Safety of mastectomy in breast cancer

BACKGROUND: Breast cancer is the most common cancer in women worldwide. Mastectomy is performed when the patient is not eligible or willing to undergo breast conserving surgery. Surgical complications add morbidity and anxiety for the patient, consume limited healthcare resources, and delay the initiation of adjuvant therapy. Thus, improving the safety of mastectomy is of utter importance. METHODS: Information of all patients undergoing mastectomy for breast cancer in the Turku University Hospital in the years 2010–2019 was retrieved from the Auria Clinical Informatics Register. The information was verified and supplemented from patient records. Patient characteristics, details of the performed surgery, and complications during the 30 postoperative days were evaluated. The data was used in each study (I-IV). In study II, an additional oncological follow-up information was gathered from electronic patient records and in study III, the results were compared with corresponding data from the Helsinki University Hospital. RESULTS: In study I, the safety of same-day mastectomy was evaluated by comparing postoperative complications in 259 patients operated in same day regime to 654 patients staying overnight in the hospital. It was detected that the rate of returning to care after the operation was similar in both patient groups (odds ratio: 0.79, p=0.26). In study II, oncological follow-up information of 71 patients undergoing a skin-sparing mastectomy with immediate breast reconstruction for extensive ductal carcinoma in situ (DCIS) was evaluated to assess the oncological safety of the procedure. No local or distant metastasis was detected during a followup of 71 months. In study III, the efficacy of antibiotic prophylaxis in mastectomy was studied by comparing 335 patients not receiving to 1078 patients receiving antibiotic prophylaxis. The rate of surgical site infections was similar in both patient groups (6.9 % vs. 6.3 %, p=0.70). In study IV, the rate of bleeding complications was compared between 364 patients operated in the Turku University Hospital using ultrasonic instrument in mastectomy and matched cohort of 364 patients operated in the Helsinki University Hospital using electrocautery. The rate of complications was lower in patients operated with ultrasonic instrument (0.3 % vs 11.5 %, p<0.001) CONCLUSIONS: The study indicates that day surgery is safe in mastectomy, and that prophylactic antibiotics are usually not needed in the procedure. The risk of postoperative bleeding complications may be diminished by using an ultrasound instrument. A skin-sparing mastectomy is oncologically safe in extensive DCIS.Rinnan poistoleikkauksen turvallisuus rintasyöpäpotilailla TAUSTA: Rintasyöpä on maailmanlaajuisesti naisten yleisin syöpä. Kun säästävä leikkaus ei ole mahdollinen tai kun potilas toivoo sitä, on kasvaimen poistamiseksi tehtävä rinnan poistoleikkaus. Leikkausturvallisuuden parantaminen on keskeisen tärkeää, sillä leikkauskomplikaatiot aiheuttavat potilaalle vaivaa ja ahdistusta, kuluttavat terveydenhuollon resursseja ja viivästyttävät liitännäishoidon aloittamista. MENETELMÄT: Auria-tietopalvelun kautta kerättiin tiedot potilaista, joille tehtiin rintasyövän vuoksi rinnan poistoleikkaus Turun yliopistollisessa keskussairaalassa vuosina 2010–2019. Tietoja potilaiden ominaisuuksista, tehdystä leikkauksesta sekä komplikaatioista verrattiin toisiinsa. Osatyössä II kerättiin lisäksi tiedot syöpäseurannoista ja osatyössä III kerättyjä tietoja verrattiin Helsingin Yliopistollisen keskussairaalan vastaavaan potilasaineistoon MENETELMÄT: Auria-tietopalvelun kautta kerättiin tiedot potilaista, joille tehtiin rintasyövän vuoksi rinnan poistoleikkaus Turun yliopistollisessa keskussairaalassa vuosina 2010–2019. Tietoja potilaiden ominaisuuksista, tehdystä leikkauksesta sekä komplikaatioista verrattiin toisiinsa. Osatyössä II kerättiin lisäksi tiedot syöpäseurannoista ja osatyössä III kerättyjä tietoja verrattiin Helsingin Yliopistollisen keskussairaalan vastaavaan potilasaineistoon. TULOKSET: Osatyössä I arvioitiin päiväkirurgisen rinnanpoistoleikkauksen turvallisuutta vertaamalla komplikaatioita 259 päiväkirurgisesti leikatun potilaan ja 654 sairaalaseurannassa olleen potilaan välillä. Hoitoon palaamisessa leikkauksen jälkeen ei ollut eroa (kerroinsuhde: 0,79, p=0,26). Osatyössä II kerättiin seurantatiedot 71 potilaalta, joille tehtiin rinnan poistoleikkaus yhdistettynä välittömään rinnan korjausleikkaukseen rintasyövän esiasteen (DCIS) takia. Yhdelläkään potilaalla ei todettu tautiuusiutumaa keskimäärin 71 kuukauden seurannan aikana. Osatyössä III selvitettiin leikkauksen yhteydessä annettavan antibioottiannoksen tehoa leikkausinfektioiden estossa vertaamalla 335 potilasta, jotka eivät saaneet antibioottia 1078 potilaaseen, jotka saivat antibiootin. Leikkausinfektion riskissä ei ollut eroa ryhmien välillä (6,9 % vs. 6,3 %, p=0,70). Osatyössä IV verrattiin leikkauksen jälkeisen verenvuodon riskiä Turun yliopistollisessa keskussairaalassa käytössä olevan ultraääniinstrumentin ja Helsingin yliopistollisessa keskussairaalassa käytössä olevan sähköisen diatermiainstrumentin välillä. Vertaistetuissa 364 potilaan ryhmissä verenvuotoriski oli selvästi alempi ultraääni-instrumenttiryhmässä (0,3 % vs. 11,5 %, p<0,001). JOHTOPÄÄTÖS: Tutkimuskokonaisuus osoittaa, että päiväkirurginen rinnan poistoleikkaus on turvallinen ja että leikkausta edeltävästä antibiootista ei ole hyötyä infektioiden estämisessä. Vuotokomplikaatioita voidaan vähentää käyttämällä ultraääni-instrumenttia leikkauksessa. Ihoa säästävä rinnanpoisto on onkologisesti turvallinen laajan DCIS:n hoidoss

