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In order to clarify the surgical aspects for parasternal lymphnode dissection to improve prognosis in patients with breast cancer, we have retrospectively investigated a total of 319 patients with breast cancer who underwent radical mastectomy with parasternal lymphnode dissection. During the 13 years from 1974 to 1986, 418 patients with breast cancer underwent radical mastectomy. Of these, 319 underwent combined dissection of the parasternal lymphnodes. Among these 319 cases, 36 (11.3%) showed pathologically-confirmed positive lymphnode metastasis. In those cases involving a tumor of diameter greater than 5 cm and more than 4 positive metastatic axillar lymphnodes, then the positive parasternal lymphnode metastasis was higher than 30%. The 5-year survival rate was 88.9% for negative parasternal lymphnode metastasis and 44.7% for positive cases (p less than 0.01 logrank test). The standard adjuvant chemotherapy, chemo-endocrine therapy and radiation therapy, each did not significantly affect or improve prognosis. We conclude that parasternal lymphnode positivity is an important factor in radical mastectomy affecting prognosis and a more powerful adjuvant chemotherapy must be developed to improve prognosis.
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