Breast Cancer Surgery During the COVID-19 Pandemic Peak in the UK: Operative Outcomes.

Emma G Macinnes,Raj Achuthan,Catherine Tait,Shireen Mckenzie,Brian Hogan,Jenny Piper,Philip Turton,Baek Kim,Kieran Horgan,Alison Waterworth

doi:10.7759/cureus.9280

Abstract

Introduction The COVID-19 pandemic caused widespread changes in delivery of breast cancer care, aiming to protect vulnerable patients whilst minimising compromise to oncological outcomes. This multicentre observational study aimed to establish early surgical outcomes from breast cancer surgery performed during the peak of the COVID-19 pandemic. Materials and methods Data were collected on consecutive patients that underwent breast surgery in four units between 16 March and 24 April 2020. Outcome data at 30 days post-operation were collected, including documented COVID-19 cases in patients and reported cases in healthcare workers directly involved in their care. Recommended modifications to practice to reduce COVID-19 transmission risk, both to patients and healthcare workers in each centre, are described. Results A total of 202 patients underwent surgery in four hospitals delivering breast services in the West Yorkshire region over the six-week period at the peak of the pandemic. The age ranged from 28 to 91 years (median 57, interquartile range, 48-65) with 22% having co-morbidities linked to COVID-19, e.g. diabetes or respiratory disease. No patients presented post-operatively with COVID-19 symptoms and at 30 days there had not been any identified COVID-19 cases. There were no unexpected critical care admissions or deaths. One healthcare worker involved in the delivery of breast surgery was diagnosed with COVID-19 during this time and made an uneventful recovery. Conclusion Breast cancer surgery, in selected groups and with meticulous adherence to measures designed to reduce COVID-19 transmission, does not appear to be associated with elevated risk to patients or healthcare workers.

Highlights

The COVID-19 pandemic caused widespread changes in delivery of breast cancer care, aiming to protect vulnerable patients whilst minimising compromise to oncological outcomes
This study describes early experience of breast cancer surgery patient outcomes in terms of morbidity and mortality during the COVID-19 situation in four different hospitals
With the benefit of this information, greater care has been taken to minimise risk and we report good outcomes for this series of 202 patients, with no identified post-operative COVID-19 related symptoms or infections and no deaths associated with surgery

Summary

Methods

Data were collected on consecutive patients that underwent breast surgery in four units between 16 March and 24 April 2020. Outcome data at 30 days post-operation were collected, including documented COVID-19 cases in patients and reported cases in healthcare workers directly involved in their care. Four breast units in West Yorkshire report consecutive patients undergoing breast cancer surgery undertaken over a six-week period between 16 March and 24 April 2020, during the peak of the pandemic in the region [14]. Data on post-operative COVID-19 status were based upon a lack of reported symptoms by patients and the absence of a positive result on any diagnostic testing (PCR, antibodies or imaging with findings typical of COVID19). Data on healthcare worker COVID-19 infections were taken from each unit based upon reported sick leave

Results

Discussion

Conclusion