AACR COVID-19: Balancing Risks and Benefits of Surgery for Breast Cancer
Posted: Thursday, August 6, 2020
Efforts to manage surgical intervention for patients with breast cancer during the COVID-19 pandemic have revealed the need for an expert committee to evaluate patient cases requiring surgery during the de-escalation period, according to a presentation during the 2020 American Association for Cancer Research (AACR) Virtual Meeting on COVID-19 and Cancer (Abstract PO-025). “Treatment decision-making should balance risk and benefits of the surgical treatment, and a ‘traffic light’ scale could be a useful tool for the medical team,” explained María Herrera De La Muela, MD, of the Woman Health Institute at San Carlos Clinical Hospital, Spain, and colleagues. In addition, the use of a preoperative protocol may increase the safety of surgical procedures during the COVID-19 pandemic.
This study assessed 28 breast cancer surgeries performed at San Carlos Clinical Hospital. Surgical resources were reduced by 25%, 50%, and 75% throughout the surgeries. To prioritize surgical time, the study authors implemented a “traffic light” system. In addition, patients were evaluated based on their different stages of comorbidities, tumor biology, and cancer treatments. Patients classified as red, amber, or green could have surgical procedures in a maximum of 2, 4, or more than 4 weeks, respectively. All patients were assessed preoperatively via phone call according to the COVID-19 protocol implemented.
Overall, the investigators reported a reduction in surgery. Of the surgical procedures performed, minimal use of oncoplastic procedures was necessary for 4 of 18 conservative surgeries and immediate breast reconstruction with implant was considered in 3 of 10 mastectomies. Moreover, 20 patients receiving neoadjuvant chemotherapy and 4 patients receiving endocrine therapy underwent surgery.
Furthermore, 14 patients with clinically node-negative breast cancer underwent sentinel node biopsies, and 10 patients receiving neoadjuvant chemotherapy required axillary lymph node dissection; six patients who had in situ ductal carcinoma also had this surgery. After surgery, all patients remained negative for COVID-19 infection with no perioperative complications.
Disclosure: No information regarding conflicts of interest was provided.
