Abstract PO-025: Management of breast cancer surgery during de-escalation of COVID-19 infection
Authors: Sánchez Juana María Brenes , Picado Amanda López , Crespo María Eugenia Olivares , Sáenz José Ángel García , De La Plata Merlo Rosa María , De La Muela María Herrera 
Published: December 2020

Abstract
Purpose: Spain has been one of the countries most severely affected by the Covid-19 pandemic, and Madrid has reported the highest number of cases and deaths. A safe management of breast cancer (BC) surgery in the de-escalation is a priority.
Patients and Methods: Surgery was considered depending on the epidemic trend. 28 BC surgeries were performed in our BC Unit inside San Carlos Clinical Hospital, from 23rd April-4th June, with a reduction of 25-50-75% surgical resources until availability of complete resources. We created a practical tool based on a "traffic light" system to prioritize surgical time. Every patient was evaluated according to the different stages (comorbidities, tumor biology, and cancer treatments): Red = Surgical procedures in maximum two weeks; Amber = Surgical procedures in maximum four weeks; Green = Surgical procedures in more than four weeks. All benign, cosmetic, and risk-reducing procedures was deferred, and microsurgeries were not performed because high levels of resources are needed. Every patient was checked by a telephone call with our hospital preoperative COVID-19 protocol. All patients were screened for symptoms and PCR test prior to surgery.
Results: Minimal surgical procedures (including patient preferences) were performed, avoiding surgical complications and reducing hospital stay to minimize the risk of occupational exposure. 2 asymptomatic patients who underwent chemotherapy were delayed by positive COVID-19 test and were referred for further evaluation. Surgical procedures were performed in 28 patients with a negative COVID-19 PCR test. 4/18 conservative surgeries required minimal use of oncoplastic procedures and in 3/10 mastectomies, an immediate breast reconstruction with an implant were considered. The surgery was more minor than planned in 3 patients, and due to the reduced risk surgery was deferred. 20 surgical procedures were performed in patients who received neoadjuvant chemotherapy and in 4 patients with endocrine therapy and with low 21 gene recurrence score (RS) (&lt;25). Sentinel lymph node biopsy was performed in 14 patients with clinically node-negative BC, and axillary lymph node dissection was necessary in 10 patients who underwent neoadjuvant chemotherapy. We also performed this surgical treatment in 6 patients with in situ ductal carcinoma along usual production was establishment. After the surgery, the patients were hospitalized in COVID-19-free areas, and no perioperative complications or COVID-19 infection were reported.
Conclusions: In the de-escalation period, an expert committee evaluation case by case must be performed for surgical procedures. Treatment decision-making should balance risk and benefits of the surgical treatment, and a “traffic light” scale could be a useful tool for the medical team. A preoperative COVID-19 protocol is necessary for a safe surgical procedure.
Citation Format: Juana María Brenes Sánchez, Amanda López Picado, María Eugenia Olivares Crespo, José Ángel García Sáenz, Rosa María De La Plata Merlo, María Herrera De La Muela. Management of breast cancer surgery during de-escalation of COVID-19 infection [abstract]. In: Proceedings of the AACR Virtual Meeting: COVID-19 and Cancer; 2020 Jul 20-22. Philadelphia (PA): AACR; Clin Cancer Res 2020;26(18_Suppl):Abstract nr PO-025.