Breast cancer surgery during the COVID-19 pandemic: A prospective observational study in a single centre

Abstract

Introduction: The COVID-19 pandemic has required unprecedented changes in the provision of surgical care. Breast cancer surgery has continued across the UK, with guidance from advisory bodies. We prospectively conducted an observational study beginning with “lockdown” in March to the September “easing” in 2020, implementing clinic/theatre changes, with comparison to the same period in 2019. Method Referral/surgical procedure data were gathered for the study periods. Modifications in practice included telephone triage, implementation of drain-free axillary-clearances and mastectomies, re-excision of margins under local anaesthetic and non-radioisotope sentinel node localisation. We reviewed data on length of stay and complications. Results: New-patient clinic attendances fell (342-208) 39.2%. Localisation cases fell (24-15) 35.5%. There was a 54.5% (22-10) reduction in mastectomies which in 2020 were drainless using cyanoacrylate glue. 30% of these required seroma drainage, with no re-operations. There were no reconstructions in 2020 as per guidelines. Re-excision of incomplete margins were performed under local anaesthetic, remaining static at 4 cases in each study period. There was a 46.2% (39-21) reduction in the number of sentinel node localisations. In 2020 all were blue-dye guided to reduce patient transit within hospital; only one case required axillary sampling. Blue-dye resulted in a cost saving of £20,880 over radio-isotope for the period. All but one patient had day-case surgery. Conclusion: Our surgical unit practice has safely evolved to meet the COVID-19 challenge. No patients gained a hospital acquired coronavirus infection peri-operatively. The measures have resulted in cost-savings to the hospital, which might usefully be continued.