Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Breast Cancer Research and Treatment
Published in: Breast Cancer Research and Treatment 1/2018

01-08-2018 | Epidemiology

Concurrent risk-reduction surgery in patients with increased lifetime risk for breast and ovarian cancer: an analysis of the National Surgical Quality Improvement Program (NSQIP) database

Authors: Maryam Elmi, Arash Azin, Ahmad Elnahas, David R. McCready, Tulin D. Cil

Published in: Breast Cancer Research and Treatment | Issue 1/2018

Login to get access

Abstract

Background

Patients with genetic susceptibility to breast and ovarian cancer are eligible for risk-reduction surgery. Surgical morbidity of risk-reduction mastectomy (RRM) with concurrent bilateral salpingo-oophorectomy (BSO) is unknown. Outcomes in these patients were compared to patients undergoing RRM without BSO using a large multi-institutional database.

Methods

A retrospective cohort analysis was conducted using the American College of Surgeon’s National Surgical Quality Improvement Program (NSQIP) 2007–2016 datasets, comparing postoperative morbidity between patients undergoing RRM with patients undergoing RRM with concurrent BSO. Patients with genetic susceptibility to breast/ovarian cancer undergoing risk-reduction surgery were identified. The primary outcome was 30-day postoperative major morbidity. Secondary outcomes included surgical site infections, reoperations, readmissions, length of stay, and venous thromboembolic events. A multivariate analysis was performed to determine predictors of postoperative morbidity and the adjusted effect of concurrent BSO on morbidity.

Results

Of the 5470 patients undergoing RRM, 149 (2.7%) underwent concurrent BSO. The overall rate of major morbidity and postoperative infections was 4.5% and 4.6%, respectively. There was no significant difference in the rate of postoperative major morbidity (4.5% vs 4.7%, p = 0.91) or any of the secondary outcomes between patients undergoing RRM without BSO vs. those undergoing RRM with concurrent BSO. Multivariable analysis showed Body Mass Index (OR 1.05; p < 0.001) and smoking (OR 1.78; p = 0.003) to be the only predictors associated with major morbidity. Neither immediate breast reconstruction (OR 1.02; p = 0.93) nor concurrent BSO (OR 0.94; p = 0.89) were associated with increased postoperative major morbidity.

