Surgical choices and complications in elderly women: a single center retrospective analysis in frail vs. non frail breast cancer patients

Abstract

Abstract Background Early breast cancer (EBC) in the elderly is a major public health problem and a risk factor for undertreatment. The authors aim to describe surgical patterns and outcomes of an elderly population diagnosed with EBC treated in a BC-dedicated reference center. Methods  Retrospective study for all EBC patients ≥70 years old submitted to breast surgery from 2018 to 2021. Patients were included if submitted to the G8 screening tool. Data on standard demographics, surgery performed, and outcomes were collected. Results Overall, 192 patients were included. Frail patients were significantly older (p<0.01), had worse Charlson Comorbidity Index (p<0.01) and ASA (p<0.01) scores and more comorbidities (p=0.09). In total, 199 breasts were operated; 173 breast conservative surgeries (BCS) and 26 mastectomies. In the frail population, oncoplastic surgery after BCS was more frequently mammoplasty; no reconstruction was reported after mastectomy. In the fit group, more diversity was seen in oncoplastic procedures; 13 breasts underwent direct-to-implant breast reconstruction (BR) after mastectomy. Frail patients were less likely to be offered BR (p<0.01). There was no association between frailty and postoperative complications, in-hospital length of stay, readmission, or reintervention. Conclusions Our results suggest that G8 frail patients are less likely to be offered BR. Even if there were no significant differences in surgical adverse outcomes between groups, this could have been masked by a higher proportion of BR among fit patients. G8 screening can be a useful instrument to support the surgeon’s decision to whether or not to consider BR in elderly breast cancer patients. Level of Evidence: Level IV, Risk/Prognostic Study.