Main Article Content
ASA classification, Breast Cancer, Risk Assessment
Background: There are various factors affecting the effectiveness of the treatment of breast cancer patients. Although the disease pathology, along with surgery and other therapeutic modalities, plays the principal role in patient outcomes, anesthesia still plays an important role in the success of treatment. This study was designed to show the effects of anesthetic plans on risk classification and assessment in breast cancer surgeries.
Methods: Two hundred sixty patients receiving different types of breast cancer surgery for therapeutic and reconstructive purposes were enrolled in this study. They were divided into three groups according to the anesthesia risk assessment. Group 1 consisted of low-risk patients (ASA I) who received small surgeries such as lumpectomy. Patients with intermediate risk of anesthesia (ASA II) or those who underwent breast cancer and axillary surgery with overnight admission (ASA I or II) were considered as group 2. Group 3 comprised the patients with higher risk for anesthesia (ASA class III) regardless of the surgery type or those in any ASA class who were about to undergo advanced and prolonged surgeries such as breast reconstruction with free or pedicle flaps.
Results: Two hundred sixty-eight surgical interventions were done in 260 patients. There were 106, 107, and 47 patients in groups 1, 2, and 3, respectively. In group 1, five patients out of 106 were admitted in the hospital for 24 hours after surgery and the remaining 101 patients were discharged from the hospital in a few hours after the operation when they were fully conscious and could tolerate the diet completely. All 107 patients in group 2 were admitted in the hospital for a few days after the operation, though the vast majority of them (98 patients) discharged from the hospital the day after surgery. In the last group, 6 out of 47 patients showed the signs of surgical complications such as partial flap ischemia in the postoperative period, mostly after TRAM or DIEP flap breast reconstruction surgery.
Conclusion: The findings of this study support the idea that breast surgeries can be done in an ambulatory situation with no considerable risk. In contrast, all medical and anesthetic considerations should be taken into account in more complex surgeries, especially when they are applied in high-risk patients.
2. Akbari ME, Sayad S, Sayad S, Khayamzadeh M, Shojaee L, et al. Breast Cancer Status in Iran: Statistical Analysis of 3010 Cases between 1998 and 2014. International journal of breast cancer. 2017;2017.
3. Otaghvar HA, Hosseini M, Tizmaghz A, Shabestanipour G, Noori H. A review on metastatic breast cancer in Iran. Asian Pacific Journal of Tropical Biomedicine. 2015;5(6):429-33.
4. Bucknor A, Syed M, Gui G, James S. Thrombosis of the internal mammary artery during delayed autologous breast reconstruction: A manifestation of occult residual cancer. JPRAS Open. 2016;8:6-8.
5. Westbrook AJ, Buggy DJ. Anaesthesia for breast surgery. Continuing Education in Anaesthesia, Critical Care & Pain. 2003;3(5):151-4.
6. Böhmer AB, Wappler F, Zwissler B. Preoperative risk assessment—from routine tests to individualized investigation. Deutsches Ärzteblatt International. 2014;111(25):437.
7. Cohn SL, Fleisher L, Saperia GM. Evaluation of cardiac risk prior to noncardiac surgery. UpToDate, Waltham, MA Accessed. 2017;6:13-8.
8. Kramer J, Graf B, Zausig Y. Preoperative risk evaluation from the perspective of anaesthesiology. Der Chirurg; Zeitschrift fur alle Gebiete der operativen Medizen. 2011;82(11):1037-50; quiz 51-2.
9. Eltzschig HK, Eckle T. Ischemia and reperfusion--from mechanism to translation. Nat Med. 2011;17(11):1391-401.
10. Cameron AC, Touyz RM, Lang NN. Vascular complications of cancer chemotherapy. Canadian Journal of Cardiology. 2016;32(7):852-62.
11. Mastectomy Risks 2013 [Available from: https://www.breastcancer.org/treatment/surgery/mastectomy/risks.
12. TRAM Flap Surgery Risks 2015 [Available from: https://www.breastcancer.org/treatment/surgery/reconstruction/types/autologous/tram/risks.
13. Breast reconstruction with flap surgery 2018 [Available from: https://www.mayoclinic.org/tests-procedures/breast-reconstruction-flap/about/pac-20384937.
14. Selber JC, Kurichi JE, Vega SJ, Sonnad SS, Serletti JM. Risk factors and complications in free TRAM flap breast reconstruction. Ann Plast Surg. 2006;56(5):492-7.
15. Kim EK, Eom JS, Ahn SH, Son BH, Lee TJ. The efficacy of prophylactic low-molecular-weight heparin to prevent pulmonary thromboembolism in immediate breast reconstruction using the TRAM flap. Plastic and reconstructive surgery. 2009;123(1):9-12.
16. Pan XL, Chen GX, Shao HW, Han CM, Zhang LP, et al. Effect of heparin on prevention of flap loss in microsurgical free flap transfer: a meta-analysis. PLoS One. 2014;9(4):e95111.
17. Chen C, Nguyen M-D, Bar-Meir E, Hess PA, Lin S, et al. Effects of vasopressor administration on the outcomes of microsurgical breast reconstruction. Annals of plastic surgery. 2010;65(1):28-31.
18. Hiltunen P, Palve J, Setala L, Mustonen PK, Berg L, et al. The effects of hypotension and norepinephrine on microvascular flap perfusion. J Reconstr Microsurg. 2011;27(7):419-26.
19. Jeong W, Lee S, Kim J. Meta-analysis of flap perfusion and donor site complications for breast reconstruction using pedicled versus free TRAM and DIEP flaps. The Breast. 2018;38:45-51.