1
|
Vemuru SR, Bronsert M, Vossler K, Huynh VD, Beaty L, Ahrendt G, Arruda J, Kaoutzanis C, Rojas KE, Bozzuto L, Kim S, Tevis SE. Postoperative Outcomes After Staged Versus Coordinated Breast Surgery and Bilateral Salpingo-Oophorectomy. Ann Surg Oncol 2023; 30:5667-5680. [PMID: 37336806 PMCID: PMC11112621 DOI: 10.1245/s10434-023-13630-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 04/27/2023] [Indexed: 06/21/2023]
Abstract
BACKGROUND The objective of this study was to compare postoperative complication rates and healthcare charges between patients who underwent coordinated versus staged breast surgery and bilateral salpingo-oophorectomy (BSO). PATIENTS AND METHODS The MarketScan administrative database was used to identify adult female patients with invasive breast cancer or BRCA1/BRCA2 mutations who underwent BSO and breast surgery (lumpectomy or mastectomy with or without reconstruction) between 2010 and 2015. Patients were assigned to the coordinated group if a breast operation and BSO were performed simultaneously or assigned to the staged group if BSO was performed separately. Primary outcomes were (1) incidence of 90-day postoperative complications and (2) 2-year aggregate perioperative healthcare charges. Fisher's exact tests, Wilcoxon rank-sum tests, and multivariable regression analyses were performed. RESULTS Of the 4228 patients who underwent breast surgery and BSO, 412 (9.7%) were in the coordinated group and 3816 (90.3%) were in the staged group. The coordinated group had a higher incidence of postoperative complications (24.0% vs. 17.7%, p < 0.01), higher risk-adjusted odds of postoperative complications [odds ratio (OR) 1.37, 95% confidence interval (CI) 1.06-1.76, p = 0.02], and similar aggregate healthcare charges before (median charges: $106,500 vs. $101,555, p = 0.96) and after risk-adjustment [incidence rate ratio (IRR) 1.00, 95% CI 0.93-1.07; p = 0.95]. In a subgroup analysis, incidence of postoperative complications (12.9% for coordinated operations vs. 11.7% for staged operation, p = 0.73) was similar in patients whose breast operation was a lumpectomy. CONCLUSIONS While costs were similar, coordinating breast surgery with BSO was associated with more complications in patients who underwent mastectomy, but not in patients who underwent lumpectomy. These data should inform shared decision-making in high-risk patients.
Collapse
Affiliation(s)
- Sudheer R Vemuru
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Michael Bronsert
- University of Colorado School of Medicine, Surgical Outcomes and Applied Research (SOAR) Program and Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), Aurora, CO, USA
| | | | - Victoria D Huynh
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Laurel Beaty
- School of Public Health Department of Biostatistics and Informatics, University of Colorado, Aurora, CO, USA
| | - Gretchen Ahrendt
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Jaime Arruda
- Department of Obstetrics and Gynecology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | | | - Kristin E Rojas
- Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Laura Bozzuto
- Department of Surgery, University of Wisconsin School of Medicine, Madison, WI, USA
| | - Simon Kim
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Sarah E Tevis
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
| |
Collapse
|
2
|
Pislar N, Peric B, Ahcan U, Cencelj-Arnez R, Zgajnar J, Perhavec A. Does concurrent gynaecological surgery affect infectious complications rate after mastectomy with implant-based reconstruction? Radiol Oncol 2023; 57:80-85. [PMID: 35853741 PMCID: PMC10039468 DOI: 10.2478/raon-2022-0026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 05/23/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Women who undergo breast cancer surgery often have an indication for gynaecological procedure. The aim of our study was to compare infectious complications rate after mastectomy with implant-based reconstruction in patients with and without concurrent gynaecological procedure. PATIENTS AND METHODS We retrospectively reviewed clinical records of 159 consecutively operated patients after mastectomy with implant-based reconstruction. The patients were divided in 2 groups: 102 patients without (Group1) and 57 with (Group 2) concurrent gynaecological procedure. Infectious complications rates between the groups were compared using χ2-test. Logistic regression was performed to test for association of different variables with infectious complications. RESULTS There were 240 breast reconstructions performed. Median follow-up time was 297 days (10-1061 days). Mean patient age was 47.2 years (95% CI 32.8-65.9); 48.2 years (95% CI 46.1-50.3) in Group 1 and 45.8 years (95% CI 43.2-48.3) in Group 2; p = 0.002). Infectious complications rate was 17.6% (17.6% vs. 17.5%, p = 0.987), implant loss occurred in 5.7% (4.9% vs. 7.0%, p = 0.58). Obesity (body mass index [BMI] > 30 kg/m2), age, previous breast conserving treatment (BCT) with radiotherapy (RT) were identified as risk factors for infectious complications in univariate analysis. Obesity (adjusted odds ratio [aOR] 3.319, 95% CI 1.085-10.157, p = 0.036) and BCT with RT (aOR 7.481, 95% CI 2.230-25.101, p = 0.001) were independently associated with infectious complications in multivariate model. CONCLUSIONS Concurrent gynaecological procedure for patients undergoing mastectomy with implant-based reconstruction did not carry an increased risk for infectious complications.
