Timing of surgery and risk of postoperative thrombotic complications after recovery from Covid-19 in breast cancer patients

Abstract

Background and purpose: The incidence of deep venous thrombosis (DVT) for patients with breast cancer after surgery is 2.00%-6.40%. The purpose of this study was to evaluate the correlation between postoperative DVT complications and surgical timing in breast cancer patients with coronavirus disease 2019 (COVID-19) infection, in order to guide clinical decision-making. Methods: From December 20, 2022 to March 20, 2023, 317 patients with breast cancer diagnosed with COVID-19 and with signs and symptoms of infection turning negative in Shandong Institute of Cancer Prevention and Treatment (Shandong Cancer Hospital), Shandong First Medical University (Shandong Academy of Medical Sciences) were enrolled. The control group included 329 patients with breast cancer who underwent surgery between May 1, 2019 and September 30, 2019 in the same hospital. Patients were grouped according to the interval between the date of COVID-19 infection and the date of surgery, and the interval time and postoperative DVT occurrence were analyzed. Results: Among 317 patients with breast cancer who underwent surgery after COVID-19 infection, 17 (5.36%), 29 (9.15%), 31 (9.78%), 50 (15.78%) and 190 (59.90%) underwent surgery after 0-2, 3-4, 5-6, 7-8 and 8 weeks, respectively. The incidence of postoperative DVT was 11.76%, 3.45%, 3.23%, 6.00% and 1.58%, respectively. The incidence of postoperative DVT in 329 patients without COVID-19 infection was 1.21%, and the incidence of postoperative DVT in patients receiving operation within 2 weeks of COVID-19 infection was significantly higher (OR=10.556; 95% CI: 1.095-303.313, P=0.03), the incidence of postoperative DVT in patients undergoing operation 3-8 weeks following COVID-19 infection was 4.55%. Multivariate analysis showed that COVID-19 infection interval was an independent predictor of DVT (OR=2.795; 95% CI: 0.692-11.278, P=0.024). All 10 patients with DVT after breast cancer surgery were recovered without serious complications such as pulmonary embolism, and the follow-up adjuvant anti-tumor therapy was not affected after symptomatic treatment. Conclusion: The incidence of DVT after breast cancer surgery within 8 weeks of COVID-19 infection is significantly higher than that of uninfected patients, especially the incidence of DVT in patients undergoing surgery within 2 weeks of COVID-19 infection is as high as 11.76%. Elective surgery for breast cancer within 2 weeks of COVID-19 infection should be avoided. Although the incidence of DVT in patients undergoing surgery 3 weeks after COVID-19 infection is still slightly high, surgical treatment can be recommended considering the urgency of breast cancer treatment, the good prognosis of DVT and the lack of influence on subsequent adjuvant therapy. However, detailed records of COVID-19 infection history of patients, early prevention and close monitoring should be made, and postoperative DVT should be treated.

Keywords

• |breast cancer|covid-19|deep vein thrombosis|surgical time