ORGAN-SPARING BREAST CANCER SURGERY

Aim. The aim of this article is to present review of current trends in organ-sparing treatment of breast cancer. Summary of own 15-year experience of organ-sparing breast cancer surgery and its analysis in the light of global trends.

Materials and methods. The analysis of results of radical treatment of 429 patients with invasive breast cancer T1-2N0-3M0 during period 1999-2013 is presented. From 1999 to 2007 quadrantectomy was performed. Since 2007 we stopped to excise fascia, and the boundaries of removed tissues around the tumor was limited by 0.5-1.0 cm. The skin over the tumor was excised only if there was suspicion of its possible tumor involvement. After removal of the specimen its margins were marked and express histological examination was performed. In case of positive margin re-resection of this margin was performed, and in case of repeatedly positive margin mastectomy was performed. Axillary lymph node dissection was performed in all patients with tumors diameter 1.0 cm or more. Until 2007 third level of lymph node dissection was performed. Since 2007, the volume of the procedure was determined depending on the level of attached lymph nodes, which was established by preoperative ultrasound or examination of axillary tissue during surgery. In cases of N0-tumors D1-lymph node dissection was performed, in cases of N1-tumors – D2 and in cases of N2-tumors – D3. Postoperative radiotherapy was used in all patients, except some patients older than 70 years with pT1N0-tumors and favorable morphological characteristics of the tumor.

Results. In January 2014 415 patients from 429 were observed. A relapse in saved breast occurred in 18 (4.3%) patients. In 6 (33.3%) cases it was combined with distant metastases. Noteworthy is that all patients with relapse received adjuvant radiotherapy and in 16 (88.9%) cases quadrantectomy was made. Patients with recurrent disease and with absence of distant metastases underwent mastectomy. In January 2014 they were all alive with the time of follow-up ranged from 30 to 162 months. Overall 5-year survival (Kaplan-Meier) was 92,3 ± 1,8% and 10-year survival was 84,2 ± 2,5%.

Conclusion. Organ-sparing treatment with careful selection of patients should be the method of choice. A retreat from the visible borders of the tumor 0.5 cm is sufficient.  The main goal of breast preserving is to achieve a good cosmetic result, so if this is not feasible - conserving surgery is meaningless.