Comparative Analysis of Oncologic and Functional Outcomes Following Breast-Conserving Surgery and Modified Radical Mastectomy in Patients with Locally Advanced Breast Cancer
Submission: 21 August 2025 | Acceptance: 26 September 2025 | Publication: 24 November 2025
1Dr Javaid Iqbal, 2Waqar Manzoor, 3Dr Kaleem Akhtar, 4Khawar Qayyum, 5Sobia Wajid, 6Abbas Ali
1Prof of Surgery, Continental Medical college Lahore.
2Mayo Hospital Lahore
3Karachi Institute of Medical Sciences Karachi
4PIMS Islamabad
5PIMS
6RIC Rawalpindi
ABSTRACT
Background: Breast-conserving surgery (BCS) has become standard in early-stage breast cancer. Still, its role in locally advanced breast cancer (LABC) remains debated, particularly in low- and middleincome countries (LMICs). This study compares oncological and functional outcomes of BCS versus modified radical mastectomy (MRM) in LABC patients following neoadjuvant chemotherapy. Methods: We conducted a retrospective observational study of 200 women with LABC treated at a tertiary care center. Patients underwent either BCS (n = 120) or MRM (n = 80) following neoadjuvant therapy. Data on tumor characteristics, recurrence, survival, postoperative morbidity, and quality of life were collected and analyzed.
Results: At a median follow-up of 60 months, the 5-year disease-free survival (DFS) was 78% in the BCS group and 65% in the MRM group (p = 0.04), while overall survival (OS) was 85% versus 70%, respectively (p = 0.02). Recurrence and distant metastasis were lower in the BCS group. Multivariate analysis identified triple-negative subtype, nodal positivity, and lack of pathologic complete response—not surgical type—as independent predictors of poorer outcomes. BCS patients reported fewer complications, shorter hospital stays, quicker recovery, and better body image and social functioning scores.
Conclusion: BCS is oncologically safe and functionally superior to MRM in selected LABC patients treated with neoadjuvant therapy, even in LMIC settings. Broader adoption of BCS in countries like Pakistan will require improved access to radiotherapy, oncoplastic training, and earlier detection strategies.
Keywords: breast cancer, locally advanced breast cancer, breast-conserving surgery, modified radical mastectomy, low- and middle-income countries, survival outcomes, quality of life, Pakistan.