Conclusion

This study demonstrated that RRM with concurrent BSO was not associated with significant additional morbidity when compared to RRM without BSO. Therefore, this joint approach may be considered for select patients at risk for both breast and ovarian cancer.
Appendix
Available only for authorised users
Literature
1.
2.
Kuchenbaecker KB et al (2017) Risks of Breast, Ovarian, and Contralateral Breast Cancer for BRCA1 and BRCA2 Mutation Carriers. Jama 317(23):2402–2416CrossRefPubMed
3.
Mavaddat N et al (2013) Cancer risks for BRCA1 and BRCA2 mutation carriers: results from prospective analysis of EMBRACE. J Natl Cancer Inst 105(11):812 – 22CrossRefPubMed
4.
Meijers-Heijboer H et al (2001) Breast cancer after prophylactic bilateral mastectomy in women with a BRCA1 or BRCA2 mutation. N Engl J Med 345(3):159 – 64CrossRefPubMed
5.
Rebbeck TR et al (2004) Bilateral prophylactic mastectomy reduces breast cancer risk in BRCA1 and BRCA2 mutation carriers: the PROSE Study Group. J Clin Oncol 22(6):1055–1062CrossRefPubMed
6.
Hartmann LC et al (1999) Efficacy of bilateral prophylactic mastectomy in women with a family history of breast cancer. N Engl J Med 340(2):77–84CrossRefPubMed
7.
Ludwig KK et al (2016) Risk reduction and survival benefit of prophylactic surgery in BRCA mutation carriers, a systematic review. Am J Surg 212(4):660–669CrossRefPubMed
8.
Gilbert M et al (2002) The genetic bases for the variation in the lipo-oligosaccharide of the mucosal pathogen, Campylobacter jejuni. Biosynthesis of sialylated ganglioside mimics in the core oligosaccharide. J Biol Chem 277(1):327 – 37CrossRefPubMed
9.
Domchek SM et al (2010) Association of risk-reducing surgery in BRCA1 or BRCA2 mutation carriers with cancer risk and mortality. Jama 304(9):967 – 75CrossRefPubMedPubMedCentral
10.
Rebbeck TR et al (2002) Prophylactic oophorectomy in carriers of BRCA1 or BRCA2 mutations. N Engl J Med 346(21):1616–1622CrossRefPubMed
11.
Kauff ND et al (2008) Risk-reducing salpingo-oophorectomy for the prevention of BRCA1- and BRCA2-associated breast and gynecologic cancer: a multicenter, prospective study. J Clin Oncol 26(8):1331–1337CrossRefPubMedPubMedCentral
12.
J, S.C., et al., Comparing Coordinated Versus Sequential Salpingo-Oophorectomy for BRCA1 and BRCA2 Mutation Carriers With Breast Cancer. Clin Breast Cancer, 2016. 16(6): 494–499
13.
14.
Del Corral GA et al (2015) Outcomes and Cost Analysis in High-Risk Patients Undergoing Simultaneous Free Flap Breast Reconstruction and Gynecologic Procedures. Ann Plast Surg 75(5):534–538CrossRefPubMed
15.
Khadim MF et al (2013) Multidisciplinary one-stage risk-reducing gynaecological and breast surgery with immediate reconstruction in BRCA-gene carrier women. Eur J Surg Oncol 39(12):1346–1350CrossRefPubMed
16.
Rebbeck TR, Kauff ND, Domchek SM (2009) Meta-analysis of risk reduction estimates associated with risk-reducing salpingo-oophorectomy in BRCA1 or BRCA2 mutation carriers. J Natl Cancer Inst 101(2):80 – 7CrossRefPubMedPubMedCentral
17.
Fatouros M, Baltoyiannis G, Roukos DH (2008) The predominant role of surgery in the prevention and new trends in the surgical treatment of women with BRCA1/2 mutations. Ann Surg Oncol 15(1):21–33CrossRefPubMed
18.
Fischer JP et al (2013) Impact of obesity on outcomes in breast reconstruction: analysis of 15,937 patients from the ACS-NSQIP datasets. J Am Coll Surg 217(4):656 – 64CrossRefPubMed
19.
Fischer JP et al (2014) Effect of BMI on modality-specific outcomes in immediate breast reconstruction (IBR)--a propensity-matched analysis using the 2005–2011 ACS-NSQIP datasets. J Plast Surg Hand Surg 48(5):297–304CrossRefPubMed
20.
Ilonzo N et al (2017) Breast reconstruction after mastectomy: A ten-year analysis of trends and immediate postoperative outcomes. Breast 32:7–12CrossRefPubMed
21.
Khoo A et al (1998) A comparison of resource costs of immediate and delayed breast reconstruction. Plast Reconstr Surg 101(4):964–968 discussion 969 – 70.CrossRefPubMed
22.
Al-Ghazal SK et al (2000) The psychological impact of immediate rather than delayed breast reconstruction. Eur J Surg Oncol 26(1):17 – 9CrossRefPubMed
23.
Casey WJ et al (2010) Safety and efficacy of perforator flap breast reconstruction with combined intraabdominal procedures. Ann Plast Surg 64(2):144 – 50CrossRefPubMed
24.
Voss SC, Sharp HC, Scott JR (1986) Abdominoplasty combined with gynecologic surgical procedures. Obstet Gynecol 67(2):181–185CrossRefPubMed
25.
Shull BL, Verheyden CN (1988) Combined plastic and gynecological surgical procedures. Ann Plast Surg 20(6):552–557CrossRefPubMed
26.
Kryger ZB, Dumanian GA, Howard MA (2007) Safety issues in combined gynecologic and plastic surgical procedures. Int J Gynaecol Obstet 99(3):257 – 63CrossRefPubMed
27.
Ma IT et al (2017) Outcomes of Concurrent Breast and Gynecologic Risk Reduction Surgery. Ann Surg Oncol 24(1):77–83CrossRefPubMed
28.
Willsher P, Ali A, Jackson L (2008) Laparoscopic oophorectomy in the management of breast disease. ANZ J Surg 78(8):670–672CrossRefPubMed
29.
Perabo M et al (2014) Prophylactic mastectomy with immediate reconstruction combined with simultaneous laparoscopic salpingo-oophorectomy via a transmammary route: a novel surgical approach to female BRCA-mutation carriers. Arch Gynecol Obstet 289(6):1325–1330PubMed
30.
Garvey EM et al (2013) Neoadjuvant therapy and breast cancer surgery: a closer look at postoperative complications. Am J Surg 206(6):894–898; discussion 898–9CrossRefPubMed
Metadata
Title
Concurrent risk-reduction surgery in patients with increased lifetime risk for breast and ovarian cancer: an analysis of the National Surgical Quality Improvement Program (NSQIP) database
Authors
Maryam Elmi
Arash Azin
Ahmad Elnahas
David R. McCready
Tulin D. Cil
Publication date
01-08-2018
Publisher
Springer US
Published in
Breast Cancer Research and Treatment / Issue 1/2018
Print ISSN: 0167-6806
Electronic ISSN: 1573-7217
DOI
https://doi.org/10.1007/s10549-018-4818-7

Other articles of this Issue 1/2018

Breast Cancer Research and Treatment 1/2018 Go to the issue

Letter to the Editor

Tamoxifen-induced fatty liver disease in a Caucasian patient

Epidemiology

Uptake of BRCA 1/2 and oncotype DX testing by medical and surgical oncologists

Clinical trial

Palbociclib in highly pretreated metastatic ER-positive HER2-negative breast cancer

Clinical trial

A double-blind, randomised trial of a polyphenolic-rich nail bed balm for chemotherapy-induced onycholysis: the UK polybalm study

Clinical trial

A phase II study evaluating the efficacy of zoledronic acid in prevention of aromatase inhibitor-associated musculoskeletal symptoms: the ZAP trial

Review

Use of cyclin-dependent kinase (CDK) 4/6 inhibitors for hormone receptor-positive, human epidermal growth factor receptor 2-negative, metastatic breast cancer: a roundtable discussion by The Breast Cancer Therapy Expert Group (BCTEG)
Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Watch now

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras
Prof. Fabrice Barlesi
Developed by: Springer Medicine
Image Credits