Skip to main content
Top
Published in: Annals of Surgical Oncology 4/2011

01-04-2011 | Breast Oncology

Perioperative Complications of Breast Cancer Surgery in Elderly Women (≥80 Years)

Authors: Paraskevi Chatzidaki, MD, Chrysovalantis Mellos, MD, Volker Briese, MD, Ioannis Mylonas, MD

Published in: Annals of Surgical Oncology | Issue 4/2011

Login to get access

Abstract

Purpose

There has been much controversy regarding the optimal management of breast cancer in very elderly women. Some clinicians are reluctant to offer surgical treatment for women older than aged 80 years because of the assumed higher operative risk associated with advanced age. This study was designed to investigate the perioperative complications of breast cancer surgery in women of this age group.

Methods

Data were reviewed of all women ≥80 years of age who underwent breast cancer surgery at a university clinic during the period 1990–2005. Symptoms, comorbidities, preoperative risk assessment, type of operation, postoperative histological diagnosis, hospital stay, morbidity, and mortality were documented and analyzed.

Results

During this 16-year period, 140 operations for breast cancer were performed in 129 women. The majority of the patients (37.9%) underwent a modified radical mastectomy, 32.1% underwent a simple mastectomy, 24.3% underwent breast-conserving therapy, and 5.7% underwent an axillary lymph node dissection. Complications occurred in 37.1% of the cohort: 31.4% were minor complications and only 5.7% were major. Intraoperative morbidity was 18.6% and postoperative morbidity was 20%. Late complications occurred in 5% of patients. The most common complications were associated with the wound region (50%). The perioperative mortality in this group of elderly women was zero.

