“Among the various guideline-concordant local therapy options available for women with early-stage breast cancer in the United States, mastectomy plus reconstruction had the highest complication rates and complication-related costs for both younger women with private insurance and older women on Medicare and was the most expensive option for younger women, according to data presented at the 2015 San Antonio Breast Cancer Symposium, held December 8–12 in San Antonio, Texas (Abstract S3-07).
“ ‘Women with early-stage breast cancer have several local therapy options. Although there’s nuance as far as what treatment is best for which patient, there is a large group of patients for whom most, if not all, of these treatment options are considered guideline-appropriate,’ said Benjamin D. Smith, MD, Associate Professor and Research Director of the Breast Radiation Oncology Section in the Department of Radiation Oncology at The University of Texas MD Anderson Cancer Center.”
“Immediate breast reconstruction following mastectomy is becoming more prevalent. However, in breast cancer patients undergoing simultaneous chemotherapy, thrombotic complications can arise that can delay or significantly modify reconstructive plans. Outcomes of cases illustrating potential complications are published in the current issue of Annals of Medicine and Surgery.
“Chemotherapy is increasingly used to treat larger operable or advanced breast cancer prior to surgery. Chemotherapy delivered via the placement of a central venous line that remains in place for the duration of treatment can result in pre-operative thromboembolic events, which can require the administration of anticoagulation agents. This in turn can complicate subsequent surgery and is particularly significant when complex reconstruction is anticipated immediately following the mastectomy.
” ‘There is limited research on the impact of this complication on breast reconstruction pathways and guidance for optimal management of these patients,’ notes Professor Charles M. Malata, FRCS (Plast), who is Consultant Plastic & Reconstructive Surgeon at the Cambridge Breast Unit (Cambridge University Hospitals NHS Foundation Trust) and Professor of Academic Plastic Surgery at the Postgraduate Medical Institute of Anglia Ruskin University. ‘My colleagues and I present our clinical experience over four years of patients with breast cancer who developed thrombotic complications of their neoadjuvant chemotherapy venous lines prior to mastectomy and immediate breast reconstruction.’ “
Editor’s note: This article discusses the results of a research study that examined the safety of breast surgery for elderly patients. The researchers found that, contrary to concerns, breast cancer surgery can be safely performed for women aged 80 years and above.
“A study conducted by National Cancer Centre Singapore (NCCS) has shown that age per se is not a contraindication to breast cancer surgery, and such surgeries may be safely performed for women aged 80 years and above. Led by Dr Ong Kong Wee, Senior Consultant in the Division of Surgical Oncology, the team consists of Dr Veronique Tan, Consultant, and Dr Lee Chee Meng, Resident Doctor. The study explores the safety of breast cancer surgery in women aged 80 years and above.
“A retrospective analysis was performed on 109 elderly women who underwent surgery in NCCS and Singapore General Hospital (SGH) from 2001 – 2010. Most patients were assessed to be fit for surgery under the American Society of Anesthesiologists (ASA) physical classification status with 75 per cent of patients having an ASA physical status of 1 or 2 .
“Although approximately 80 per cent of patients had 1 – 4 co-existing medical problems such as hypertension, dyslipidaemia and diabetes mellitus, there were no deaths recorded following the breast surgery. More than 60 per cent of patients recovered without any complications, while only 3 per cent developed major complications but recovered subsequently. The average length of stay in the hospital was 3 days.
” ‘The results of this study are important as they dispel the misconception and fear among the public that surgery for elderly patients is unsafe and has a high complication rate’, said Dr Ong. ‘Surgery is the most important modality in the treatment of breast cancer. It also relieves symptoms in patients who have tumours that do not respond to other therapies. Elderly patients should not be deprived of such treatment options.’ “
“Using robotic techniques to remove a cancerous bladder doesn’t reduce the risk of complications compared with conventional ‘open’ surgery, according to a new comparison of 118 patients conducted by surgeons at the Memorial Sloan Kettering Cancer Center in New York.
“The study, detailed in the New England Journal of Medicine, marks the first ongoing comparison of the risks and benefits of the two techniques. Past studies concluded that the robotic technique meant less time in the hospital and fewer complications but they were done by looking back at the records of already-treated patients.
” ‘There’s been a lot of hype surrounding robots and it’s been hard to gain perspective,’ said Dr. Vincent Laudone, one of the coauthors.
“Dr. Jennifer Yates, director of minimally invasive urology at the University of Massachusetts Medical School, who was not involved in the test, told Reuters Health that the findings will give surgeons pause because they’re going to be surprised by the results.
“Robots have shown to be so valuable for prostate removal, many surgeons were convinced that a similar benefit would appear when they were used for bladder removal, she said. ‘They’re going to say, “Hey, I’m kinda surprised by this.” They’re also going to be encouraged that the complication rate was comparable.’ “
Jemal A, Simard EP ... Yankey D, Edwards BK. Journal of the National Cancer Institute. Jan. 7, 2013.
The Annual Report on the status of cancer shows a decline in cancer deaths from major cancers including lung, colorectal, prostate, and breast, but some cancer deaths continue to increase specifically for men with melanoma as well as for those with liver, uterine, and pancreatic cancers.