A PROSPECTIVE COMPARATIVE STUDY BETWEEN MODIFIEDRADICAL MASTECTOMY AND BREAST CONSERVATION SURGERY IN EARLY BREAST CANCER

Background: The improvement in the treatment of breast cancer is due to early diagnosis, better understanding of the natural history of this disease and therapeutic improvements over the years. There is a gradual shift away from radical surgery advocated by Halsted to the breast conservative surgery during the last few decades all over the world mainly influenced by the results of several large trials of lesser surgical procedures. Methods: Hospital based descriptive study was conducted on patients with Early Breast Cancer presenting to the Department of General Surgery in Guru Gobind Singh Medical College & Hospital, Faridkot. Results: Mean blood loss of the subjects of the BCS group was observed to be 44.07±15.76 ml as compared to 94.36 ± 31.50 ml in the subjects of the MRM. Mean operative time of the subjects of the BCS group was observed to be 46.03±8.68 minutes as compared to the mean operative time of 64.03±16.56 minutes in the subjects of the MRM group. Mean VAS score on day-1 in BCS group and in MRM group was 5.3±1.98 and 6.73±1.70 respecively. Mean VAS score on day-3 in BCS group and in MRM group was 4.46±1.50 and 5.1±1.56 respectively. Mean VAS score on day-5 in BCS group and in MRM group was 2.96±0.76 and 2.96±1.06 respectively. Seroma Formation was observed in 3.33 % cases in BCS group and 16.67 % in MRM group. Flap necrosis was observed in 0 % in BCS group whereas 10.00 % of the patients had flap necrosis in MRM group. Positive margins were absent in both BCS group and MRM group. Wound infection was observed in 6.67% of the patients in the BCS group and 20.00% in the MRM group. Quality of life score for BCS and MRM was 108.53±14.62 and 95.26±14.70 respectively. Conclusion: Breast conservation surgery should be the preferred treatment for Stage-I and Stage-II Breast cancer disease due to its lesser post-operative pain, shorter duration of surgery, lesser blood loss and short hospital stay thus helping in early returning to normal activity. Breast conservation surgery has better outcomes compared with Modified radical mastectomy.


Introduction
The improvement in the treatment of breast cancer is due to early diagnosis, better understanding of the natural history of this disease and therapeutic improvements over the years. The surgical treatment provides a reasonable chance of curing for most of the early breast cancers. It mainly aims at dealing with potentially curable cancer confined to the breast and regional lymph nodes. 1 The approach to operable breast cancer changed dramatically over the past century and so is the use of adjuvant therapy and presentation of the disease. Due to increasing awareness and improved diagnostic techniques and screening modalities breast cancer is nowadays diagnosed at an earlier stage. 2 During the 1970s, the Fisher propagated the idea that the disease in the majority of patients has already disseminated sub clinically at an early stage before diagnosis. The Fisher attitude put an emphasis on systemic therapy than extensive surgery 2 . There is a gradual shift away from radical surgery advocated by Halsted to the breast conservative surgery during the last few decades all over the world mainly influenced by the results of several large trials of lesser surgical procedures. 3 Conservative procedures refer to various treatment strategies that leave the breast largely intact with or without postsurgical radiation therapy and with or without axillary dissection. Several randomised studies compared different aspects of modified radical mastectomy and breast conservative surgery. 4,5 They all confirmed almost identical survival after these two treatment options. Sample Size: 60 consecutive patients were included and using randomisation software were divided in to two groups Group-A and GROUP-B.

Group-A Included patients undergoing Modified Radical Mastectomy
Group-B Included patients undergoing Breast Conservative Surgery Data was collected and compared, and analysed for Post-op complications, outcome and psychosocial effects.

Statistical Analysis
Statistical testing was conducted with the statistical package for the social science system version SPSS 17.0. Continuous variables were presented as mean ±SD or median if the data was unevenly distributed. Categorical variables were expressed as frequencies and percentages. The comparison of normally distributed continuous variables between the groups was performed using Student's t-test. Nominal categorical data between the groups were compared using Chi-squared test or Fisher's exact test as appropriate. Non-normal distribution continuous variables were compared using Mann Whitney U test. For all statistical tests, a p-value less than 0.05 were taken to indicate a significant difference  In study conducted by Irwig and Bennetts it was concluded that apart body image it is unclear whether breast conservation or mastectomy results in better psychosocial outcomes. 12

Conclusion
Breast conservation surgery should be the preferred treatment for Stage-I and Stage-II Breast cancer disease due to its lesser post-operative pain, shorter duration of surgery, lesser blood loss and short hospital stay thus helping in early returning to normal activity. Breast conservation surgery has better outcomes compared with Modified radical mastectomy.
Further Modified radical mastectomy is a more debilitating surgery and preservation of breast after Breast conservation surgery boosts psychological well-being of the patient thus improving quality of life. Hence we recommend routine use of Breast Conservation Surgery where patients are motivated to undergo Breast conservation surgery.