[Controversies in the surgical options for the patient with primary breast cancer]

We analysed the results of relapse free survivals for breast cancer patients treated with traditional mastectomy through 10 years of follow up. In the consecutive series of 162 patients with Stage III breast tumor, we noted that the mastectomy followed by radiation to axilla and adjacent area failed to confirm the efficacy to support the prevention for local and distant relapse in the past decade (1962-1974) (27.2%). The concepts of neoadjuvant and/or adjuvant chemotherapy were evolved primarily from clinical trials: these have been shown to influence favorably for the 228 patients with STAGE III in the next decade (1975-1985) (46.1%). Modified mastectomy, which involved removal of the breast, overlying skin and axillary contents but spares the pectoralis muscle, has recently been established as an entirely satisfactory approach for STAGE I (295 patients) and STAGE II (281 patients) breast carcinomas (1986-1991). Five-year relapse free survivals of these 2 categories calculated 93.7% and 86.8%, respectively. In recent studies, the many trials to breast conservation therapy reported, such as partial mastectomy plus nodes dissection with or without radiotherapy for selected patients with early cancer represent as effective results as modified mastectomy. Breast preservation has focused attention on the extent and distribution of cancer (multifocality, residual foci of surgical margin, etc) for clinicians.