Breast Conserving Surgery for Breast Cancer

Kim, Pyung Jib; Chang, Eil Sung

Abstract

One hundred twenty-nine patients with breast cancer were treated by breast-conserving surgery between January 1990 and December 1996 at the Department of Surgery, College of Medicine, Chungnam National University. Clinical results, various risk factors for local recurrence and distant metastasis were analyzed retrospectively. The median follow up period was 25 months, ranging from 6 months to 72 months. The most prevalent age was the fifth decade in 45 cases (35%). The most common tumor size was 2~5 cm (T2) in 52 cases (40%). The distance from the nipple to the tumor mass was 2~4 cm in 52 cases (40%), followed by 4~6 cm in 45 cases (35%) and 6~10 cm in 20 cases (16%). The breast skin incision for breast-conserving surgery was performed with a curvilinear incision in 72 cases (56%), followed by a radial incision in 57 cases (44%). The axillary skin incision was performed with separated incision in 103 cases (80%), continuous incision in 26 cases(20%). We performed a quadrantectomy in 83 cases (64%) and a lumpectomy in 46 cases (36%). A clear resection margin was obtained in all cases (129 cases). The most common complication was wound seroma (13 cases, 10%). By the time of follow up, the crude local recurrence rate was 8% (10 out of 129 cases) and the crude distant metastasis rate was 11% (15 out of 129 cases). Postoperative radiation therapy was the only factor significantly related to the local recurrence (2.4% for radiation therapy vs. 17.4% for no radiation therapy, p<0.05). Stage, positive axillary nodes, preoperative chemotherapy, distance from the nipple to the mass, age, and operation method were not significantly related to the local recurrence. Of the 10 patients with a local recurrence, salvage mastectomy was performed in five and a wide excision in two. A these patients are still alive with no evidence of disease at their last follow up. One patient refused on operation, and fellow ups were lost in two cases. Distant metastasis developed in 11% of the patients (15/129). Only pathologic stage was related significantly to the development of metastatic disease (2.2% for stage I and IIa vs. 33.3% for stage IIb, p<0.05).