Awake breast cancer surgery: strategy in the beginning of COVID-19 emergency

Abstract

Introduction COVID-19 is a declared worldwide pandemic. In our country, due to shortage of hospitals and beds in intensive care unit, oncological and breast cancer (BC) resources are temporarily shifted to COVID-19 patients. In addition, risk of cross-infections should be considered in these frail patients. To accomplish more surgical procedures and to reduce the length of hospital stay (LOS), fast track awake BC surgery should be implemented. The aim of the study is to estimate the effects of surgical shift in our facility during the early COVID-19 outbreak. Materials and methods From 30th January 2020 to 30th of March 2020, 86 consecutive patients were retrospectively enrolled and divided into pre-COVID-19-BC and COVID-19-BC. Clinical parameters and anamnestic data were collected and analyzed. Surgical procedures, relative complications and type of anaesthesia were reported. The effect on surgical time (ST), operative room time (ORT) and length of stay (LOS) were described and examined. Results No statistical difference was found in complications rate, clinical data and surgical procedures ( p > 0.05). Awake breast conservative surgery (BCS) was the most frequent procedure in COVID-19-BC ( p = 0.006). A statistically significant decrease in ORT and LOS was reported in COVID-19-BC ( p = 0.040 and p = 0.0015 respectively), while comparable time resulted for ST ( p = 0.976). Mean ORT and LOS reduction were 20.79 min and 0.57 hospital bed days. Conclusion In the “COVID-19 era”, fast track awake breast surgery provides a reduction of ORT, LOS and potentially surgical treatment for a wider number of oncological patients.

Delay in Breast Cancer Treatments During the First COVID-19 Lockdown. A Multicentric Analysis of 432 Patients

“…Although breast cancer is the most frequent cancer and represents the leading cause of oncological death among women worldwide; latest statistics suggest that there has been an improvement in term of prognosis (14,15). Both, empowerment of breast cancer treatments and higher incidence of early diagnosis, due to the screening, have led to this improvement (9)(10)(11)(12)(13)(14)(15)(16). The benefits of screening are largely attributed to the ability to diagnose breast cancer in earlier stages (17).…”

“…Many researches have reported that in addition to the improvement in survival, there is a significant reduction in breast cancer diagnosed by physical examination (e.g. palpable lesion) (7,(10)(11)(12). We hypothesized that screening suspension and surgical treatment delay could alter the clinical presentation and features of breast cancer.…”

Impact of the COVID-19 pandemic on breast surgery and breast reconstruction in a Japanese university hospital setting

“…Some reports have indicated that breast reconstruction during the COVID-19 pandemic was limited to immediate tissue expander insertion and silicone breast implant replacement only [ 3 , 4 ]. Avoiding autologous tissue reconstruction reduces the operation time and hospital stay, and awake surgery has been reported as a method to reduce the operation time [ 18 ].…”

Role of Breast-Conserving Surgery on the National Health System Economy From and to SARS-COVID-19 Era

“…We have introduced the concept of awake breast surgery during the COVID-19 pandemic as a means of reducing the incidence of viral infection and maximizing the utility of hospital service during a period of intense pressure ( 11 – 13 ).…”

“…Based on our report ( 11 ), financial analysis of awake breast surgery would be beneficial to help improve the current model of care for patients with breast cancer that require wide local excision.…”