Abstract PS1-45: Surgical management of the axilla in breast cancer in Latin American countries: Surgeon´s conduct

Abstract

IntroductionAfter knowing the safety of the sentinel lymph node and the omission of axillary dissection inpatients with clinically negative and / or positive (1-2 lymph nodes) breast cancer withconservative surgery and the evidence from the ACOSOG Z011 randomized clinical trial andother evidence caution against proceeding with the use of axillary lymph node dissection inbreast cancer patients; a standardization of this practice is established globally, however indeveloping countries where treatments are affected by their availability, little is known aboutthe frequency of acquisition of these practices.MethodsAn online survey was carried out in different Latin American countries, which was distributedvia electronic link and QR code, with an open invitation to congresses and medical associations.The study lasted from August 16th, 2019 to April 30th, 2020. Surgeons with low, intermediateand high clinical practice in breast cancer were categorized, their type of clinical practice(private or public) and the period of clinical practice after discharge of the specialty.ResultsIn total, 260 replies were collected from surgeons from 10 different countries: Bolivia (1),Colombia (15), Ecuador (6), El Salvador (19), Guatemala (12), Nicaragua (12), Mexico (182),Paraguay (1), Peru (1) and Venezuela (11).Of these, the group that participated the most was the Surgical Oncologists (surgeons andgynecologists with a subspecialty in oncology), representing 82% of the participants, the rest ofthe participants being: Mastologists, Gynecologists and General Surgeons.The age group with the highest participation was 30-40 years old with 51.92% of the total(135), followed by the 41-50 year old group with 24% (63). 60% of the participants reported aprofessional practice of 10 years or less. In addition to referring to a mixed but mostly publicpractice in 48%, however, 56.93% of the participants reported a low practice (10 or less casesof breast cancer per month) of which between 60-100% of the occasions they offer earlysurgical treatment to their patients; responding that they always perform Sentinel Ganglion incN0 only 50% of the total, however it was mentioned that on average 85% of the occasions it isobtained between 2-3 lymph nodes number. The question was asked about completing theaxillary dissection when having 1-2 positive nodes with the scenarios of "always complete""almost always" "only in mastectomy" "only in breast conservation" and 63% answered thatalways or almost always will perform axillary dissection, 38.83% even referred the probabilityof doing it with micrometastasis in the setting of conservative surgery. In an exploratory manner, a question was added about the possibility of sentinel node after neoadjuvanttherapy, for which 52% answered that they would not perform such a procedure.ConclusionThe result of this survey shows a trend of resistance of less extensive surgical treatments in theaxilla for patients with breast cancer. Thus, reflecting that Latino populations are perhapsoverexposed to locoregional treatment; similar findings were reported by Dr. Morrow in astudy published in 2018 which showed the substantial variation in surgeon acceptance formore limited procedures. Citation Format: Nereida Esparza-Arias, Juan E Bargallo-Rocha, Sarish Del Real-Ordoñez, Yessica Pacheco-Vallejo, Sarina Navarro-Santiesteban, María A Salazar-Alvarez, Rafael E Vasquez-Cordoba, Karen A Girón-Orellana, Juan C Guerrero-Mogrovejo, Cesar E Alvarez. Surgical management of the axilla in breast cancer in Latin American countries: Surgeon´s conduct [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS1-45.