Oncological Safety of Skin-Sparing Mastectomy and Immediate Breast Reconstruction in Extensive Ductal Carcinoma In Situ

Introduction: Skin-sparing mastectomy (SSM) with immediate breast reconstruction is the ideal treatment for interested and suitable patients with extensive ductal carcinoma in situ (DCIS). There is no guideline to indicate on how large DCIS the procedure can be performed safely. The primary target of this study was to define the oncological safety of SSM in extensive pure DCIS. The secondary target was to find predictive factors for DCIS upstaging to invasive disease.Materials and methods: A total of 71 consecutive patients with extensive pure DCIS and undergoing SSM with immediate latissimus dorsi (LD) breast reconstruction were retrospectively evaluated. Results: The median size of DCIS lesion in preoperative imaging was 60 mm, the median weight of mastectomy specimen was 350 g, and the median resection margin (RM) was 2.0 mm. A total of 20 patients (28%) had an RM less than 0.5 mm and nine patients (13%) had ink positive margins. Six patients having positive RM underwent reoperation. A total of 29 patients (41%) presented invasive cancer foci in final histopathological assessment and nine patients (13%) had an axillary metastasis. Adjuvant therapy was given to 23 patients presenting invasive cancer. There were no local recurrences or distant metastases (0%, 95% confidence interval 0-0.051) during the mean follow-up of 71 mo. None of the factors evaluated predicted upstaging to invasive disease.Conclusions: SSM with immediate breast reconstruction in patients with extensive DCIS is oncologically safe even when the margins are close or positive. Additional invasive foci and solitary axillary lymph node metastases are frequent but do not worsen the outcome. (c) 2022 The Author(s). Published by Elsevier Inc. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).Peer reviewe

Same-day mastectomy and axillary lymph node dissection is safe for most patients with breast cancer