Conclusions

Breast cancer surgery has acceptable perioperative morbidity and mortality in women aged ≥80 years. Surgery is the cornerstone of breast cancer treatment and should be offered as first-line treatment for all patients regardless of their age.
Literature
1.
go back to reference Brenner H, Stegmaier C, Ziegler H. Long-term survival of cancer patients in Germany achieved by the beginning of the third millennium. Ann Oncol. 2005;16:981–6.PubMedCrossRef Brenner H, Stegmaier C, Ziegler H. Long-term survival of cancer patients in Germany achieved by the beginning of the third millennium. Ann Oncol. 2005;16:981–6.PubMedCrossRef
2.
go back to reference Jemal A, Siegel R, Ward E, Hao Y, Xu J, Thun MJ. Cancer statistics, 2009. CA Cancer J Clin. 2009;59:225–49.PubMedCrossRef Jemal A, Siegel R, Ward E, Hao Y, Xu J, Thun MJ. Cancer statistics, 2009. CA Cancer J Clin. 2009;59:225–49.PubMedCrossRef
3.
go back to reference Gennari R, Curigliano G, Rotmensz N, Robertson C, Colleoni M, Zurrida S, et al. Breast carcinoma in elderly women: features of disease presentation, choice of local and systemic treatments compared with younger postmenopausal patients. Cancer. 2004;101:1302–10.PubMedCrossRef Gennari R, Curigliano G, Rotmensz N, Robertson C, Colleoni M, Zurrida S, et al. Breast carcinoma in elderly women: features of disease presentation, choice of local and systemic treatments compared with younger postmenopausal patients. Cancer. 2004;101:1302–10.PubMedCrossRef
4.
go back to reference Bernardi D, Errante D, Gallligioni E, Crivellari D, Bianco A, Salvagno L, et al. Treatment of breast cancer in older women. Acta Oncol. 2008;47:187–98.PubMedCrossRef Bernardi D, Errante D, Gallligioni E, Crivellari D, Bianco A, Salvagno L, et al. Treatment of breast cancer in older women. Acta Oncol. 2008;47:187–98.PubMedCrossRef
5.
go back to reference Hutchins LF, Unger JM, Crowley JJ, Coltman CA Jr, Albain KS. Underrepresentation of patients 65 years of age or older in cancer-treatment trials. N Engl J Med. 1999;341:2061–7.PubMedCrossRef Hutchins LF, Unger JM, Crowley JJ, Coltman CA Jr, Albain KS. Underrepresentation of patients 65 years of age or older in cancer-treatment trials. N Engl J Med. 1999;341:2061–7.PubMedCrossRef
6.
go back to reference Evron E, Goldberg H, Kuzmin A, Gutman R, Rizel S, Sella A, et al. Breast cancer in octogenarians. Cancer. 2006;106:1664–8.PubMedCrossRef Evron E, Goldberg H, Kuzmin A, Gutman R, Rizel S, Sella A, et al. Breast cancer in octogenarians. Cancer. 2006;106:1664–8.PubMedCrossRef
7.
go back to reference Wildiers H, Kunkler I, Biganzoli L, Fracheboud J, Vlastos G, Bernard-Marty C, et al. Management of breast cancer in elderly individuals: recommendations of the International Society of Geriatric Oncology. Lancet Oncol. 2007;8:1101–15.PubMedCrossRef Wildiers H, Kunkler I, Biganzoli L, Fracheboud J, Vlastos G, Bernard-Marty C, et al. Management of breast cancer in elderly individuals: recommendations of the International Society of Geriatric Oncology. Lancet Oncol. 2007;8:1101–15.PubMedCrossRef
8.
go back to reference Badgwell BD, Giordano SH, Duan ZZ, Fang S, Bedrosian I, Kuerer HM, et al. Mammography before diagnosis among women age 80 years and older with breast cancer. J Clin Oncol. 2008;26:2482–8.PubMedCrossRef Badgwell BD, Giordano SH, Duan ZZ, Fang S, Bedrosian I, Kuerer HM, et al. Mammography before diagnosis among women age 80 years and older with breast cancer. J Clin Oncol. 2008;26:2482–8.PubMedCrossRef
9.
