Nick Mulcahy

May 01, 2014

There are significantly more complications and deaths soon after primary surgery for metastatic breast cancer than for earlier-stage disease, according to a new retrospective study.

Metastatic patients had a 30-day morbidity rate of 7.5% and a mortality rate of 1.8%, whereas the nonmetastatic group experienced corresponding rates of 3.7% and 0.1%.

Metastatic disease was also an independent predictor of postoperative morbidity.

The most common postsurgery complications in women with metastatic disease were infectious (2.1%, including sepsis), bleeding (1.6%), respiratory (1.2%, including pneumonia), thrombolic (0.9%, including deep venous thrombosis), and cardiac (0.2%).

The findings, which reveal a "mild increase in morbidity," are unprecedented, said lead author Erin Cordeiro, MD, from the University of Toronto, Ontario, Canada.

"One question that has never been answered in the literature to date is whether or not these women [with metastatic disease] are at an increased risk of postoperative complications," she said.

Dr. Cordeiro spoke at a presscast yesterday from the American Society of Breast Surgeons (ASBS) 15th Annual Meeting in Las Vegas Nevada.

The results come from an analysis of more than 68,000 women who had a primary surgery for breast cancer from 2005-2012 and were entered into an American College of Surgeons (ACS) database.

The results "reinforce" the need to inform patients about all possible outcomes of surgery, said Deanna Attai, MD, a breast surgeon from Burbank, California, who moderated the presscast. She is also a member of the ASBS communications committee.

"We really need to counsel them as far as the potential risks and complications," Dr. Attai said.

Dr. Cordeiro also emphasized that surgery is a "fairly safe procedure."

The results ultimately need to be interpreted in the light of more data on whether or not primary breast surgery improves survival in women with metastatic disease.

"We are unsure if that [surgery] will provide a survival benefit," she told reporters, adding that results from studies are mixed.

A survival benefit over a longer term could help justify use of surgery and the risk for more complications and short-term mortality, she suggested.

More Likely to Undergo Mastectomy

Dr. Cordeiro and colleagues from the University of Toronto looked at outcomes from the National Surgical Quality Improvement Program, which is a database sponsored by the ACS and generated from more than 400 participating hospitals across the world.

The vast majority of the women in the study (more than 67,000 of the 68,000 participants) had nonmetastatic disease.

Only 1031, or 1.5%, had metastatic disease, which is below the North American average of 3% to 5%.

However, the study excluded patients who were undergoing bilateral breast surgery and those with concurrent surgery that was not breast- and/or reconstruction-related.

Notably, patients with metastatic disease were more likely to undergo a mastectomy (71% vs 49%; P < .0001) than the nonmetastatic patients.

The analysis of factors that predicted postsurgery complications controlled for a host of patient and treatment characteristics, including types of surgery performed, such as axillary lymph node dissection and mastectomy.

Patients with metastatic disease were 1.6 times as likely to experience a complication as those with nonmetastatic disease (odds ratio [OR], 1.6; P < .001).

Not surprisingly, mastectomy had a similar predictive value (odds ratio, 1.7; P < .001).

Other statistically significant predictors of having a complication included age, diabetes, smoking status, axillary lymph node dissection, and operative time.

Why are patients with metastatic disease more likely to have a complication?

A patient with metastatic breast cancer likely has "systemic changes" that predispose them to other medical difficulties, said Dr. Cordeiro.

The authors and commentator have disclosed no relevant financial relationships.

American Society of Breast Surgeons (ASBS) 15th Annual Meeting.

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