Background and Objective The aim of this study was to evaluate the safety of same-day mastectomy, with or without a sentinel node biopsy (SNB) and/or axillary lymph node dissection (ALND). Methods In this retrospective study, we reviewed 913 consecutive women who underwent a simple mastectomy for breast cancer between the years 2014 and 2019 and were treated either with same-day surgery (SDS) or an overnight stay (OS) regime. We reviewed all surgical complications, any unplanned return to care (RTC) and the rehospitalization rate for 30 postoperative days. Results A total of 259 patients (28%) were treated with SDS and 654 patients (72%) with an OS regime. There was no difference in RTC (odds ratio: 0.79 [95% confidence interval: 0.53-1.18], p = 0.26) or any major complications between the groups. None of the investigated subgroups, such as patients with previous neoadjuvant therapy, diabetes, obesity (up to a body mass index of 40 kg/m(2)), the American Society of Anaesthesiologist Class of 3, or elderly patients aged 75-84 years, showed an increased complication rate when treated with the SDS regime. Conclusion A same-day simple mastectomy is safe with SNB and/or ALND. It can be performed safely for most patients with stable co-morbidities.Peer reviewe

Preoperative antibiotic prophylaxis in mastectomy: A retrospective comparative analysis of 1413 patients with breast cancer

Background and objective: The reported rate of surgical site infections (SSIs) in breast cancer surgery varies widely in previous literature. The use of antibiotic prophylaxis is controversial but recommended by several guidelines. The aim of this study was to evaluate the efficacy of routine antibiotic prophylaxis in patients with breast cancer undergoing mastectomy.Methods: In this retrospective single-institution study, we reviewed 1413 consecutive female breast cancer patients who underwent mastectomy and/or axillary lymph node surgery between years 2012 and 2019. Prophylactic antibiotics for all patients undergoing mastectomy was introduced in our hospital in 2016 and before that the prophylaxis was prescribed individually on surgeons' preference. All patient records for 30 postoperative days were evaluated in detail and all SSIs were recorded. The rate of SSIs was compared between patients who received antibiotic prophylaxis and those who did not. A multivariate logistic regression model was used to define the odds ratio (OR) for the efficacy of antibiotic prophylaxis.Results: A total of 335 patients underwent mastectomy without antibiotic prophylaxis and 1078 with prophylaxis. The rate of SSIs was 6.9% in patients who received prophylaxis and 6.3% in patients without prophylaxis (p = 0.70). The rate of SSIs was similar before and after the introduction of regular antibiotic prophylaxis and there was no difference in any of the patient subgroups investigated. In multivariable logistic regression analysis, the OR for antibiotic prophylaxis was 1.04 (95% CI: 0.62-1.73, p = 0.88).Conclusions: Routine use of antibiotic prophylaxis did not reduce the rate of SSIs in mastectomy. Unselective antibiotic prophylaxis for all patients does not seem mandatory in mastectomy.</p

Ultrasonic scissors decrease postoperative bleeding complications in mastectomy : A retrospective multicenter cohort study on 728 patients

Introduction: The aim of this study was to evaluate the rate of postoperative bleeding complications (primary outcome) and any other surgical complications (secondary outcome) in mastectomy between two surgical instruments, ultrasonic SonoSurg (R) scissors (US) and traditional electrocautery (EC). Materials and methods: In total 728 patients undergoing mastectomy in two adjacent university hospitals were retrospectively evaluated in terms of postoperative bleeding episodes, surgical site infections, skin flap necrosis, and any reoperations for 30 postoperative days. A propensity score matching was performed to acquire balanced groups. Patients consuming medications affecting hemostasis were excluded from the study. A multivariable logistic regression analysis was conducted to define the odds ratio (OR) for each complication separately. A cost analysis was performed. Results: The rate of postoperative bleeding complications was significantly lower in patients operated with US (0.3% vs 11.5%, OR 0.020, 95% CI 0.034-0.14) when compared to EC. The rate of surgical site infections (OR 0.65, 95% CI 0.35-1.23) was similar with both instruments, but there were less skin flap necroses (OR 0.35, 95% CI 0.13-0.98) in US group. For any reoperation, the OR for US was 0.13 (95% CI 0.046-0.39), mainly due to the lower number of acute bleeding complications. Even though the US instrument is more expensive than EC, the total cost of the treatment is lower in patients operated with US (3419 vs. 3475 euro). Conclusions: US seems to be associated with a lower risk of bleeding complications in mastectomy.(c) 2022 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).Peer reviewe

Same-day mastectomy and axillary lymph node dissection is safe for most patients with breast cancer

