefits of surgical treatment of stage IV breast cancer for patients with known hormone receptor and HER2 status.
        Ann Surg Oncol. 2021; 28: 2646-2658
        • Dominici L.
        • Najita J.
        • Hughes M.
        • et al.
        Surgery of the primary tumor does not improve survival in stage IV breast cancer.
        Breast Cancer Res Treat. 2011; 129: 459-465
        • Cady B.
        • Nathan N.R.
        • Michaelson J.S.
        • et al.
        Matched pair analyses of stage IV breast cancer with or without resection of primary breast site.
        Ann Surg Oncol. 2008; 15: 3384-3395
        • King T.
        • Lyman J.
        • Gonen M.
        • et al.
        Abstract P2-18-09: TBCRC 013: a prospective analysis of the role of surgery in stage IV breast cancer.
        Cancer Res. 2013; 73 (18-09-P2-18-09): P2
        • King T.A.
        • Lyman J.
        • Gonen M.
        • et al.
        A prospective analysis of surgery and survival in stage IV breast cancer (TBCRC 013).
        J Clin Oncol. 2016; 34: 1006
        • Badwe R.
        • Hawaldar R.
        • Nair N.
        • et al.
        Locoregional treatment versus no treatment of the primary tumour in metastatic breast cancer: an open-label randomised controlled trial.
        Lancet Oncol. 2015; 16: 1380-1388
        • Soran A.
        • Ozmen V.
        • Ozbas S.
        • et al.
        Randomized trial comparing resection of primary tumor with no surgery in stage IV breast cancer at presentation: protocol MF07-01.
        Ann Surg Oncol. 2018; 25: 3141-3149
        • Fitzal F.
        • Bjelic-Radisic V.
        • Knauer M.
        • et al.
        Impact of breast surgery in primary metastasized breast cancer: outcomes of the prospective randomized phase III ABCSG-28 POSYTIVE trial.
        Ann Surg. 2019; 269: 1163-1169
        • Khan S.A.
        • Zhao F.
        • Goldstein L.J.
        • et al.
        Early local therapy for the primary site in de novo stage IV breast cancer: results of a randomized clinical trial (EA2108).
        J Clin Oncol. 2022; 40: 978-987
        • Khan S.A.
        • Zhao F.
        • Solin L.J.
        • et al.
        A randomized phase III trial of systemic therapy plus early local therapy versus systemic therapy alone in women with de novo stage IV breast cancer: a trial of the ECOG-ACRIN Research Group (E2108).
        J Clin Oncol. 2020; 38: LBA2
        • Shien T.
        • Mizutani T.
        • Tanaka K.
        • et al.
        A randomized controlled trial comparing primary tumor resection plus systemic therapy with systemic therapy alone in metastatic breast cancer (JCOG1017 PRIM-BC).
        J Clin Oncol. 2017; 35: TPS588
        • Hotton J.
        • Lusque A.
        • Leufflen L.
        • et al.
        Early locoregional breast surgery and survival in de novo metastatic breast cancer in the multicenter national ESME cohort.
        Ann Surg. 2021;
        • Barinoff J.
        • Schmidt M.
        • Schneeweiss A.
        • et al.
        Primary metastatic breast cancer in the era of targeted therapy – Prognostic impact and the role of breast tumour surgery.
        Eur J Cancer. 2017; 83: 116-124
        • Bishop A.J.
        • Ensor J.
        • Moulder S.L.
        • et al.
        Prognosis for patients with metastatic breast cancer who achieve a no-evidence-of-disease status after systemic or local therapy.
        Cancer. 2015; 121: 4324-4332
        • Singletary S.E.
        • Walsh G.
        • Vauthey J.-N.
        • et al.
        A Role for curative surgery in the treatment of selected patients with metastatic breast cancer.
        Oncologist. 2003; 8: 241-251
        • Fan J.
        • Chen D.
        • Du H.
        • et al.
        Prognostic factors for resection of isolated pulmonary metastases in breast cancer patients: a systematic review and meta-analysis.
        J Thorac Dis. 2015; 7: 1441-1451
        • Chmura S.J.
        • Winter K.A.
        • Al-Hallaq H.A.
        • et al.
        NRG-BR002: a phase IIR/III trial of standard of care therapy with or without stereotactic body radiotherapy (SBRT) and/or surgical ablation for newly oligometastatic breast cancer (NCT02364557).
        J Clin Oncol. 2019; 37: TPS1117
        • Wingo P.A.
        • Jamison P.M.
        • Young J.L.
        • et al.
        Population-based statistics for women diagnosed with inflammatory breast cancer (United States).
        Cancer Causes & Control. 2004; 15: 321-328
        • Fouad T.M.
        • Kogawa T.
        • Liu D.D.
        • et al.
        Overall survival differences between patients with inflammatory and noninflammatory breast cancer presenting with distant metastasis at diagnosis.
        Breast Cancer Res Treat. 2015; 152: 407-416
        • Akay C.L.
        • Ueno N.T.
        • Chisholm G.B.
        • et al.
        Primary tumor resection as a component of multimodality treatment may improve local control and survival in patients with stage IV inflammatory breast cancer.
        Cancer. 2014; 120: 1319-1328
        • Warren L.E.
        • Guo H.
        • Regan M.M.
        • et al.
        Inflammatory breast cancer: patterns of failure and the case for aggressive locoregional management.
        Ann Surg Oncol. 2015; 22: 2483-2491
        • Takiar V.
        • Akay C.L.
        • Stauder M.C.
        • et al.
        Predictors of durable no evidence of disease status in de novo metastatic inflammatory breast cancer patients treated with neoadjuvant chemotherapy and post-mastectomy radiation.
        Springerplus. 2014; 3: 166