go back to reference Randolph WM, Goodwin JS, Mahnken JD, Freeman JL. Regular mammography use is associated with elimination of age-related disparities in size and stage of breast cancer at diagnosis. Ann Intern Med. 2002;137:783–90.PubMed Randolph WM, Goodwin JS, Mahnken JD, Freeman JL. Regular mammography use is associated with elimination of age-related disparities in size and stage of breast cancer at diagnosis. Ann Intern Med. 2002;137:783–90.PubMed
10.
go back to reference Witherby SM, Muss HB. Update in medical oncology for older patients: focus on breast cancer: management of early breast cancer. Cancer J. 2005;11:506–17.PubMedCrossRef Witherby SM, Muss HB. Update in medical oncology for older patients: focus on breast cancer: management of early breast cancer. Cancer J. 2005;11:506–17.PubMedCrossRef
11.
go back to reference Amsterdam E, Birkenfeld S, Gilad A, Krispin M. Surgery for carcinoma of the breast in women over 70 years of age. J Surg Oncol. 1987;35:180–3.PubMedCrossRef Amsterdam E, Birkenfeld S, Gilad A, Krispin M. Surgery for carcinoma of the breast in women over 70 years of age. J Surg Oncol. 1987;35:180–3.PubMedCrossRef
12.
go back to reference Singh R, Hellman S, Heimann R. The natural history of breast carcinoma in the elderly: implications for screening and treatment. Cancer. 2004;100:1807–13.PubMedCrossRef Singh R, Hellman S, Heimann R. The natural history of breast carcinoma in the elderly: implications for screening and treatment. Cancer. 2004;100:1807–13.PubMedCrossRef
13.
go back to reference Davis SJ, Karrer FW, Moor BJ, Rose SG, Eakins G. Characteristics of breast cancer in women over 80 years of age. Am J Surg. 1985;150:655–8.PubMedCrossRef Davis SJ, Karrer FW, Moor BJ, Rose SG, Eakins G. Characteristics of breast cancer in women over 80 years of age. Am J Surg. 1985;150:655–8.PubMedCrossRef
14.
go back to reference Swanson RS, Sawicka J, Wood WC. Treatment of carcinoma of the breast in the older geriatric patient. Surg Gynecol Obstet. 1991;173:465–9.PubMed Swanson RS, Sawicka J, Wood WC. Treatment of carcinoma of the breast in the older geriatric patient. Surg Gynecol Obstet. 1991;173:465–9.PubMed
15.
go back to reference Punglia RS, Morrow M, Winer EP, Harris JR. Local therapy and survival in breast cancer. N Engl J Med. 2007;356:2399–405.PubMedCrossRef Punglia RS, Morrow M, Winer EP, Harris JR. Local therapy and survival in breast cancer. N Engl J Med. 2007;356:2399–405.PubMedCrossRef
16.
go back to reference El-Tamer MB, Ward BM, Schifftner T, Neumayer L, Khuri S, Henderson W. Breast cancer surgery in women: national benchmarks for standards of care. Ann Surg. 2007;245:665–71.PubMedCrossRef El-Tamer MB, Ward BM, Schifftner T, Neumayer L, Khuri S, Henderson W. Breast cancer surgery in women: national benchmarks for standards of care. Ann Surg. 2007;245:665–71.PubMedCrossRef
17.
18.
go back to reference Mak PH, Campbell RC, Irwin MG, American Society of Anesthesiologists. The ASA Physical Status Classification: inter-observer consistency. American Society of Anesthesiologists. Anaesth Intensive Care. 2002;30:633–40.PubMed Mak PH, Campbell RC, Irwin MG, American Society of Anesthesiologists. The ASA Physical Status Classification: inter-observer consistency. American Society of Anesthesiologists. Anaesth Intensive Care. 2002;30:633–40.PubMed
19.
go back to reference Loskant G. Gynecologic surgery in the aged patient. Geburtshilfe Frauenheilkd. 1968;28:492–7.PubMed Loskant G. Gynecologic surgery in the aged patient. Geburtshilfe Frauenheilkd. 1968;28:492–7.PubMed
20.
go back to reference Angood PB, Gingalewski CA, Andersen DK. Surgical complications. In: Townsend CM, editors. Sabiston textbook of surgery. Philadelphia: WB Saunders; 2001. p. 199–203. Angood PB, Gingalewski CA, Andersen DK. Surgical complications. In: Townsend CM, editors. Sabiston textbook of surgery. Philadelphia: WB Saunders; 2001. p. 199–203.
21.
