Breast surgical oncology in elderly and unfit patients: a systematic review

Healthcare delivery to elderly and unfit patients with breast disease and comorbidities under an outpatient regime: A report of a personal surgical technique named “Cut&Sew”

“…This study included 58 women diagnosed with breast disease and comorbidities between March 2019 and December 2022 at the Ambulatory of Senology of San Giacomo Hospital in Novi Ligure (AL, Italy) and the Civil Hospital in Ovada (AL, Italy). The patients were evaluated by a multidisciplinary consensus according to the guidelines provided to limit SLNB in older women [ 10 , 12 , 15 , [49] , [50] , [51] ] prior to surgery using the “Cut&Sew” technique. Indeed, this procedure has not been targeted to involve SLNB since the literature (The Society for Surgical Oncology, SSO, and the Choosing Wisely Foundation) [ 52 , 53 ] identified a list of common practices in surgical oncology that recommend against the routine use of SLNB in women over 70 with T1N0M0 hormone receptor positivity.…”

“…Such a well-documented relationship between older age and a delay in BC diagnosis is associated with larger tumors and more advanced stage at presentation [ [7] , [8] , [9] ], a situation usually referred to as neoadjuvant hormonal medical treatment for 4–6 months after which patients either continue with medical therapy or opt for surgery facing some risks [ 10 ]. The percentage of patients not receiving any surgery, axillary surgery, increases with age in many countries [ 11 ], and about one-third of treatment omissions were due to patient preference [ 12 ].…”

“…The growing need for proper geriatric assessment [ [14] , [15] , [16] ] and short-stay surgical programs supported by the availability of less invasive approaches, even in ambulatory settings, are recognized as feasible options for patients with BC with comorbidities [ 10 , 17 , 18 ]. Outpatient treatment is longer a contraindication for most pathologies, as the outpatient surgical complication rate has become very low [ 19 ].…”

“…Outpatient treatment is longer a contraindication for most pathologies, as the outpatient surgical complication rate has become very low [ 19 ]. Surgical de-escalation procedures even in an-ambulatory setting are recognized as a feasible option in these patients to prevent or palliate breast or chest wall symptoms [ 10 ].…”

“…After searching PubMed for “breast ambulatory surgery in Italy,” only 15 papers emerged that evidence the structures that provide specialist outpatient services [ 10 , 18 , 20 , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] ]. Over time, similar to the trend of reduction in the number of hospitals, there has been a contraction in the number of these structures.…”