Management of early breast cancer with breast conservative surgery. An egyptian experience.

Background: Breast conservative surgery (BCS) has been an established method for treatment of early breast cancer. The volume of the procedure varies from a wide local excision to partial mastectomy and ipsilateral axillary lymphadenectomy. The nipple and areola complex sparing, depends on their proximity to the tumour. Radiotherapy, chemotherapy and or hormonal treatment play an integral role in the treatment of early breast cancer.

Aim Of The Study: In the present study we present our experience at National Cancer Institute, Cairo University with breast conservative surgery in treatment of female patients with early (T1-T2) breast cancer. The aim is to examine the evidence based management of those cases and the outcome of treatment in terms of loco regional recurrence and/or distant metastasis.

Patients And Methods: The study includes 200 with early breast cancer patients who presented to the department of surgery, National Cancer Institute between May 2002 and February 2007. The average age was 46±6.5 years and the range was (26-72 years). Bilateral mammography, chest X-ray and full blood count were done routinely in the entire patients' group. The inclusion criteria included all patients presented with a breast tumor up to 4cm in greatest dimension (T1-2N0).

Results: Sixty Eight percent of patients underwent wide local excision, 20%underwent quadrantectomies, and 12% underwent partial mastectomy with or without nipple and areola preservation. All patients who underwent quadrantectomy or partial mastectomy required an augmentation mammoplasty to restore the breast volume. A latissmus dorsi myocutaneous flap was used in the majority of cases (70%), the rest were reconstructed with either a prosthetic implant or transverse rectus abdominis flap. The complications involved a total flap loss in 2 patients, partial flap loss in 2, nipple and areola sloughing in 4, wound infection in 5, haematoma in 4, seroma in 60, and donor site morbidity in 12 patients. Ninety three percent of patients had a radical radiotherapy treatment (4500G) and 86 percent received adjuvant chemotherapy while only 74% were given hormonal treatment based on the protocol of treatment and the histopathological findings. Late complications in the form of fat necrosis took place in 12% of patients, local recurrence developed in 7% of patients and distant metastasis in 8%, whereas 3% had both local recurrence and distant metastasis.

Conclusion: The results of the current study showed that evidence based management of early breast cancer with breast conservative surgery; in terms of the incidence of locoregional recurrence matches favorably with the reported international studies. The present study showed an increased risk of local recurrence in younger patients, patients with high grade disease and those with lymph node metastasis with capsular invasion. Those patients In particular, should be followed up on a regular basis for several years so that any sign of local failure can be diagnosed early and treated accordingly.

Key Words: Breast conservative surgery - Loco regional recurrence - Evidence based management of breast cancer.