Finland: A recent study in the Journal of Surgical Oncology found same-day mastectomy to be feasible for most breast cancer patients when immediate breast reconstruction (IBR) is not planned. In the study, there was no increased risk of complication in patient groups treated with same-day surgery (SDS) regime.
"In simpler words, a same-day simple mastectomy is safe with sentinel node biopsy (SNB) and/or axillary lymph node dissection (ALND). It can be safely performed for most patients with stable co-morbidities," Anselm Tamminen, University of Turku, Turku, Finland, and colleagues wrote in their study.
Breast cancer is the most commonly occurring cancer in women. In Western countries, approximately one in eight women are expected to develop breast cancer during their lifetime. Breast cancer surgery has become increasingly conservative that has resulted in the treatment being less cumbersome for the patients. Although breast-conserving surgery (BCS) is being utilized more, mastectomy is still required frequently in cases where the patient has a large tumor compared to the breast size, the tumor is multicentric, or for the patients not eligible to receive radiation therapy.
Against the above backdrop, Dr. Tamminen and the team aimed to evaluate the safety of same-day mastectomy, with or without a sentinel node biopsy and/or axillary lymph node dissection compared with the overnight stay (OS) approach in a retrospective study.
For this purpose, the researchers reviewed 913 consecutive women who underwent a simple mastectomy for breast cancer between the years 2014 and 2019 and were treated either with SDS or an OS regime. They reviewed all surgical complications, any unplanned return to care (RTC), and the rehospitalization rate for 30 postoperative days.
A total of 259 patients (28%) were treated with SDS and 654 patients (72%) with an OS regime.
Salient findings of the study include:
There was no difference in RTC (odds ratio: 0.79) 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/m2), 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.
Interestingly, the rate of RTC was lower in SDS than OS regime in most subgroups, including patients aged 75–84 years, ASA Class levels 1–3, obese patients with BMI up to 40 kg/m2, and patients having a reoperation, although the statistical significance was not reached in any of these groups.
To conclude, a same-day simple mastectomy is safe with SNB and/or ALND. It can be performed safely for most patients with stable co-morbidities.
Reference:
Tamminen, A, Meretoja, T, Koskivuo, I. Same-day mastectomy and axillary lymph node dissection is safe for most patients with breast cancer. J Surg Oncol. 2022; 1- 8. doi:10.1002/jso.26799