EVALUATION OF THE RESULTS OF SURGICAL TREATMENT OF PATIENTS DIAGNOSED WITH BREAST CANCER FOR 2020-2021

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Relevance. Breast cancer is a global problem all over the world, as it is often found among malignant neoplasms in women. The main task of oncology is research in the field of oncogenesis, diagnosis, treatment and prevention of tumors. According to the estimates of the World Health Organization, 800 thousand to 1 million cases of breast cancer are registered in the world every year, which ranks second in the number of deaths. In the Russian Federation in 2020-2021, for the first time, 299,967 and 315,376 cases were detected, of which 1,832 and 1,515 patients were found in the Samara region. The increase in this indicator compared to 2020 was 4.4% [1, 2]. The greatest proportion of the spread of malignant neoplasms of the breast can be detected in the age group of 30-59 years (17.1%), which determines the high social significance of this disease. It is known that oncology has a hereditary predisposition and the effect of external factors.
Goal. To analyze the structure of patients diagnosed with breast cancer in 2020 and 2021 after surgical treatment according to appropriate parameters, such as age group, lesion side, number of tumors, pathomorphological stages of malignant neoplasm, name of the operation, its time and volume of blood loss.
Materials and methods. During the period of 2020-2021, surgical treatment was performed among 768 patients with breast cancer (25-89 years old) in the Samara Regional Clinical Oncological Dispensary. We decided to look at all possible parameters, evaluate and analyze the age of our patients, with what probability the side of the lesion is more common, in what number tumors prevail, find a more effective surgical treatment, calculate the average time of surgery and the amount of blood loss. According to our study, the distribution of patients by age group: 25-29 years - n=3 (0.40%), 30-34 years - n=13 (1.70%), 35-39 years - n=29 (3.77%), 40-44 years - n=76 (9.90%), 45-49 years - n=83 (10.80%), 50-54 years - n=71 (9.25%), 55-59 years - n=99 (12.90%), 60-64 years - n=124 (16.15%), 65-69 years - n=136 (17.70%), 70-74 years - n=82 (10.67%), 75-79 years - n=29 (3.77%), 80-84 years - n=19 (2.47%), 85-89 years - n=4 (0.52%). We can conclude that the main increase in patients who are most susceptible to breast cancer is the category of people from 65 to 69 years old (n=136 (17.70%). Relative to the side of the tumor lesion: on the left - n=416 (54.20%), on the right - n=352 (45.80%). It turns out that in 2020-2021, malignant neoplasm was detected from the left region to a greater extent in women (n=416 (54.20%). According to the number of tumors: one - n=680 (88.55%), two - n=73 (9.50%), three - n=8 (1.04%), four - n=7 (0.91%). In this case, our patients with the highest result have one tumor (n=680 (88.55%). Depending on the pathomorphological stage: stage 0 (TisN0M0) - n=0 (0%); stage IA: T1N0M0 - n=171 (22.30%); stage IIA: T1N1M0 - n=28 (3.64%), T2N0M0 - n=240 (31.25%); Stage IIB: T2N1M0 - n=174 (22.65%), T3N0M0 - n=19 (2.50%); stage IIIA: T1N2M0 - n=6 (0.80%), T2N2M0 - n=26 (3.40%), T3N1M0 - n=22 (2.86%), T3N2M0 - n=6 (0.80%); stage IIIB: T4bN0M0 - n=12 (1.56%), T4bN1M0 - n=15 (1.95%), T4bN2M0 - n=1 (0.13%) , T4bN3M0 - n=3 (0.40%); stage IIIC: T1N3M0 - n=15 (1.95%), T2N3M0 - n=15 (1.95%), T3N3M0 - n=6 (0.80%); stage IV: T1N0M1 - n=2 (0.26%), T2N0M1- n=6 (0.80%). According to the results, we can say that most of the patients with stage IIA are: T2N0M0 (n=240 (31.25%).According to the name of the operation: radical mastectomy according to Madden - n=569 (74.08%), radical resection - n=159 (20.70%), bisectoral resection - n=1 (0.13%), bilateral resection - n=5 (0.65%), sheath-fascial excision of the tumor - n=9 (1.18%), replacement of the expander with an endoprosthesis - n=12 (1.56%), delayed mammoplasty with an expander - n=13 (1.70%). According to the results of this calculation, it can be seen that mostly radical mastectomy was performed according to Madden (n=569 (74.08%). By operation time: 30 min - n=47 (6.12%), 60 min - n=281 (36.60%), 90 min - n=220 (28.65%), 120 min - n=81 (10.54%), 150 min - n=53 (6.90%), 180 min - n=72 (9.37%), 210 min and more - n=14 (1.82%). Based on the results obtained, our surgeons spend on average on the operation at diagnosis: breast cancer 60 minutes (n=281 (36.60%). By volume of blood loss: 10 ml - n=41 (5.33%), 20 ml - n=38 (4.95%), 30 ml - n=36 (4.70%), 40 ml - n=34 (4.42%), 50 ml - n=292 (38.02%), 60 ml - n=53 (6.90%), 70 ml - n=112 (14.60%), 80 ml - n=110 (14.32%), 90 ml - n=25 (3.25%), 100 ml - n=27 (3.51%). Thus, from this parameter it can be seen that a huge number of patients – 292 people (38.02%) lose 50 ml of blood at the time of surgery. This disease is systemic, which requires a proper approach to its treatment, in which the surgical stage is considered the main one, its results directly affect the quality of life of patients [3].
Results. According to the results of our study for 2020-2021, most operations were performed in women aged 65 to 69 years. The main localization of breast cancer prevails on the left side. More often, one neoplasm is found in our patients. Diagnostic studies of patients made it possible to establish a diagnosis at an early stage, which favorably affected the outcome of the disease. Madden mastectomy surgery is the most common among women with breast cancer. The amount of blood loss averaged 50 ml, and the time within 60 minutes. A key factor that contributes to increased survival after breast cancer diagnosis is its early removal. There are also factors that can increase the risk of developing an unfavorable outcome, these include: multiple lesions in one organ or in several organs and systems, an unresponsive reaction of the body to treatment, reproductive age.
Conclusion. Thus, it can be concluded that the most effective surgical treatment is to perform a Madden mastectomy, which reduces the risk of various complications. Early diagnosis and primary prevention of breast cancer favorably affects the outcome of the disease. Lifestyle and environmental factors play an important role in the development of this disease.

About the authors

Alexandra Valentinovna Morozova

Federal State Budgetary Educational Institution of Higher Education «Samara State Medical University» of the Ministry of Healthcare of the Russian Federation

Author for correspondence.
Email: sashamorozova98@yandex.ru
ORCID iD: 0000-0001-7537-2843
Russian Federation, 89 Chapaevskaya str., Samara, 443099, Russia

Darya Sergeevna Martynyuk

Federal State Budgetary Educational Institution of Higher Education «Samara State Medical University» of the Ministry of Healthcare of the Russian Federation

Email: daria.martyniuck.com@yandex.ru
ORCID iD: 0000-0002-3576-5519
Russian Federation, 89 Chapaevskaya str., Samara, 443099, Russia

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