Collapse
Affiliation(s)
- Nina Pislar
- Department of Surgical Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Barbara Peric
- Department of Surgical Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Uros Ahcan
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
- Department of Plastic Surgery and Burns, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Romi Cencelj-Arnez
- Department of Surgical Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Janez Zgajnar
- Department of Surgical Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Andraz Perhavec
- Department of Surgical Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| |
Collapse
|
3
|
Factors Associated With Increased Complications in Patients With BRCA Gene Mutations Undergoing Reconstructive Breast Surgery. Plast Surg Nurs 2021; 41:43-50. [PMID: 33626564 DOI: 10.1097/psn.0000000000000331] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Reconstructive breast surgery after bilateral prophylactic mastectomy in patients who carry a mutation of the breast cancer (BRCA) gene has been increasing. Undergoing risk-reducing breast surgery can be of great benefit to young patients who have a high risk of developing breast cancer. There is little available evidence about the rate of complications in these patients and which factors are related to increased complications. The objective of this study was to identify predictors of complications in BRCA gene mutation carriers who underwent reconstructive breast surgery. A single-center, retrospective cohort study was conducted that included all patients with a mutation of the BRCA gene who underwent a breast reconstructive procedure, either immediate or delayed, between January 2013 and March 2019 and received a minimum of 6 months' follow-up. The results of our study showed that smoking is the most important modifiable risk factor associated with an increased complication rate for reconstructive breast surgery in patients with BRCA gene mutation. Smoking cessation will reduce the patient's risk for postoperative complications by 50%; therefore, it should be encouraged in all surgical patients and enforced in patients undergoing prophylactic procedures.
Collapse
|
4
|
Gaba F, Goyal S, Marks D, Chandrasekaran D, Evans O, Robbani S, Tyson C, Legood R, Saridogan E, McCluggage WG, Hanson H, Singh N, Evans DG, Menon U, Manchanda R. Surgical decision making in premenopausal BRCA carriers considering risk-reducing early salpingectomy or salpingo-oophorectomy: a qualitative study. J Med Genet 2021; 59:122-132. [PMID: 33568437 PMCID: PMC8788252 DOI: 10.1136/jmedgenet-2020-107501] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 11/20/2020] [Accepted: 11/21/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND Acceptance of the role of the fallopian tube in 'ovarian' carcinogenesis and the detrimental sequelae of surgical menopause in premenopausal women following risk-reducing salpingo-oophorectomy (RRSO) has resulted in risk-reducing early-salpingectomy with delayed oophorectomy (RRESDO) being proposed as an attractive alternative risk-reducing strategy in women who decline/delay oophorectomy. We present the results of a qualitative study evaluating the decision-making process among BRCA carriers considering prophylactic surgeries (RRSO/RRESDO) as part of the multicentre PROTECTOR trial (ISRCTN:25173360). METHODS In-depth semistructured 1:1 interviews conducted using a predeveloped topic-guide (development informed by literature review and expert consultation) until informational saturation reached. Wording and sequencing of questions were left open with probes used to elicit additional information. All interviews were audio-recorded, transcribed verbatim, transcripts analysed using an inductive theoretical framework and data managed using NVIVO-v12. RESULTS Informational saturation was reached following 24 interviews. Seven interconnected themes integral to surgical decision making were identified: fertility/menopause/cancer risk reduction/surgical choices/surgical complications/sequence of ovarian-and-breast prophylactic surgeries/support/satisfaction. Women for whom maximising ovarian cancer risk reduction was relatively more important than early menopause/quality-of-life preferred RRSO, whereas those more concerned about detrimental impact of menopause chose RRESDO. Women managed in specialist familial cancer clinic settings compared with non-specialist settings felt they received better quality care, improved hormone replacement therapy access and were more satisfied. CONCLUSION Multiple contextual factors (medical, physical, psychological, social) influence timing of risk-reducing surgeries. RRESDO offers women delaying/declining premenopausal oophorectomy, particularly those concerned about menopausal effects, a degree of ovarian cancer risk reduction while avoiding early menopause. Care of high-risk women should be centralised to centres with specialist familial gynaecological cancer risk management services to provide a better-quality, streamlined, holistic multidisciplinary approach.
