ABSTRACT
Surgical management of phyllodes tumors is not clearly defined in literatures and even controversial due to the unpredictable biological behavior of these neoplasms. The authors present a prospective cohort of patients who underwent a wide range of tumor excisions to evaluate the oncologic and long term results of these procedures. Starting at June 1990 through September 2004, 64 evaluable female patients were operated for the treatment of PT in our hospital. Patients had a median age of 38 years [16-74] and a median clinical tumor size of 8 cm [3-25]. Preoperative diagnosis was made by the usual triple assessment [clinical examination, mammography and/or ultrasonography and fine needle cytology]. Surgical options included local excision [36 patients], wide local resection [13 patients], simple mastectomy [7 patients], modified radical mastectomy [4 patients], and skin sparing mastectomy [4 patients]. The median follow-up period was 89 months [3-203], where patients were regularly investigated by the same triple assessment together with the metastatic work-up. Histological examination of the surgical specimens showed 39 benign, 10 borderline and 15 malignant phyllodes tumors. Surgical margin was jeopardized in 16/36 44%] after local excision in contrast to the other procedures and consequently local recurrence rate was high 22/36 [61%]. Benign and borderline tumors had less recurrence rate com-wed to malignant lesions [40% Vs. 60%]. Overall 5-year survival rate [73.4%] was not decreased by these high rates of local recurrence because most of them could be resected adequately and the risk of distant metastasis a as low [5 patients or 7.8%]. Tumor grade, tumor margin and age of the patients were significant prognostic factors whereas, tumor size was found non significant. Phyllodes tumor in general should be reacted widely if tumor size to breast size permits clear margins. We encourage re-excision of accidentally discovered tumors after local excision of what was thought as fibroadenomas. Skin sparing mastectomy is an excellent alternative to mastectomy for these tumors provided skin of the breast is intact and away of tumor margin