Management of breast cancer surgeryduring de-escalation of COVID-19 infection

Purpose: Spain has been one of the countries most severely affected by the Covid-19 pandemic, and Madrid hasreported 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 wereperformed 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, tumorbiology, and cancer treatments): Red = Surgical procedures in maximum two weeks;Amber = Surgical proceduresin 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 areneeded Every patient was checked by a telephone call with our hospital preoperative COVID-19 protocol Allpatients were screened for symptoms and PCR test prior to surgery Results: Minimal surgical procedures (including patient preferences) were performed, avoiding surgicalcomplications and reducing hospital stay to minimize the risk of occupational exposure 2 asymptomatic patientswho 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 surgeriesrequired minimal use of oncoplastic procedures and in 3/10 mastectomies, an immediate breast reconstruction withan implant were considered The surgery was more minor than planned in 3 patients, and due to the reduced risksurgery was deferred 20 surgical procedures were performed in patients who received neoadjuvant chemotherapyand in 4 patients with endocrine therapy and with low 21 gene recurrence score (RS) (<25) Sentinel lymph nodebiopsy was performed in 14 patients with clinically node-negative BC, and axillary lymph node dissection wasnecessary in 10 patients who underwent neoadjuvant chemotherapy We also performed this surgical treatment in 6patients with in situ ductal carcinoma along usual production was establishment After the surgery, the patients werehospitalized 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 forsurgical 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 asafe surgical procedure