Single stage risk-reducing breast and gynecologic surgery for hereditary predisposition to breast and ovarian cancer

Abstract

Objectives: We sought to evaluate the perioperative outcomes of patients undergoing single-stage breast and gynecologic surgery for either breast cancer or a hereditary breast and ovarian cancer syndrome (HBOC). Methods: All patients with documented genetic testing undergoing single-stage breast and gynecologic extirpative surgery for breast cancer or an HBOC syndrome with or without immediate breast reconstruction were included. Perioperative outcomes including intraoperative, Results: Forty-three patients underwent single-stage surgery between September 2015 and July 2020 at a single academic tertiary referral hospital. Most patients underwent combined surgery for breast cancer (81.3%) and concurrent gynecologic prophylaxis (97.7%). Median patient age was 48 years and median BMI was 26.8 kg/m2. There were 33 patients (76.7%) with a pathogenic genetic mutation, the most common of which was BRCA1 (41.9%). All breast surgeries were mastectomies, 90.7% of which were bilateral; 48.8% included axillary lymph node dissection. The majority (88.4%) of breast extirpative procedures were followed by immediate reconstruction. The gynecological procedures were most commonly performed via conventional laparoscopy (55.8%): Fifty-eight percent of patients underwent total hysterectomy and bilateral salpingo-oophorectomy (BSO) and 37.5% underwent BSO alone. Median total operative time was 459.5 minutes (74-818 min). Median length of hospital stay was four days (1-14 d), and median estimated blood loss was 25cc (25-200 cc). The only intraoperative complication was a breast reconstructive flap failure that required vascular reanastomosis. Overall, 34.8% of patients had a complication. Complications during the first 30 post-operative days included four readmissions for reoperation, one venous thromboembolism (VTE), two transfusions, and nine complications of breast surgery (three hematomas, three wound dehiscences, and three surgical site infections). Six of these patients required reoperation Download : Download high-res image (91KB) Download : Download full-size image Conclusions: Single-stage breast and risk-reducing gynecologic surgeries are associated with similar complication rates to multi-stage surgeries with the benefit of providing the patient with a single recovery period. Further studies are encouraged to motivate multi-disciplinary collaboration with the ultimate goal of shorter overall recovery time for patients with breast cancer or an HBOC syndrome.