Comparative Clinical Outcomes and Recurrence Patterns Following Mastectomy versus Breast Conserving Surgery in Female Breast Cancer Patients: A Multicenter Retrospective Cohort Study in Western Libya

Suzan Abusahmen; Fadia Oshkondale; Sumaya Draa; Hussein Ahmes; Younis Elfounas; Hana Almashkawi; Mohammed Aljarmi; Heba Khalifa

doi:10.54361/ajmas.2691005

Authors

Suzan Abusahmen Surgical Department, Faculty of Medicine, Zawia University, Zawia, Libya https://orcid.org/0009-0006-5013-3217
Fadia Oshkondale Department of Pharmacology, Faculty of Medicine, University of Zawia, Zawia, Libya https://orcid.org/0009-0008-2792-2343
Sumaya Draa Surgical Department, Faculty of Medicine, Zawia University, Zawia, Libya https://orcid.org/0009-0001-3856-0308
Hussein Ahmes Surgical Department, Subrata National Cancer Institute (SNCI), Subrata, Libya https://orcid.org/0009-0005-5370-1454
Younis Elfounas Surgical Department, Abu Salim Trauma Hospital, Tripoli, Libya https://orcid.org/0009-0005-7095-4461
Hana Almashkawi Surgical Department, Faculty of Medicine, Zawia University, Zawia, Libya https://orcid.org/0009-0001-6365-594X
Mohammed Aljarmi Libyan Authority for Scientific Research, Tripoli, Libya https://orcid.org/0009-0001-2879-6464
Heba Khalifa Department of Obstetrics and Gynecology, Faculty of Medicine, Zawia University, Zawia, Libya https://orcid.org/0009-0003-1500-6448

DOI:

https://doi.org/10.54361/ajmas.2691005

Keywords:

Breast Cancer, Mastectomy, Breast-Conserving Surgery, Recurrence, Libya

Abstract

Breast cancer is the most common cancer diagnosed in women worldwide. In high-income countries, breast-conserving surgery combined with radiotherapy gives survival similar to mastectomy in early-stage disease. Whether this holds in low-resource settings such as Libya, where radiotherapy access and follow-up are less consistent, is not well documented. We conducted a retrospective cohort study of 122 women treated for histologically confirmed, non-metastatic breast cancer at two centers in Western Libya between 2021 and 2026. Sixty-nine patients underwent breast-conserving surgery and 53 underwent mastectomy. Baseline characteristics, treatment, recurrence, and follow-up adherence were compared between groups using the independent t-test, chi-square test, or Fisher's exact test as appropriate. Logistic regression identified predictors of recurrence. Patients who had mastectomy presented with larger tumors (2.5 ± 0.6 cm vs 2.0 ± 0.7 cm, p<0.001) and more often had positive lymph nodes (64.2% vs 5.8%, p<0.001) than patients who had breast-conserving surgery. Twelve recurrences were recorded overall (9.8%), all distant, occurring more often after mastectomy than breast-conserving surgery (18.9% vs 2.9%, p=0.009). Tumor size was the strongest independent predictor of recurrence (adjusted odds ratio 5.44 per cm, 95% Confidence Interval (CI) 1.79–16.50, p=0.003), and mastectomy remained associated with recurrence after adjustment for tumor size (adjusted odds ratio 5.37, 95% CI 1.04–27.56, p=0.044). About one in five patients who had breast-conserving surgery did not receive documented radiotherapy. Follow-up adherence did not differ between groups (87.0% vs 83.0%, p=0.74). In this Western Libyan cohort, mastectomy was reserved largely for women with larger, node-positive tumors, and the higher recurrence observed after mastectomy appears driven mainly by this underlying disease burden rather than the surgical approach itself. Gaps in radiotherapy delivery after breast-conserving surgery deserve attention. Larger prospective studies with longer follow-up are needed.