Liver Transplantation Does Not Increase Morbidity or Mortality in Women Undergoing Surgery for Breast Cancer

Abstract Purpose The incidence of breast cancer (BC) in solid organ transplant recipients is comparable to the age-matched general population. The rate of reported de novo breast cancer following liver transplantation (LT) varies. Further, there is limited information on the management and outcomes of breast cancer in liver transplant recipients (LTR). We aim to evaluate the impact of LT on breast cancer surgery outcomes. Further we compare the outcomes after breast cancer surgery in LTR in transplant versus non-transplant centers. Methods National Inpatient Sample (NIS) database was accessed to identify LTR with BC. Mortality, complications, hospital charges and total length of stay (LOS) were evaluated with multivariate logistic regression testing. Weighted multivariate regression models were employed to compare outcomes at transplant and non-transplant centers. Results Ninety-nine women met inclusion criteria for LT + BC and were compared against a cohort of women with BC without LT (n=736,527). LT + BC had lower performance status as confirmed via higher Elixhauser Comorbidity Index (20.5% vs.10.2%, p < 0001). There were significantly more complications in the LT cohort when compared to the non-LTR (15.0% vs. 8.2%, p=0.012). However, on multivariate analysis, LT was not an independent risk factor for post-operative complications following breast cancer surgery (OR 1.223, p=0.480). Cost associated with breast cancer care was significantly higher in those with LT (2.621, p<0.001). Breast conservation surgery in LT had shorter LOS as compared to BC alone (OR 0.568, p 0.027) in all hospitals. Conclusion LT does not increase short-term mortality when undergoing breast cancer surgery. Although there were significantly more complications in the LT cohort when compared to the non-LTR (15.0% vs. 8.2%, p=0.012), on multivariate analysis, LT was not an independent risk factor for postoperative complications following breast cancer surgery. Additionally, breast cancer treatment is more costly in LTR. Breast cancer management in LTR at non-transplant centers incurred higher charges but no difference in complication rate, nor LOS when compared to breast cancer management in LTR at transplant centers.

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Liver Transplant Recipients Incur More Costly Care When Undergoing Treatment for Breast Cancer

10.21203/rs.3.rs-706435/v1 ◽

2021 ◽

Author(s):

Gregory Veillette ◽

Maria Castaldi ◽

Sacha A Roberts ◽

Afshin Parsikia ◽

Ankur Choubey ◽

...

Keyword(s):

Breast Cancer ◽

Multivariate Analysis ◽

Risk Factor ◽

Liver Transplant ◽

Independent Risk Factor ◽

Cancer Surgery ◽

Breast Cancer Surgery ◽

Transplant Recipients ◽

Operative Complications ◽

Liver Transplant Recipients

Abstract Purpose The incidence of breast cancer (BC) in solid organ transplant recipients is comparable to the age-matched general population. It is among the three top-most commonly occurring cancers in women after liver transplantation (LT). There is limited information on the management and outcomes of breast cancer in liver transplant recipients (LTR). We aim to evaluate the impact of LT on breast cancer surgery outcomes. Further we compare the outcomes after breast cancer surgery in LTR in transplant versus non-transplant centers. Methods National Inpatient Sample (NIS) database was accessed to identify LTR with BC. Mortality, complications, hospital charges and total length of stay (LOS) were evaluated with multivariate logistic regression testing. Weighted multivariate regression models were employed to compare outcomes at transplant and non-transplant centers. Results Ninety-nine women met inclusion criteria for LT + BC and were compared against a cohort of women with BC without LT (n = 736,527). LT + BC had lower performance status as confirmed via higher Elixhauser Comorbidity Index (20.5% vs.10.2%, p < 0001). There were significantly more complications in the LT cohort when compared to the non-LTR (15.0% vs. 8.2%, p = 0.012). However, on multivariate analysis, LT was not an independent risk factor for post-operative complications following breast cancer surgery (OR 1.223, p = 0.480). Cost associated with breast cancer care was significantly higher in those with LT (2.621, p < 0.001). Breast conservation surgery in LT had shorter LOS as compared to BC alone (OR 0.568, p 0.027) in all hospitals. Conclusion LT does not increase short-term mortality when undergoing breast cancer surgery. Although there were significantly more complications in the LT cohort when compared to the non-LTR (15.0% vs. 8.2%, p = 0.012), on multivariate analysis, LT was not an independent risk factor for post-operative complications following breast cancer surgery. Additionally, breast cancer treatment is more costly in LTR.

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Breast Cancer Surgery: New Issues

Current Oncology ◽

10.3390/curroncol28050344 ◽

2021 ◽

Vol 28 (5) ◽

pp. 4053-4066

Author(s):

Francesca Magnoni ◽

Sofia Alessandrini ◽

Luca Alberti ◽

Andrea Polizzi ◽

Anna Rotili ◽

...

Keyword(s):

Breast Cancer ◽

Tumor Biology ◽

Surgical Techniques ◽

Well Being ◽

Cancer Surgery ◽

Breast Cancer Surgery ◽

Cancer Management ◽

Breast Cancer Management ◽

Ancient Times ◽

Personalized Approach

Since ancient times, breast cancer treatment has crucially relied on surgeons and clinicians making great efforts to find increasingly conservative approaches to cure the tumor. In the Halstedian era (mid-late 19th century), the predominant practice consisted of the radical and disfiguring removal of the breast, much to the detriment of women’s psycho-physical well-being. Thanks to enlightened scientists such as Professor Umberto Veronesi, breast cancer surgery has since impressively progressed and adopted a much more conservative approach. Over the last three decades, a better understanding of tumor biology and of its significant biomarkers has made the assessment of genetic and molecular profiles increasingly important. At the same time, neo-adjuvant treatments have been introduced, and great improvements in genetics, imaging technologies and in both oncological and reconstructive surgical techniques have been made. The future of breast cancer management must now rest on an ever more precise and targeted type of surgery that, through an increasingly multidisciplinary and personalized approach, can ensure oncological radicality while offering the best possible quality of life.

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