Awake breast cancer surgery: strategy in the beginning of COVID-19 emergency

Breast Cancer. 2021 Jan;28(1):137-144. doi: 10.1007/s12282-020-01137-5. Epub 2020 Jul 30.


Introduction: COVID-19 is a declared worldwide pandemic. In our country, due to shortage of hospitals and beds in intensive care unit, oncological and breast cancer (BC) resources are temporarily shifted to COVID-19 patients. In addition, risk of cross-infections should be considered in these frail patients. To accomplish more surgical procedures and to reduce the length of hospital stay (LOS), fast track awake BC surgery should be implemented. The aim of the study is to estimate the effects of surgical shift in our facility during the early COVID-19 outbreak.

Materials and methods: From 30th January 2020 to 30th of March 2020, 86 consecutive patients were retrospectively enrolled and divided into pre-COVID-19-BC and COVID-19-BC. Clinical parameters and anamnestic data were collected and analyzed. Surgical procedures, relative complications and type of anaesthesia were reported. The effect on surgical time (ST), operative room time (ORT) and length of stay (LOS) were described and examined.

Results: No statistical difference was found in complications rate, clinical data and surgical procedures (p > 0.05). Awake breast conservative surgery (BCS) was the most frequent procedure in COVID-19-BC (p = 0.006). A statistically significant decrease in ORT and LOS was reported in COVID-19-BC (p = 0.040 and p = 0.0015 respectively), while comparable time resulted for ST (p = 0.976). Mean ORT and LOS reduction were 20.79 min and 0.57 hospital bed days.

Conclusion: In the "COVID-19 era", fast track awake breast surgery provides a reduction of ORT, LOS and potentially surgical treatment for a wider number of oncological patients.

Keywords: Awake surgery; Breast cancer; COVID-19; Conservative surgery.

MeSH terms

  • Aged
  • Anesthesia / methods
  • Breast Neoplasms / pathology
  • Breast Neoplasms / surgery*
  • COVID-19* / prevention & control
  • Female
  • Humans
  • Italy
  • Length of Stay
  • Lymph Node Excision
  • Mastectomy / adverse effects
  • Mastectomy / methods*
  • Mastectomy, Segmental / adverse effects
  • Mastectomy, Segmental / methods
  • Middle Aged
  • Operative Time
  • Postoperative Complications / etiology
  • Retrospective Studies
  • Wakefulness