COMPARATIVE OUTCOMES OF BREAST-CONSERVING SURGERY VERSUS MODIFIED RADICAL MASTECTOMY IN EARLY-STAGE BREAST CANCER: A RETROSPECTIVE STUDY FROM A TERTIARY CARE CENTER IN NORTH INDIA
Main Article Content
Keywords
Breast-conserving surgery, Modified radical mastectomy, Early-stage breast cancer, Disease-free survival, Cosmetic outcomes, Recurrence, Survival rate
Abstract
Breast-conserving surgery (BCS) and modified radical mastectomy (MRM) are the principal surgical options for early-stage breast cancer. While international studies demonstrate comparable oncologic outcomes, Indian data remain limited owing to variability in access to radiotherapy, delayed presentation, and socio-cultural influences.
Objectives: This study aims to compares oncological and postoperative outcomes between BCS and MRM in a tertiary care center in North India.
Methods: A retrospective observational study was conducted at a tertiary care hospital from July 2024 to June 2025. Female patients ≥18 years with AJCC Stage I–II breast cancer who underwent BCS or MRM were included. Patients with locally advanced/metastatic cancer, prior breast malignancy, neoadjuvant chemotherapy, or incomplete records were excluded. Clinical, pathological, and follow-up data were retrieved from hospital records. Primary outcomes were recurrence patterns, disease-free survival (DFS), and overall survival (OS). Secondary outcomes included postoperative complications, hospital stay, re-intervention, and cosmetic outcomes.
Statistical analysis was performed using Chi-square and t-tests; p <0.05 was considered significant.
Results: Of 180 eligible patients, 92 (51.1%) underwent BCS and 88 (48.9%) underwent MRM. Mean age was comparable (48.7 ± 9.6 vs. 51.2 ± 10.4 years, p = 0.08), though mean tumor size was significantly smaller in the BCS cohort (2.1 ± 0.8 cm vs. 2.8 ± 1.0 cm; p < 0.001). Overall complication rates did not differ significantly (17.4% vs. 22.7%; p = 0.35). Mean hospital stay was shorter with BCS (4.2 ± 1.8 vs. 6.5 ± 2.1 days; p <0.001). After a median 24-month follow-up, recurrence (6.5% vs. 9.1%; p = 0.50), DFS (93.5% vs. 90.9%; p = 0.48), and OS (97.8% vs. 95.5%;
p = 0.40) were comparable. Cosmetic satisfaction was significantly higher in the BCS group (87.0% vs. 34.1%; p <0.001).
Conclusion: BCS and MRM demonstrated similar short-term oncological outcomes in early-stage breast cancer. However, BCS provided superior cosmetic satisfaction and shorter hospitalization. Enhanced radiotherapy access and patient counseling may increase BCS uptake in suitable Indian patients.
References
2. Nandakumar A, Rath GK, Kataki AC, et al. Decreased survival with mastectomy vis-à-vis breast-conserving surgery in stage II and III breast cancers: a comparative treatment effectiveness study. Journal of Global Oncology. 2017 Aug;3(4):304-13. Available from: https:// pmc.ncbi.nlm.nih.gov/articles/PMC5560451/
3. Veronesi U, Cascinelli N, Mariani L, et al. Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. New England Journal of Medicine. 2002 Oct 17;347(16):1227-32. Available from: https:// www.nejm.org/doi/full/10.1056/NEJMoa020989
4. Christiansen P, Mele M, Bodilsen A, Rocco N, Zachariae R. Breast-conserving surgery or mastectomy?: impact on survival. Annals of Surgery Open. 2022 Dec 1;3(4):e205. Available from: https://journals.lww.com/aosopen/fulltext/2022/12000/ breast_conserving_surgery_or_ mastectomy impact.6.aspx
5. Kr A, Sp S, Kumar R. Rate of breast-conserving surgery vs mastectomy in developing countries. Annals of Oncology. 2019 May 1;30:iii43-4. Available from: https:// www.annalsofoncology.org/article/S0923-7534(19)30407-7/fulltext
6. de Boniface J, Szulkin R, Johansson AL. Survival after breast conservation vs mastectomy adjusted for comorbidity and socioeconomic status: a Swedish national 6-year follow-up of 48 986 women. JAMA surgery. 2021 Jul 1;156(7):628-37. Available from: https:// jamanetwork.com/journals/jamasurgery/fullarticle/2779531
