17 Comparing Outcomes of Sequential vs Concurrent Breast and Gynecologic Risk Reduction Surgery

Background/Significance

Women who are diagnosed with breast cancer and/or inherited cancer gene mutations may be presented with ovary removal as part of their breast cancer treatment plan, either for risk reduction or for ovarian suppression as an adjunct to endocrine therapy in premenopausal women with high-risk features. Many hospitals have begun to offer concurrent breast and gynecologic surgery in order to minimize the number of surgeries, operative time, and length of stay. We examined the outcomes of women undergoing breast and gynecologic operations in order to determine the safety of concurrent operations.

Materials and Methods

We conducted a retrospective chart review of patients undergoing breast and gynecologic surgery, either sequentially or concurrently, for a newly diagnosed breast cancer and/or inherited cancer gene mutation at a single institution from 2015 to 2020.

Results

A total of 104 patients with a mean age of 50 years (range, 26-72) were identified. Seventy patients (69%) had breast and/or reconstructive surgery followed by gynecologic surgery and 32 patients (31%) had concurrent operations. Most patients had an invasive cancer diagnosis or ductal carcinoma in situ (94%) and 40 patients had a high-risk mutation (39%). Minimally invasive bilateral salpingectomies were the most common gynecologic procedure performed (98%). Of the concurrent operations, 3 were performed with breast surgery, 12 were performed with breast surgery and immediate reconstruction, 15 were performed with later-stage reconstruction and 2 were performed with surgery on the axilla. Thirty-one patients (30%) experienced a total of 35 surgical complication (Clavian grade I-III) during their breast cancer treatment. Most of the complications were minor and did not require hospitalization or reoperation. On univariate analysis, there was no difference between the complication rates for patients who opted for concurrent surgeries vs sequential surgeries (25.0% vs 32.9%; P = .57). In a multivariate regression, patients who had concurrent surgery were not more likely than patients who had sequential operations to experience complications, controlling for race, medical comorbidities, smoking history, and if the patient had reconstruction (odds ratio, 0.81; 95% CI, 0.26-2.54).

Conclusions

We observed no increase in complication rates in patients who underwent combination breast and gynecologic surgery. Based on these results, we can continue to increase coordination among specialties in order to reduce the burden of multiple operations placed on patients with breast cancer.