go back to reference Cheung KL, Wong AW, Parker H, Li VW, Winterbottom L, Morgan DA, et al. Pathological features of primary breast cancer in the elderly based on needle core biopsies—a large series from a single centre. Crit Rev Oncol Hematol. 2008;67:263–7.PubMedCrossRef Cheung KL, Wong AW, Parker H, Li VW, Winterbottom L, Morgan DA, et al. Pathological features of primary breast cancer in the elderly based on needle core biopsies—a large series from a single centre. Crit Rev Oncol Hematol. 2008;67:263–7.PubMedCrossRef
22.
go back to reference Daidone MG, Coradini D, Martelli G, Veneroni S. Primary breast cancer in elderly women: biological profile and relation with clinical outcome. Crit Rev Oncol Hematol. 2003;45:313–25.PubMedCrossRef Daidone MG, Coradini D, Martelli G, Veneroni S. Primary breast cancer in elderly women: biological profile and relation with clinical outcome. Crit Rev Oncol Hematol. 2003;45:313–25.PubMedCrossRef
23.
go back to reference Molino A, Giovannini M, Auriemma A, Fiorio E, Mercanti A, Mandara M, et al. Pathological, biological and clinical characteristics, and surgical management, of elderly women with breast cancer. Crit Rev Oncol Hematol. 2006;59:226–33.PubMedCrossRef Molino A, Giovannini M, Auriemma A, Fiorio E, Mercanti A, Mandara M, et al. Pathological, biological and clinical characteristics, and surgical management, of elderly women with breast cancer. Crit Rev Oncol Hematol. 2006;59:226–33.PubMedCrossRef
24.
go back to reference Eppenberger-Castori S, Moore DH Jr, Thor AD, Edgerton SM, Kueng W, Eppenberger U, et al. Age-associated biomarker profiles of human breast cancer. Int J Biochem Cell Biol. 2002;34:1318–30.PubMedCrossRef Eppenberger-Castori S, Moore DH Jr, Thor AD, Edgerton SM, Kueng W, Eppenberger U, et al. Age-associated biomarker profiles of human breast cancer. Int J Biochem Cell Biol. 2002;34:1318–30.PubMedCrossRef
25.
go back to reference Bouchardy C, Rapiti E, Fioretta G, Laissue P, Neyroud-Caspar I, Schafer P, et al. Undertreatment strongly decreases prognosis of breast cancer in elderly women. J Clin Oncol. 2003;21:3580–7.PubMedCrossRef Bouchardy C, Rapiti E, Fioretta G, Laissue P, Neyroud-Caspar I, Schafer P, et al. Undertreatment strongly decreases prognosis of breast cancer in elderly women. J Clin Oncol. 2003;21:3580–7.PubMedCrossRef
26.
go back to reference Jatoi I, Chen BE, Anderson WF, Rosenberg PS. Breast cancer mortality trends in the United States according to estrogen receptor status and age at diagnosis. J Clin Oncol. 2007;25:1683–90.PubMedCrossRef Jatoi I, Chen BE, Anderson WF, Rosenberg PS. Breast cancer mortality trends in the United States according to estrogen receptor status and age at diagnosis. J Clin Oncol. 2007;25:1683–90.PubMedCrossRef
27.
go back to reference Nagadowska M, Kulakowski A. Breast cancer in elderly women: characteristics of the disease. Eur J Surg Oncol. 1991;17:609–14.PubMed Nagadowska M, Kulakowski A. Breast cancer in elderly women: characteristics of the disease. Eur J Surg Oncol. 1991;17:609–14.PubMed
28.
go back to reference Lazovich D, Solomon CC, Thomas DB, Moe RE, White E. Breast conservation therapy in the United States following the 1990 National Institutes of Health Consensus Development Conference on the treatment of patients with early stage invasive breast carcinoma. Cancer. 1999;86:628–37.PubMedCrossRef Lazovich D, Solomon CC, Thomas DB, Moe RE, White E. Breast conservation therapy in the United States following the 1990 National Institutes of Health Consensus Development Conference on the treatment of patients with early stage invasive breast carcinoma. Cancer. 1999;86:628–37.PubMedCrossRef
29.