7. Saini PK, Bhatnagar M. Comparison of rate of breast-conserving surgery vs mastectomy in breast cancer patients. Int J Acad Med Pharm. 2022;4(5):272-5. Available from: https:// www.academicmed.org/Uploads/Volume4Issue5/54.-1.-JAMP_Mohit-272-275.pdf
8. Jain U, Kothari A, Joshi S, Masannat YA. Breast conserving surgery revisited: a narrative review. Ann Breast Surg 2022;6:35. Available from: https://abs.amegroups.org/article/view/ 7368/html
9. Kadam SS, Tripathi P, Jagtap R, et al. Modified radical mastectomy vs breast-conserving surgery: current clinical practice in women with early stage breast cancer at a corporate tertiary cancer center in India. Indian journal of surgical oncology. 2022 Jun;13(2):322-8. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC9240152/
10. Nair NS. Paradigm shift in surgery for breast cancer: The Indian reality. Indian Journal of Cancer. 2011 Oct 1;48(4):389-90. Available from: https://journals.lww.com/indianjcancer/ fulltext/2011/48040/paradigm_shift_in_surgery_for_breast_cancer the.1.aspx
11. Plesca M, Bordea C, El Houcheimi B, Ichim E, Blidaru A. Evolution of radical mastectomy for breast cancer. Journal of medicine and life. 2016 Apr;9(2):183. Available from: https:// pmc.ncbi.nlm.nih.gov/articles/PMC4863512/
12. Fisher B, Anderson S, Bryant J, Margolese RG, Deutsch M, Fisher ER, Jeong JH, Wolmark N. Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. New England Journal of Medicine. 2002 Oct 17;347(16):1233-41. Available from: https://pubmed.ncbi.nlm.nih.gov/ 12393820/
13. Clarke M, Collins R, Darby S, et al. Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of the randomised trials. Lancet. 2005;366(9503):2087-106. Available from: https:// pubmed.ncbi.nlm.nih.gov/16360786/
14. Mendenhall NP. Breast-conserving therapy for early-stage breast cancer. Hematology/Oncology Clinics. 2001 Apr 1;15(2):219-42. Available from: https://pubmed.ncbi.nlm.nih.gov/11370490/
15. Li W, Zheng Y, Wu H, Li X. Breast-conserving therapy versus mastectomy for breast cancer: a ten-year follow-up single-center real-world study. Gland Surgery. 2022 Jul;11(7):1148. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC9346212/
16. Kim YS, Ryu DW, Lee CH. Comparison of survival outcomes between modified radical mastectomy and breast conserving surgery in early breast cancer patients. Kosin Medical Journal. 2016 Feb 4;31(1):19-29. Available from: https://www.kosinmedj.org/journal/view.php? doi=10.7180/kmj.2016.31.1.19
17. Suo S, Liu R, Yu X, Wang J, Wang M, Zhang Y, Liu Y. Incidence and risk factors of pain following breast cancer surgery: a retrospective national inpatient sample database study. BMC Women's Health. 2024 Oct 29;24(1):583. Available from: https://link.springer.com/article/ 10.1186/s12905-024-03430-3
18. Rosenkranz KM, Ballman K, McCall L, McCarthy C, Kubicky CD, Cuttino L, Hunt KK, Giuliano A, Van Zee KJ, Haffty B, Boughey JC. Cosmetic outcomes following breast conservation surgery and radiation for multiple ipsilateral breast cancer: Data from the Alliance Z11102 Study. Annals of surgical oncology. 2020 Jul 22;27(12):4650. Available from: https:// pmc.ncbi.nlm.nih.gov/articles/PMC7554157/
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All articles published in JPTCP are licensed under Copyright Creative Commons Attribution-NonCommercial 4.0 International License.
Dr Suraj Sahu
1Post Graduate Resident, Department of General Surgery, Government Medical College, Jammu,
India
Dr Aditya Chaubey
Post Graduate Resident, Department of Orthopaedics, Government Medical College, Jammu, India
Dr Jatin Rathore
Post Graduate Resident, Department of General Surgery, Government Medical College, Jammu, India
Dr Jatin Prajapati
Post Graduate Resident, Department of Community Medicine, RNT Medical College, Udaipur, Rajasthan, India