Comparison of Surgical Outcomes of Breast-Conserving Surgery Performed Under Local and General Anesthesia

Surgical resection remains the cornerstone of early breast cancer treatment. However, older patients with multiple co-morbidities may be unsuitable for general anesthesia (GA). The COVID-19 pandemic necessitated some surgeries under local anesthesia (LA), especially those without an option for anti-hormonal bridging therapy. This retrospective study compares the outcomes of breast-conserving surgery (BCS) under LA and GA.

Thirty-one consecutive patients under LA (April 2018-March 2022) were compared with 31 patients under GA. The primary outcomes included the length of hospital stay, postoperative complications within 1 month (including wound infections and seromas needing ≥ 3 aspirations), margin positivity, and re-operation rates. Statistical analysis was performed using R-4.2.2 with significance set at p < 0.05.

Five LA cases were performed 2 years before and 26 cases after the March 2020 UK lockdown. Between the LA and GA cohorts, there was no significant difference in median ages (LA: 73 years, IQR, 82.5-69 vs. GA: 72, IQR, 82-69; p = 0.760) and median tumor size (LA: 16.6 mm, IQR, 21.5-12.25 vs. GA: 23.1, IQR, 30.25-14; p = 0.081). Three LA patients underwent Sentinel node biopsy versus 28 GA. No LA patients underwent axillary node clearance versus one GA patient. Hospital stay was significantly shorter in LA versus GA (0 vs. 10, p < 0.001). There were no significant differences in postoperative complications (LA: 5 vs. GA: 4, p = 1), positive resection margins (LA: 10 vs. GA: 18, p = 0.074) and re-operation rates (LA: 1 vs. GA: 5; p = 0.08).

BCS under LA increased fivefold following the pandemic. Outcomes under LA were comparable to GA, providing a viable alternative approach for those unfit for GA, thus optimizing healthcare resources.