This article is more than 5 years old. Information may no longer be current.
Breast surgery alone may be safer than in combination with plastic, gynecologic surgeries
Click Here to Manage Email Alerts
Women who underwent combined breast, plastic reconstructive and gynecologic surgery exhibited higher rates of postoperative complications, readmission and reoperation than women who underwent breast surgery alone, according to study results published in Breast Journal.
“Patients have the impression, ‘I want to have one surgery and have everything done at one time.’ However, complication rates are higher with that approach. For patients at high risk for developing breast cancer and ovarian cancer, we recommend having the prophylactic bilateral mastectomy along with breast reconstruction, but then trying to keep gynecologic surgery separate. It is safer and easier to undergo them separately,” Sarah E. Tevis, MD, breast surgeon at UCHealth University of Colorado Hospital, said in a press release.
Tevis and colleagues sought to assess whether the addition of gynecologic and plastic reconstructive surgeries to breast surgery increased the risk for postoperative complications and hospital readmission among women included in a large national surgical database.
According to study results, women who underwent the combined procedures experienced a significantly longer length of hospital stay (P < .001) and significantly higher rates of complications, readmission and reoperation (P < .001 for all) than women who underwent breast surgery alone.
HemOnc Today spoke with Tevis about what prompted this research, what she and colleagues found and what subsequent research should entail.
Question: What prompted this research?
Answer: We were curious as to whether having all of these procedures at once had an impact on postoperative complication rates. We know from literature on breast cancer that women who undergo bilateral mastectomy have higher complication rates than women who undergo unilateral mastectomy. However, we could not find data on women who underwent breast, plastic reconstructive and gynecologic surgery at the same time.
Q: How did you conduct the research ?
A: We wanted to gather a large patient population, so we pooled data from the American College of Surgeons National Surgery Quality Improvement Program database. We identified patients who likely had breast cancer by examining patients who underwent breast surgery with axillary surgery. This allowed us to look at a larger patient population.
Q: Can you elaborate on your findings?
A: We found that patients who had combined breast, plastic reconstructive and gynecologic surgery had higher rates of complications, hospital readmissions and reoperations than patients who underwent breast surgery alone. Patients who underwent all three surgeries had a complication rate of 9.5% compared with 4.2% among patients who had breast surgery alone.
Q: Did any of your findings surprise you?
A: We were not surprised to learn that patients who had more surgery had a higher complication rate, but we were surprised to find that patients who underwent breast surgery alone were older and had more medical problems. This seems to suggest that surgeons are offering the combined surgery approach only to younger and healthier patients. Yet, the complication rate is still higher even though those who underwent breast surgery alone were much more likely to be older, have diabetes, smoke and have other medical problems that would increase their risk for complications.
Q: W hat are the clinical implications of the findings ?
A: We cannot definitively say that patients should not have combined surgery, but it is something we should include in our conversations with patients. We need to learn more, but this is a good initial study to help us discuss risks with our patients.
Q: What should subsequent research entail?
A: This database was chosen because it is a large sample of patients, but it is difficult to study because there is a limited number of variables and not a lot of granularity to the data. We limited our study to patients with cancer and did not look at high-risk patient populations, which tend to be young, healthy women who need all three surgeries. This is just the tip of the iceberg, and we should look in more detail at women with breast cancer as well as those who are at high risk for developing breast cancer. We were not able to take a detailed look at the types of complications that occurred among these patients, so this should be studied in the future. We also were not able to assess patients’ perception of these operations and how they felt about needing multiple operations at different time points or as a combined procedure. This would provide insight from the patient point of view. – by Jennifer Southall
Reference:
Tevis SE, et al. Breast J. 2019;doi:10.1111/tbj.13429.
For more information:
Sarah E. Tevis, MD, can be reached at UCHealth University of Colorado Hospital, 12605 E. 16th Ave., Aurora, CO 80045; email: sarah.tevis@ucdenver.edu.
Disclosure: Tevis reports no relevant financial disclosures.