P044. COVID-19 and perioperative outcomes after breast reconstruction during the SARS-COV-2 pandemic: A Prospective cohort study

Abstract

s European Journal of Surgical Oncology 47 (2021) e296ee347 identify clinical trial and cohort studies between 1946 to 05/10/2020. Identified records were manually screened by title, abstract and full-text review by two independent reviewers. Data extraction will be conducted using a pre-piloted data collection tool. Risk of bias will be assessed using Cochrane Collaboration tools. Results: The search identified 2368 articles. After removing duplicates, 1610 articles were eligible for title screening. Title screening resulted in 323 articles eligible for abstract screening and 35 eligible for full-text review. Eight papers were identified by reference checking, and in total 23 papers were eligible for final review. Data extraction and evidence synthesis is currently in progress. Conclusion: Understanding surgical and patient-reported outcomes with NET may impact surgical practice. The evaluation of current evidence will also inform future trials assessing the impact of NET on surgical outcomes and QoL. P042. BREAST CANCER MANAGEMENT IN OVER 70s A SINGLE CENTRE REVIEW Lar a Armstrong, Jessica Lockhart, Dearbhla Deeny, Richard Mayes, Norah Scally, Helen Mathers. General Surgical Department, Craigavon Area Hospital, Portadown, United Kingdom Aim: The national audit of breast cancer in older patients (NABCOP) was established in 2016 to evaluate age disparity in the care received by women diagnosed with breast cancer in NHS hospitals. Our aim is to evaluate the process and outcomes for women aged 70 and older, diagnosed with breast cancer in a single centre, compared to NABCOP 2020. Methods: All consecutive women aged 70 or over diagnosed with breast cancer, from 2016 2019 were reviewed. Data was collated from an institutional database. Patients with metastatic disease at time of diagnosis, previous diagnosis of breast cancer or a concomitant primary malignancy were excluded. Results: A total of 298 patients aged 70 or over were included in the data, comprised of 5.4% ductal carcinoma in situ (DCIS) and 95.3% early invasive breast cancer (EIBC). Screening as a route to diagnosis was noted in 15.1%. A larger proportion of patients received triple diagnostic assessment on a single visit (100% vs 68%) and reported contact with a clinical nurse specialist (100% vs 96%). The proportion of women with operative management in both the EIBC and DCIS group was higher than NABCOP (72.5% vs 71% and 87.5% vs 82% respectively). 15.4% of patients did not undergo surgery through personal choice. Conclusions Overall, we found that our operative statistics and treatment allocations matched and exceeded those stated in the NABCOP. Routes to diagnosis followed the expected pathways. Recommendations for ongoing practice included the incorporation of preoperative frailty. P043. IMPACT OF COVID-19 PANDEMIC ON OUR BREAST CARE SERVICES Samreen Khan, Steven Goh. Peterborough City Hospital, Peterborough, United Kingdom Background: Our breast unit treats around 500 new breast cancers in a typical year. We assessed the changes brought about to our service provision as a result of the COVID-19 pandemic. Materials and Methods: Retrospective audit on data collected prospectively between April and September 2020. Outpatient attendance and surgical procedures were compared to data from the same interval in 2019. Results: April Sept 2019 April Sept 2020 Number of operations 370 185 Mastectomy : BCS ratio 30 : 70 40 : 60 Number of outpatients 6231 5066 New symptomatic cancers 130 139 Number of patients screened 8636 1912 New screen detected cancers 60 25 e307 Essential cancer service was maintained at 60% capacity at the onset of the lockdown, between April to June 2020. Our workload returned to near prepandemic level from July 2020. Oncoplastic procedures were reintroduced from August 2020. Conclusion: The number of new symptomatic breast cancers diagnosed in the study period was comparable to the previous year. Despite a reduced service, there is minimal backlog of new cancer patients awaiting surgery. Some patients were denied immediate breast reconstruction in the beginning of the pandemic, and these will need to be rescheduled. Adjusted referral criteria for adjuvant treatment meant few patients did not receive radiotherapy, and others have had a reduced therapeutic dose. The potential longer term repercussions of these changes are yet to be seen. Further studies will be needed to evaluate true impact of the pandemic. P044. COVID-19 AND PERIOPERATIVE OUTCOMES AFTER BREAST RECONSTRUCTION DURING THE SARS-COV-2 PANDEMIC: A PROSPECTIVE COHORT STUDY Aadil Khan , Liza Van Kerckhoven , Rachel O Connell , Marios Tasoulis , Jennifer Rusby , Peter Barry , Katherine Krupa , Karyn Shenton , Theo Nanidis , Kieran Power , Stuart James , Gerald Gui , Nicola Roche , Fiona MacNeill , Kelvin Ramsey . Royal Marsden Hospital, London, United Kingdom; Kingston Hospital, Kingston upon Thames, United Kingdom Introduction: Surgical guidelines have been altered in light of the SARSCoV-2-pandemic. In March 2020, these guidelines advised against all breast reconstruction in the United Kingdom with the aim of protecting patients and resources. As breast reconstruction is regarded as integral to breast cancer recovery, rapid but safe reintroduction is a priority. We present a study that describes how breast reconstructionwas reintroduced and benchmark peri-operative outcomes during the first wave recovery phase in a large UK Cancer Centre. Methods: Local audit committee approval (ID: BR_2021_169). Prospective cohort study of patients undergoing autologous or implant +/Acellular Dermal Matrix (ADM) breast reconstruction between June 1st and August 31st, 2020. We defined a composite primary outcome to include positivity for COVID-19, adverse pulmonary outcomes, clinically manifest thromboembolism or mortality. Results: Fifty breasts were reconstructed in 42 patients (62% autologous; 38% implant-based). This represents a 40% reduction in activity when compared with the same timeframe for 2019. All tested negative for COVID-19 based at pre-operative clinical screening and by RT-PCR swabs for COVID-19 RNA 72 hours prior to surgery. No patients were diagnosed with COVID-19, experienced adverse pulmonary or clinically manifest thromboembolic outcomes or died within 30-days post-operatively. There were no cases of flap or implant loss and the return-to-theatre rate was 2%. Conclusions: Our data show that both autologous and implant-breast reconstruction can be performed safely with low risk of post-operative COVID-19 infection when performed within a COVID-19-protected pathway and should continue to be offered to women undergoing mastectomy at this time. P045. SHOULD AN MDT BE RECOMMENDING CHEMOTHERAPY IN THE ABSENCE OF A GENOMIC ASSAY IN ER POSITIVE, HER2 NEGATIVE BREAST CANCER PATIENTS? Adam Yarwood , Akriti Nanda , Pankaj Roy , Marianne Dillon . 1 Swansea Bay University Health Board, Swansea, United Kingdom; Oxford University Hospitals NHS Trust, Oxford, United Kingdom Introduction: National guidelines (NICE) approve the use of genomic assays to advise adjuvant chemotherapy use in addition to endocrine therapy in lymph node-negative, ER positive, HER2 negative breast cancer patients, who have an intermediate risk of distant recurrence via Nottingham Prognostic Index (NPI) and/or PREDICT. Methods: Prospectively collected databases held locally in Swansea and Oxford were collated and retrospectively reviewed comparing the MDT