Short Term Outcome of Management of Early Breast Cancer Patients in COVID-19 Era. Ain Shams University Experience

Abstract

Introduction: COVID-19 implied that a great number of infected individuals were hospitalized and possibly admitted to intensive care units. Cancer centers have rapidly changed models of care by delaying non-urgent surgeries. Breast surgeries were delayed for early breast cancer patients forcing clinicians to potentially alter treatment recommendations by neoadjuvant chemotherapy until appropriate conditions were established. Aim of the work: to assess conservative breast cancer surgery after neo-adjuvant therapy in early breast cancer patients in COVID-19 era as regard surgical outcome, complications and early recurrence comparing results with previous results when patients underwent primary conservative breast surgery. Patients and Methods: This is a cohort study that was conducted 52 patients with early breast cancer stage I and II a. Patients were divided into two groups (A) and (B). Group A included 26 patients who underwent primary conservative breast surgery. Group B included 26 patients who underwent conservative breast surgery after neo-adjuvant therapy during COVID-19 era. Results: Intra-operative re-excision was done in 5 patients (19.2%) in group A and 3 patients (11.5%) in group B. Two patients (7.7%) in group A and 1 patient (3.8%) in group B were converted to modified radical mastectomy. Sentinel lymph node (SLN) was done in all 26 patients in group A while only 25 patients in group B with 1 patient undergoing axillary dissection from the start. SLN was positive in 8 patients (30.8%) in group A & 6 (24 %) patients in group B. Consequently, 8 patients (30.8%) in group A and 7 patients (26.9%) in group B underwent axillary dissection. Conclusion: Conservative breast cancer surgery after neo-adjuvant therapy in early breast cancer patients in COVID-19 era has comparable results to primary conservative breast surgery. Thus, the obligatory decision to delay primary surgery during COVID-19 era by giving neoadjuvant chemotherapy was effective.