Background and Objective: The aim of this study was to evaluate the safety of same-day mastectomy, with or without a sentinel node biopsy (SNB) and/or axillary lymph node dissection (ALND). Methods: In this retrospective study, we reviewed 913 consecutive women who underwent a simple mastectomy for breast cancer between the years 2014 and 2019 and were treated either with same-day surgery (SDS) or an overnight stay (OS) regime. We reviewed all surgical complications, any unplanned return to care (RTC) and the rehospitalization rate for 30 postoperative days. Results: A total of 259 patients (28%) were treated with SDS and 654 patients (72%) with an OS regime. There was no difference in RTC (odds ratio: 0.79 [95% confidence interval: 0.53-1.18], p = 0.26) or any major complications between the groups. None of the investigated subgroups, such as patients with previous neoadjuvant therapy, diabetes, obesity (up to a body mass index of 40 kg/m(2)), the American Society of Anaesthesiologist Class of 3, or elderly patients aged 75-84 years, showed an increased complication rate when treated with the SDS regime. Conclusion: A same-day simple mastectomy is safe with SNB and/or ALND. It can be performed safely for most patients with stable co-morbidities.</p

Oncological Safety of Skin-Sparing Mastectomy and Immediate Breast Reconstruction in Extensive Ductal Carcinoma In Situ

IntroductionSkin-sparing mastectomy (SSM) with immediate breast reconstruction is the ideal treatment for interested and suitable patients with extensive ductal carcinoma in situ (DCIS). There is no guideline to indicate on how large DCIS the procedure can be performed safely. The primary target of this study was to define the oncological safety of SSM in extensive pure DCIS. The secondary target was to find predictive factors for DCIS upstaging to invasive disease.Materials and methodsA total of 71 consecutive patients with extensive pure DCIS and undergoing SSM with immediate latissimus dorsi (LD) breast reconstruction were retrospectively evaluated.ResultsThe median size of DCIS lesion in preoperative imaging was 60 mm, the median weight of mastectomy specimen was 350 g, and the median resection margin (RM) was 2.0 mm. A total of 20 patients (28%) had an RM less than 0.5 mm and nine patients (13%) had ink positive margins. Six patients having positive RM underwent reoperation. A total of 29 patients (41%) presented invasive cancer foci in final histopathological assessment and nine patients (13%) had an axillary metastasis. Adjuvant therapy was given to 23 patients presenting invasive cancer. There were no local recurrences or distant metastases (0%, 95% confidence interval 0-0.051) during the mean follow-up of 71 mo. None of the factors evaluated predicted upstaging to invasive disease.ConclusionsSSM with immediate breast reconstruction in patients with extensive DCIS is oncologically safe even when the margins are close or positive. Additional invasive foci and solitary axillary lymph node metastases are frequent but do not worsen the outcome.</p

Ultrasonic scissors decrease postoperative bleeding complications in mastectomy: A retrospective multicenter cohort study on 728 patients

IntroductionThe aim of this study was to evaluate the rate of postoperative bleeding complications (primary outcome) and any other surgical complications (secondary outcome) in mastectomy between two surgical instruments, ultrasonic SonoSurg® scissors (US) and traditional electrocautery (EC).Materials and methodsIn total 728 patients undergoing mastectomy in two adjacent university hospitals were retrospectively evaluated in terms of postoperative bleeding episodes, surgical site infections, skin flap necrosis, and any reoperations for 30 postoperative days. A propensity score matching was performed to acquire balanced groups. Patients consuming medications affecting hemostasis were excluded from the study. A multivariable logistic regression analysis was conducted to define the odds ratio (OR) for each complication separately. A cost analysis was performed.ResultsThe rate of postoperative bleeding complications was significantly lower in patients operated with US (0.3% vs 11.5%, OR 0.020, 95% CI 0.034–0.14) when compared to EC.The rate of surgical site infections (OR 0.65, 95% CI 0.35–1.23) was similar with both instruments, but there were less skin flap necroses (OR 0.35, 95% CI 0.13–0.98) in US group. For any reoperation, the OR for US was 0.13 (95% CI 0.046–0.39), mainly due to the lower number of acute bleeding complications. Even though the US instrument is more expensive than EC, the total cost of the treatment is lower in patients operated with US (3419 vs. 3475 euro).ConclusionsUS seems to be associated with a lower risk of bleeding complications in mastectomy.</p