go back to reference Yoshinaga Y, Shirakusa T, Baba M, Beppu R, Hiratsuka M, Maekawa T, et al. Surgical treatment for elderly breast cancer patients over the age of 70. Int Surg. 2003;88:169–74.PubMed Yoshinaga Y, Shirakusa T, Baba M, Beppu R, Hiratsuka M, Maekawa T, et al. Surgical treatment for elderly breast cancer patients over the age of 70. Int Surg. 2003;88:169–74.PubMed
30.
go back to reference Morishita Y, Tsuda H, Fukutomi T, Mukai K, Shimosato Y, Hirohashi S. Clinicopathological characteristics of primary breast cancer in older geriatric women: a study of 39 Japanese patients over 80 years old. Jpn J Cancer Res. 1997;88:693–9.PubMed Morishita Y, Tsuda H, Fukutomi T, Mukai K, Shimosato Y, Hirohashi S. Clinicopathological characteristics of primary breast cancer in older geriatric women: a study of 39 Japanese patients over 80 years old. Jpn J Cancer Res. 1997;88:693–9.PubMed
31.
go back to reference Svastics E, Sulyok Z, Besznyak I. Treatment of breast cancer in women older than 70 years. J Surg Oncol. 1989;41:19–21.PubMedCrossRef Svastics E, Sulyok Z, Besznyak I. Treatment of breast cancer in women older than 70 years. J Surg Oncol. 1989;41:19–21.PubMedCrossRef
32.
go back to reference Singletary SE, Shallenberger R, Guinee VF. Breast cancer in the elderly. Ann Surg. 1993;218:667–71.PubMedCrossRef Singletary SE, Shallenberger R, Guinee VF. Breast cancer in the elderly. Ann Surg. 1993;218:667–71.PubMedCrossRef
33.
go back to reference Kesseler HJ, Seton JZ. The treatment of operable breast cancer in the elderly female. Am J Surg. 1978;135:664–6.PubMedCrossRef Kesseler HJ, Seton JZ. The treatment of operable breast cancer in the elderly female. Am J Surg. 1978;135:664–6.PubMedCrossRef
34.
go back to reference Hunt KE, Fry DE, Bland KI. Breast carcinoma in the elderly patient: an assessment of operative risk, morbidity and mortality. Am J Surg. 1980;140:339–42.PubMedCrossRef Hunt KE, Fry DE, Bland KI. Breast carcinoma in the elderly patient: an assessment of operative risk, morbidity and mortality. Am J Surg. 1980;140:339–42.PubMedCrossRef
35.
go back to reference Bertin ML, Crowe J, Gordon SM. Determinants of surgical site infection after breast surgery. Am J Infect Control. 1998;26:61–5.PubMedCrossRef Bertin ML, Crowe J, Gordon SM. Determinants of surgical site infection after breast surgery. Am J Infect Control. 1998;26:61–5.PubMedCrossRef
36.
go back to reference Gupta R, Sinnett D, Carpenter R, Preece PE, Royle GT. Antibiotic prophylaxis for post-operative wound infection in clean elective breast surgery. Eur J Surg Oncol. 2000;26:363–6.PubMedCrossRef Gupta R, Sinnett D, Carpenter R, Preece PE, Royle GT. Antibiotic prophylaxis for post-operative wound infection in clean elective breast surgery. Eur J Surg Oncol. 2000;26:363–6.PubMedCrossRef
37.
go back to reference Wagman LD, Tegtmeier B, Beatty JD, Kloth DD, Kokal WA, Riihimaki DU, et al. A prospective, randomized double-blind study of the use of antibiotics at the time of mastectomy. Surg Gynecol Obstet. 1990;170:12–6.PubMed Wagman LD, Tegtmeier B, Beatty JD, Kloth DD, Kokal WA, Riihimaki DU, et al. A prospective, randomized double-blind study of the use of antibiotics at the time of mastectomy. Surg Gynecol Obstet. 1990;170:12–6.PubMed
38.
go back to reference Cunningham M, Bunn F, Handscomb K. Prophylactic antibiotics to prevent surgical site infection after breast cancer surgery. Cochrane Database Syst Rev. 2006:CD005360. Cunningham M, Bunn F, Handscomb K. Prophylactic antibiotics to prevent surgical site infection after breast cancer surgery. Cochrane Database Syst Rev. 2006:CD005360.
39.
