Awake breast surgery and de-escalation treatment: strategies for frail and elderly breast cancer patients

Abstract

Objective: Awake breast surgery has been proven to be a concrete alternative to surgery under general anesthesia. This technique was shown to be advantageous in various aspects such as length of hospitalization and economic sustainability. Our study aims to verify the advantages of this technique in terms of operating room times, length of stay, and outcome in frail patients diagnosed with breast cancer. Patients and methods: Our retrospective study enrolled all frail patients, ASA ≥ 3, diagnosed with breast cancer and scheduled to undergo a surgical intervention. The type of surgery, duration of surgery, length of hospital stay, type of anesthesia, postoperative complications, postoperative dissociative episodes and CCI (Charlson Comorbidity Index) score were evaluated by comparing the data between the group of awake surgery and the group of patients undergoing surgery under general anesthesia. Results: A total of 34 patients were enrolled; 16 patients (45.7%) undergoing awake surgery with a mean age of 78 years [75;95], and 18 patients (54.3%) receiving general anesthesia. CCI was significantly higher in the Awake group with a median score of 12 [9;13] vs. 10 [9;11] in the No-Awake group: relative p-value was <0.001. Postoperative complications were comparable between the groups, showing no statistically significant differences. Six patients (33.3%) in the general anesthesia group experienced dissociative complications vs. 1 (6.3%) in the awake surgery group (p=0.05). There were no statistically significant differences regarding the other parameters. Conclusions: Awake breast surgery in elderly patients, especially in frail ones, could reduce the incidence of postoperative delirium by enabling a shorter hospitalization and allowing for a faster recovery.

Keywords

• de-escalation
• breast cancer surgery
• awake breast surgery
• elderly