Surgery for Metastatic Breast Cancer Holds Higher Risks

Advanced breast cancer patients are more likely to incur postoperative complications.

A retrospective analysis of surgical outcomes in metastatic vs non-metastatic breast cancer patients shows that patients with advanced disease are 1.6 times more likely to incur postoperative complications compared with patients with early-stage disease. Women with metastatic disease had a longer operative time, as well as a longer hospital recovery time.

The metastatic cancer patients also had a significantly higher all-cause 30-day mortality rate compared with non-metastatic patients (1.8% vs 0.06%, respectively; P < .0001). The 30-day morbidity rate was about two times higher in women with advanced disease compared with those with early-stage disease (7.5% vs 3.7%, respectively; P < .0001).

The analysis was based on data on women undergoing surgery from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. Study author Erin Cordeiro, MD, of the University of Toronto, presented the results at the 15th Annual Meeting of the American Society of Breast Surgeons held April 30–May 4 in Las Vegas, Nevada.

Non-metastatic patients were more likely to have outpatient surgery compared with metastatic patients. Infections after surgery, as well as respiratory, cardiac, bleeding, and thromboembolic complications, were more common among the metastatic breast cancer cohort. “This was a mild increase in postoperative complications that surgeons and patients should be aware of, but that surgery is a relatively safe procedure,” said Cordeiro at a press briefing.

“One question that has never been answered in the literature to date is whether or not [metastatic breast cancer patients] are at an increased risk of postoperative complications due to their metastatic disease,” said Cordeiro.

According to the study authors, this is the first study to analyze both morbidity and mortality outcomes after surgery in women with metastatic breast cancer.

Of the 68,316 women included in this study, 1.5% (1,031) had been diagnosed with metastatic disease. The median age of metastatic and non-metastatic breast cancer patients in this study was 59.3 and 60.7 years, respectively.

About 3.5% of the women diagnosed with breast cancer in North America are diagnosed with late-stage disease. It is estimated that there will be 232,670 new cases of breast cancer diagnosed in 2014.

According to the study authors, there is no standard surgical management for patients with stage IV disease, and differences in post-surgery risks between metastatic and non-metastatic breast cancer patients have not been well examined.

Patients with advanced disease were more likely to undergo a mastectomy (71% of metastatic patients vs 49% of non-metastatic patients; P < .0001). The women with metastatic disease were also more likely to undergo a full axillary lymph node dissection (47% vs 32%; P < .0001).

According to Cordeiro, these results may have implications for surgery decisions in those patients who are diagnosed with metastatic disease.

“As breast surgeons, we are unsure of the role of primary breast surgery. Whether removing the primary breast tumor in women who have evidence of metastatic breast cancer will provide a survival advantage is not clear, and there are randomized trials currently accruing to hopefully answer this question,” said Cordeiro during the press briefing.