go back to reference Friis E, Hørby J, Sørensen LT, Pilsgaard B, Wille-Jørgensen P, Johansen L, et al. Thromboembolic prophylaxis as a risk factor for postoperative complications after breast cancer surgery. World J Surg. 2004;28:540–3.PubMedCrossRef Friis E, Hørby J, Sørensen LT, Pilsgaard B, Wille-Jørgensen P, Johansen L, et al. Thromboembolic prophylaxis as a risk factor for postoperative complications after breast cancer surgery. World J Surg. 2004;28:540–3.PubMedCrossRef
40.
go back to reference van Wijk I, Kappelle LJ, J van Gijn, Koudstaal PJ, Franke CL, Vermeulen M, et al. Long-term survival and vascular event risk after transient ischaemic attack or minor ischaemic stroke: a cohort study. Lancet. 2005;365:2098–104.PubMedCrossRef van Wijk I, Kappelle LJ, J van Gijn, Koudstaal PJ, Franke CL, Vermeulen M, et al. Long-term survival and vascular event risk after transient ischaemic attack or minor ischaemic stroke: a cohort study. Lancet. 2005;365:2098–104.PubMedCrossRef
41.
go back to reference Wolters U, Wolf T, Stutzer H, Schroder T. ASA classification and perioperative variables as predictors of postoperative outcome. Br J Anaesth. 1996;77:217–22.PubMed Wolters U, Wolf T, Stutzer H, Schroder T. ASA classification and perioperative variables as predictors of postoperative outcome. Br J Anaesth. 1996;77:217–22.PubMed
42.
go back to reference Audisio RA, Ramesh H, Longo WE, Zbar AP, Pope D. Preoperative assessment of surgical risk in oncogeriatric patients. Oncologist. 2005;10:262–8.PubMedCrossRef Audisio RA, Ramesh H, Longo WE, Zbar AP, Pope D. Preoperative assessment of surgical risk in oncogeriatric patients. Oncologist. 2005;10:262–8.PubMedCrossRef
43.
go back to reference Harari D, Hopper A, Dhesi J, Babic-Illman G, Lockwood L, Martin F. Proactive care of older people undergoing surgery (‘POPS’): designing, embedding, evaluating and funding a comprehensive geriatric assessment service for older elective surgical patients. Age Ageing. 2007;36:190–6.PubMedCrossRef Harari D, Hopper A, Dhesi J, Babic-Illman G, Lockwood L, Martin F. Proactive care of older people undergoing surgery (‘POPS’): designing, embedding, evaluating and funding a comprehensive geriatric assessment service for older elective surgical patients. Age Ageing. 2007;36:190–6.PubMedCrossRef
44.
go back to reference Hosking MP, Warner MA, Lobdell CM, Offord KP, Melton LJ 3rd. Outcomes of surgery in patients 90 years of age and older. JAMA. 1989;261:1909–15.PubMedCrossRef Hosking MP, Warner MA, Lobdell CM, Offord KP, Melton LJ 3rd. Outcomes of surgery in patients 90 years of age and older. JAMA. 1989;261:1909–15.PubMedCrossRef
45.
go back to reference Klotz HP, Candinas D, Platz A, Horvath A, Dindo D, Schlumpf R, Largiader F. Preoperative risk assessment in elective general surgery. Br J Surg. 1996;83:1788–91.PubMedCrossRef Klotz HP, Candinas D, Platz A, Horvath A, Dindo D, Schlumpf R, Largiader F. Preoperative risk assessment in elective general surgery. Br J Surg. 1996;83:1788–91.PubMedCrossRef
46.
go back to reference Tejler G, Aspegren K. Complications and hospital stay after surgery for breast cancer: a prospective study of 385 patients. Br J Surg. 1985;72:542–4.PubMedCrossRef Tejler G, Aspegren K. Complications and hospital stay after surgery for breast cancer: a prospective study of 385 patients. Br J Surg. 1985;72:542–4.PubMedCrossRef
Metadata
Title
Perioperative Complications of Breast Cancer Surgery in Elderly Women (≥80 Years)
Authors
Paraskevi Chatzidaki, MD
Chrysovalantis Mellos, MD
Volker Briese, MD
Ioannis Mylonas, MD
Publication date
01-04-2011
Publisher
Springer-Verlag
Published in
Annals of Surgical Oncology / Issue 4/2011
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-010-1389-1

Other articles of this Issue 4/2011

Annals of Surgical Oncology 4/2011 Go to the issue