Breast-Conserving Surgery Under Local Anesthesia in Elderly Patients with Severe Cardiorespiratory Comorbidities: A Hospital-Based Case-Control Study

Abstract

Introduction: We report the feasibility and safety of local anesthesia (LA) in patients having breast-conserving surgery (BCS). Methods: 37 patients with American Society of Anesthesiologists (ASA) score of 4 having BCS under LA and 54 age-matched subjects with ASA score of 3-4 having BCS under general anesthesia (GA) were included. Patients were retrospectively evaluated for the follow-up duration, duration of surgery, postoperative satisfaction scores (1-10), complication and survival time for locoregional recurrence and overall survival rates. Results: The mean follow-up duration was 55.09 ± 13.49 months (range 38-104) in GA group, and 58.7 ± 15.5 months (range 20-99) in LA group. There was a significant difference in the duration of surgery (p < 0.001). In the LA group, 5 patients (13.5%) had minor complications including seroma, wound infection or hematoma, whereas 6 patients (11.1%) had minor complications in the GA group (p > 0.05). The re-excision rate due to positive tumor margins was 5.4% (2 patients) in the LA group and 5.5% in the GA group, respectively. The locoregional recurrence-free survival and overall survival rate was not different between 2 groups (p = 0.192, p = 0.93). Conclusion: BCS under LA seemed to be effective and safe in selected high-risk elderly patients.

Association of Patient Frailty With Increased Morbidity After Common Ambulatory General Surgery Operations

“…Reports have documented the successful use of local anesthesia in breast-conserving therapy and mastectomy, although most studies are small, have focused on feasibility without conversion to general anesthesia, and have not shown significant differences in complications or oncologic outcomes. [56][57][58][59][60] The use of local with monitored anesthesia care may be challenging in complex surgical procedures for breast cancer, such as modified radical mastectomy or axillary dissection, but it should be considered for patients with increased anesthesia risk who are undergoing ambulatory breast surgery. Most studies of local anesthesia in thyroidectomy and parathyroidectomy report using it in combination with regional superficial and deep cervical plexus blocks.…”

“…For frail patients who choose to undergo hernia repair, local and monitored anesthesia care should be used whenever possible. Reports have documented the successful use of local anesthesia in breast-conserving therapy and mastectomy, although most studies are small, have focused on feasibility without conversion to general anesthesia, and have not shown significant differences in complications or oncologic outcomes . The use of local with monitored anesthesia care may be challenging in complex surgical procedures for breast cancer, such as modified radical mastectomy or axillary dissection, but it should be considered for patients with increased anesthesia risk who are undergoing ambulatory breast surgery.…”

The relationship between post-surgery infection and breast cancer recurrence

“…Breast cancer recurrence was mentioned in only 15 of the 99 papers in the SSI alone searches [22,23,32,45,59,61,64,70,78,79,82,93,95,104,105]; 8.6% of these patients developed recurrence after surgery. Incidences of recurrence and SSI were recorded independently of each other in the studies, rather than linked and correlated.…”

Current Status and Prospects of Anesthesia and Breast Cancer: Does Anesthetic Technique Affect Recurrence and Survival Rates in Breast Cancer Surgery?

“…Thirteen retrospective studies on anesthetic techniques and breast cancer recurrence have been reported (Table 1). Inhalation GA has been compared with RA techniques such as PVB-based GA (98,99,(101)(102)(103), intravenous propofol-based GA (100,104,105,(107)(108)(109)(110), and LA and propofol-based anesthesia (106). In two of these studies, recurrence rates were lower and RFS rates were higher in patients who underwent MT with RA or IV propofol-based GA than in those who underwent the procedure with inhalation-based GA (98,104).…”