[Changes in radical surgery of breast carcinoma in the last 20 years]

The retrospective analysis of 383 female patients with breast cancer of all tumor stages from the department of surgery (323 patients since 1979) and the department of gynaecology (58 patients since 1993) shows the abandonment of the radical mastectomy according to Rotter-Halsted (116 patients until 1989), acceptance of the modified radical mastectomy (178 patients since 1979) and introduction and rise of the breast conserving operations (67 patients since 1983). In 1992 there was an extension of breast conservation treatment from T1 N0 to T2 N1-2 tumors (tumor diameter till 4 cm). Operation technique: 1. Circular incision above the tumor, 2. tumor excision in histologically healthy tissue, 3. lower axillary dissection (level I and II with > or = 10 lymph nodes), 4. no suture of the gland and drainage without suction, 5. postoperative computerised high energy radiotherapy of the conserved breast (Clinic of radiotherapy of the University of Leipzig). Because of the high operation risk a simple mastectomy without axillary dissection was performed in 22 of 383 patients.

3 of 383 patients died = 0.78% postoperatively due to tumor independent complications. One local tumor recurrence was observed 6 years after breast conserving therapy in 25 patients operated until 1992. In 42 patients operated since 1993 a tumor recurrence did not occur so far. The 5-year-survival-rate in 153 patients of all tumor stages amounted to 64%, in node-negative patients 80.3%, in node positive patients 51.7%.

Breast conservation will be always recommended if the relation between tumor diameter and breast volume permits a cosmetic attractive result.