Revisiting surgical management of breast cancer in a geriatric population

Abstract OBJECTIVE: Breast cancer is a leading cause of death not only in the young population but also in the elderly. There are no consensus treatment guidelines for elderly breast cancer patients. We purposed to discuss surgical treatment options for breast cancer cases over 80 years concerning morbidity and mortality. METHODS: This retrospective study includes 58 patients over 80 years of age at the time of surgery for breast cancer between 2006 and 2017. A sum of 58 cases (54 females and 4 males), over 80 years of age, with an average age of 84.5±4.07 (80-94) years were included in the study. The modified radical mastectomy was the most common surgical modality in 30 (51.7%) cases, and the axillary intervention was performed on 41 (70.7%). Axillary dissection and sentinel lymph node biopsy were performed for 30 (51.7%) and 11 (18.9%) cases, respectively. RESULTS: Minor and major complications were observed in 8 (13.8%) cases. The average follow-up period of the patients was 37.5 (1-120) months. During the follow-up period, breast cancer-related mortality was observed in 9 (15.52%) cases. No statistical differences were detected in mortality with/without axillary intervention and chosen surgical modality. CONCLUSIONS: Comorbidity, the American Society of Anesthesiologists score, and life expectancy should be considered in the management and surgical planning of patients over 80 years of age with breast cancer. Minimally invasive approaches should be preferred for the elderly whenever feasible and applicable in the light of oncologic surgery principles in order to reduce complications and mortality rates.

Management of appendicitis in coronavirus disease 2019, severe acute respiratory syndrome coronavirus 2, pandemic era: decreasing incidence with increasing complicated cases?

SUMMARY OBJECTIVE: This study aimed to examine the impact of the coronavirus disease 2019 (COVID-19) pandemic on appendicitis and the relevant outcomes in a tertiary hospital, designated as a "pandemic institution" by the Ministry of Health, between pre-COVID-19 and post-COVID-19, i.e., between 2019 and 2020, of the identical period in terms of the annual schedule. METHODS: The data of cases with acute appendicitis, who were followed up at the Department of General Surgery, a 400-bed, tertiary care, a university-affiliated education and research hospital, providing health care to a population of approximately 450,000 people, during the novel coronavirus SARS-CoV-2, during the identical time intervals of pre-COVID-19 (March 12, 2020 to November 12, 2020) and post-COVID-19 (March 12, 2019 to November 12, 2019), were retrospectively analyzed in a detail. RESULTS: Of the 212 appendectomy operations in total, 99 (46.7%) were performed in the pre-COVID-19 and 113 (53.3%) were performed in post-COVID-19. Compared to the pre-pandemic period, patients who had undergone appendectomies in post-COVID-19 revealed significantly lower neutrophil counts and significantly greater appendix diameters (p<0.001 for both). A significantly lower (p=0.041) acute appendicitis with abundant gangrenous appendicitis and phlegmonous appendicitis (p=0.043 and p=0.032, respectively) was recognized in post-COVID-19 compared with pre-COVID-19 interval. CONCLUSION: The number of appendectomy operations decreased in the COVID-19 pandemic. Patients operated during the pandemic period had wider appendix diameter and lower neutrophil levels. The pathological diagnosis was less frequent acute appendicitis, more frequent gangrenous appendicitis, and phlegmonous appendicitis in the pandemic period.