title: Breast-conserving surgery in early-stage breast cancer (indications, local recurrences, survival, cosmetic results).
abstract: BACKGROUND
  Breast cancer is an extremely actual problem in modern medicine and surgery in particular. Constantly growing frequency, younger age of the newly diagnosed patients, severe psychological collapse of the patients and serious impairment of quality of life are only some of the factors determining actuality of the problem.
  
  
  OBJECTIVE
  The aim of the present survey is to make a retrospective comparative clinical analysis of the results obtained after breast-conserving surgery and simple mastectomy in terms of 5- and 10-year survival, local recurrences and cosmetic outcome.
  
  
  METHODS
  Over a 19-year period, 269 breast cancer patients were treated in the Clinic. Breast-conserving surgery plus axillary lymph node dissection in levels I, II and III was performed in 66.17% of the patients. In 33.83% of the patients ablation of the mammary gland (simple mastectomy) plus axillary lymph node dissection was done. In both groups adjuvant radiation therapy was performed and patients with positive axillary lymph nodes were further subjected to chemotherapy. Adjuvant hormone therapy with anti-estrogen drugs was administered in estrogen positive patients.
  
  
  RESULTS
  Study of the late (5- and 10-year) results showed that in complex treatment the recurrence rate in patients subjected to breast-conserving surgery (BCS) was 4.00% and in those treated by simple mastectomy (SM)--2.99%. The 5-year survival was 90.10% for the patients undergoing BCS and 88.89% for those treated by SM. The 10-year survival was 80.56% for the patients treated by BCS and 77.14% for those subjected to SM.
  
  
  CONCLUSIONS
  Breast-conserving surgery is indicated in all patients in stage I and II of the disease and tumor measured up to 3.5 cm regardless of the axillary lymph nodes status. There is no statistically significant difference in the survival rate between the two compared groups and cosmetic results are much better in the patients subjected to breast-conserving surgery. When complex treatment is accomplished breast-conserving operations provide recurrence rate equal to that in simple mastectomy. Unfavorable prognostic factors for recurrence are younger age, bigger lump size, greater number of positive lymph nodes and estrogen/progesterone negative status.
authors.affiliation: Third Surgical Clinic, University Hospital St George, Medical University, Plovdiv, Bulgaria.
authors.forename: Franz S
authors.initials: FS
authors.lastname: Mitov
authors.forename: Vesselin V
authors.initials: VV
authors.lastname: Molov
mesh_terms: D000328:Adult; D001365:Axilla; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000401:mortality* / Q000601:surgery; D002277:Carcinoma / Q000175:diagnosis* / Q000401:mortality* / Q000601:surgery; D003131:Combined Modality Therapy; D004954:Esthetics; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000601:surgery; D015412:Mastectomy, Segmental / Q000379:methods*; D015413:Mastectomy, Simple / Q000379:methods; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D012189:Retrospective Studies; D015996:Survival Rate