Surgical Procedures with Questionable Indications: A Letter from Russia

Partial isolation of Russian medicine and medical research from the international community had consequences for the healthcare. Obviously, it is one of the causes of the relatively low life expectancy [1]. According to the author's estimates after a practice abroad, an average size of malignant tumors in surgical specimens was considerably larger in central Moscow clinics compared to hospitals in some countries of Western Europe, which means that early detection of malignancies is less efficient in Russia. Abroad, almost all mastectomy specimens were without muscle. In Moscow hospitals, the modified radical mastectomy (Patey) with the removal of the pectoralis minor muscle has been the standard procedure in the last decades; but the Halsted operation with the removal of both major and minor pectoralis muscles was applied as well. The Halsted operation prevailed earlier; it was recommended by Soviet-time textbooks for all types of breast cancer. The Halsted operation was presented as a main treatment modality for breast cancer even in some handbooks edited after the year 2000 [2,3]. The worldwide tendency towards conservation in the treatment of breast cancer remained largely unnoticed in the former Soviet Union (SU) for a long time.