The surgical treatment of early breast cancer. Results of a prospective study on 204 cases

The authors report the results of a prospective study on 204 patients (1980-1993) affected by early infiltrating breast cancer (size £ 2 cm) as a part of a surgical series of 608 cases. 53 cases who underwent QUART (25.9%) and 151 cases (74.1 %) who underwent mastectomy modified according to Patey have been collected. 10 years actuarial survival has been respectively 79% after extensive surgery and 78% after conservative treatment. Local recurrences have been observed in 9 cases after meticolous follow-up (median 74.8 months, range 12-178): 3 (5,66%) patients after QUART and 6 (3.97%) after mastectomy; furthermore 1 patient after a conservative treatment (1.88%) has developed a second tumor at the same side probably dependent on the presence in the primary tumor of an extensive intraductal component. No correlations between histological features, grading, positive nodes, receptor status and local recurrences have been found. Only the age of patients looks significantly correlated with frequency of recurrences: 44.45% of local recurrences have been observed in patients less than 45 years old. Local recurrences after QUART have obliged, in all cases, to a radical mastectomy. Furthermore, frequency of distant metastases has been considered: after QUART percentage is lower (9.43%) than after radical mastectomy (13.9%). This consideration looks correlated with the longer follow-up of the later group. A multidisciplinar approach is adviced but the most important role is plaied by surgery. In conclusion it is outlined that conservative surgery is addressed to selectioned and consenting patients.