Collapse
Affiliation(s)
- Faiza Gaba
- Wolfson Institute of Preventive Medicine, Barts CRUK Centre, Queen Mary University of London-Charterhouse Square Campus, London, UK.,Gynaecological Oncology, Barts Health NHS Trust, London, UK
| | - Shivam Goyal
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Dalya Marks
- Department of Public Health, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Dhivya Chandrasekaran
- Wolfson Institute of Preventive Medicine, Barts CRUK Centre, Queen Mary University of London-Charterhouse Square Campus, London, UK.,Gynaecological Oncology, Barts Health NHS Trust, London, UK
| | - Olivia Evans
- Wolfson Institute of Preventive Medicine, Barts CRUK Centre, Queen Mary University of London-Charterhouse Square Campus, London, UK.,Gynaecological Oncology, Barts Health NHS Trust, London, UK
| | - Sadiyah Robbani
- Centre for Experimental Cancer Medicine, Barts CRUK Cancer Centre, Queen Mary University of London, London, UK
| | - Charlotte Tyson
- Centre for Experimental Cancer Medicine, Barts CRUK Cancer Centre, Queen Mary University of London, London, UK
| | - Rosa Legood
- Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Ertan Saridogan
- Department of Gynaecology, University College London Hospitals NHS Foundation Trust, London, UK
| | - W Glenn McCluggage
- Department of Pathology, Belfast Health and Social Care Trust, Belfast, UK
| | - Helen Hanson
- South West Thames Regional Genetics Service, South West Thames Regional Genetic Services, London, UK
| | - Naveena Singh
- Department of Pathology, Barts Health NHS Trust, London, UK
| | - D Gareth Evans
- Centre for Genomic Medicine, University of Manchester, Manchester, UK
| | - Usha Menon
- MRC Clinical Trials Unit, University College London, London, UK
| | - Ranjit Manchanda
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK .,Department of Gynaecological Oncology, Barts Health NHS Trust, London, UK
| | | |
Collapse
|
5
|
Leach CM, Collins MS. Breast Reconstruction in the Setting of Surgical Prevention for Breast Cancer. CURRENT BREAST CANCER REPORTS 2018. [DOI: 10.1007/s12609-018-0283-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
6
|
Elmi M, Azin A, Elnahas A, McCready DR, Cil TD. Concurrent risk-reduction surgery in patients with increased lifetime risk for breast and ovarian cancer: an analysis of the National Surgical Quality Improvement Program (NSQIP) database. Breast Cancer Res Treat 2018; 171:217-223. [PMID: 29761322 DOI: 10.1007/s10549-018-4818-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Accepted: 05/03/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Patients with genetic susceptibility to breast and ovarian cancer are eligible for risk-reduction surgery. Surgical morbidity of risk-reduction mastectomy (RRM) with concurrent bilateral salpingo-oophorectomy (BSO) is unknown. Outcomes in these patients were compared to patients undergoing RRM without BSO using a large multi-institutional database. METHODS A retrospective cohort analysis was conducted using the American College of Surgeon's National Surgical Quality Improvement Program (NSQIP) 2007-2016 datasets, comparing postoperative morbidity between patients undergoing RRM with patients undergoing RRM with concurrent BSO. Patients with genetic susceptibility to breast/ovarian cancer undergoing risk-reduction surgery were identified. The primary outcome was 30-day postoperative major morbidity. Secondary outcomes included surgical site infections, reoperations, readmissions, length of stay, and venous thromboembolic events. A multivariate analysis was performed to determine predictors of postoperative morbidity and the adjusted effect of concurrent BSO on morbidity. RESULTS Of the 5470 patients undergoing RRM, 149 (2.7%) underwent concurrent BSO. The overall rate of major morbidity and postoperative infections was 4.5% and 4.6%, respectively. There was no significant difference in the rate of postoperative major morbidity (4.5% vs 4.7%, p = 0.91) or any of the secondary outcomes between patients undergoing RRM without BSO vs. those undergoing RRM with concurrent BSO. Multivariable analysis showed Body Mass Index (OR 1.05; p < 0.001) and smoking (OR 1.78; p = 0.003) to be the only predictors associated with major morbidity. Neither immediate breast reconstruction (OR 1.02; p = 0.93) nor concurrent BSO (OR 0.94; p = 0.89) were associated with increased postoperative major morbidity. CONCLUSION This study demonstrated that RRM with concurrent BSO was not associated with significant additional morbidity when compared to RRM without BSO. Therefore, this joint approach may be considered for select patients at risk for both breast and ovarian cancer.
Collapse
Affiliation(s)
- Maryam Elmi
- Department of Surgery, University of Toronto, Toronto, ON, Canada.
- Division of General Surgery, University Health Network, Toronto, ON, Canada.
| | - Arash Azin
- Department of Surgery, University of Toronto, Toronto, ON, Canada
- Division of General Surgery, University Health Network, Toronto, ON, Canada
| | - Ahmad Elnahas
- Department of Surgery, Western University, London, ON, Canada
| | - David R McCready
- Department of Surgery, University of Toronto, Toronto, ON, Canada
- Division of General Surgery, University Health Network, Toronto, ON, Canada
| | - Tulin D Cil
- Department of Surgery, University of Toronto, Toronto, ON, Canada
- Division of General Surgery, University Health Network, Toronto, ON, Canada
- Department of Surgery, Women's College Hospital, Toronto, ON, Canada
| |
Collapse
|
7
|
Ma IT, Gray RJ, Wasif N, Butler KA, Cornella JL, Magrina JF, Magtibay PM, Casey WJ, Mahabir R, Rebecca AM, Hunt KS, Pockaj BA. Outcomes of Concurrent Breast and Gynecologic Risk Reduction Surgery. Ann Surg Oncol 2016; 24:77-83. [DOI: 10.1245/s10434-016-5479-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Indexed: 11/18/2022]
|