Extended radical operations on breast cancer of medial or central location

Two groups of patients with central or medical primary breast cancer (T1-2N0-1M0) were studied. One group of 478 patients had an extended radical mastectomy (Urban-Kholdin) that included removal of the parasternal lymph nodes and adjoining costal cartilages. A second group of 519 concurrently treated patients had a conventional radical mastectomy (Halsted-Meyer). Among the patients who had an extended radical mastectomy, metastases were found in parasternal lymph nodes in 17.7% of those who had no metastasis in axillary or subclavicular lymph nodes, 40.9% of those who had a single metastatic focus in axillary or subclavicular lymph nodes, and 54.2% of those who had multiple axillary and/or subclavicular nodal metastases. Comparison of the two groups for the interval to tumor recurrence showed that extended radical mastectomy provided a better disease-free survivorship at both 5 and 10 years. Among patients who had an extended radical mastectomy, results at 5 years were better by 10.1% for those who had no lymph node metastases at all, better by 15.6% for those who had a single axillary or subclavicular metastasis, and better by 16.6% when multiple axillary and/or subclavicular nodal metastases were present. Follow-up at 10 and 20 years also showed a margin favoring extended radical mastectomy. Among the patients who had metastases only in parasternal lymph nodes, the disease-free survival rate was 67.4% at 5 years and 46.2% at 10 years. Extended radical mastectomy should be considered the preferred operative procedure for patients 60 years of age or younger who have primary breast cancer (T1-2N0-1M0) of central or medial origin.