Scope of Advanced Breast Cancer Surgery in a Govt. Hospital - A Single Centre Experience
Authors: Sharmin Islam, Sadia Afrin Tani, Mst Jesmen Nahar, Fahimul Islam Mondol, Prof. Salma Sultana
Institution: Dept. of Surgery, Dhaka Medical College Hospital
Introduction
Breast cancer is the 2nd leading cancer worldwide. Breast cancer management has been upgraded tremendously. Breast cancer surgery has been also evolved day by day. Paradigm shifted from Haisted Radical Mastectomy to Patey's Modified Radical Mastectomy Breast Conserving Surgery (BCS) with Axillary Dissection (ALND) / Sentinel Lymph node Biopsy (SLNB). Treatment cost aiso increased along with the modernized management. Though Govt. Hospital has its own limitations, we are trying to provide current surgical practice to our patients.
Methods
A retrograde observational study was done in Department of Surgery, Dhaka Medical College Hospital from 01.01.2024 till date, among the Breast cancer patients who underwent BCS. Purposive sampling technique was applied. Preoperatively, MRI of Both breast was present in most of the cases other than conventional triple assessment and Staging investigations, Hydromarker was present in 3 cases, NACT given in 7 cases, Post NACT response was assessed clinically and radiologically. Peroperatively, Specimen radiograph, Frozen Section biopsy done in all cases to assess the resection margin. Postoperatively, adjuvant as well as tumour Boost Radiotherapy were ensured in all cases.
Results
Among 9 patients, BCS with level 1 oncoplasty done in 2 pts, wire guided wide local excision in 3 patients, Lateral mammoplasty in 2 patients, Grisotti technique in 1 patient, dermoglandular rotation technique in 1 patient. Among complications, seroma developed in 2 cases, SSI in 2 cases.
Conclusion
Breast Conserving Surgery provides better cosmesis along with oncological safety if treated properly and timely completed all modalities of management in breast cancer patients. Other than patient burden, single machine for frozen section biopsy, trained staff, any sort of adjuvant radiotherapy for breast can not be provided by Govt. hospitals. So patient motivation for expensive Radiotherapy after BCS is very difficult. Our Govt. should come forward to overcome the difficulties and financial issues regarding cancer management, so that we can step forward along with other developed countries.
