Locoregional Resection in Stage IV Breast Cancer: Tumor Biology, Molecular and Clinical Perspectives

The intact primary in patients diagnosed with Stage IV breast cancer is generally reserved for palliative indications. Haagensen and Stout's 1943 criteria of inoperability for carcinoma of the breast, including tumor fixation to the chest wall, ulceration, and peau d'orange, hold true. Surgery alone is unlikely to prolong life in such patients. Improvements in breast cancer screening and awareness mean fewer patients having inoperable breast cancer. The current problem is that imagining studies reveal some patients to have oligometastatic disease with an intact primary. This article considers surgical treatment as part of multimodal Stage IV breast cancer treatment for such patients. Several challenges to previous dogma to never operate on Stage IV breast cancer patients except with palliative intent have arisen.