Goals: The Association of Breast Surgery published “COVID-altered” guidance for the management of breast cancer during the COVID-19 pandemic, including that neoadjuvant chemotherapy was only to be used only in inoperable disease and not to downstage the axilla or facilitate breast conserving surgery. In addition, there has been concern over delayed cancer presentation with increased axillary node involvement. This observational study aims to establish if the practice of axillary node dissection (AND) has increased in the context of the COVID-19 pandemic. Methods: Patients undergoing operative management for breast cancer were identified retrospectively from theatre coding in a UK breast unit. Pre-COVID (March 2018 - February 2020) and COVID pandemic (March - September 2020) cohorts were defined and compared. For those undergoing AND the following data was ascertained: indication, tumour biology, neoadjuvant therapy, deviation from routine practice and histological outcomes.Results: AND was performed in 20.2% (23/114) of all breast cancer operations during the COVID pandemic compared with 18.9% (78/ 411) pre-COVID. Indication for AND during COVID pandemic and pre- COVID respectively: clinically node positive 82.6%/79.4%;positive sentinel node biopsy 4.3%/17.9%;recurrence or metastases from contralateral cancer 13%/2.5%. Neoadjuvant chemotherapy preceded AND in 30% of cases in both cohorts. Case review identified one patient in whom neoadjuvant chemotherapy for a clinically node positive HER2+ was omitted due to the pandemic and one other who had adjuvant chemotherapy omitted for a HER2+ cancer with a single positive sentinel node mandating an AND which yielded no further positive nodes. Conclusion(s): The COVID-19 pandemic has not had a major impact on rates of AND in our practice. However, we identified 2 patients who may have avoided AND had there not been deviation from routine neoadjuvant and adjuvant chemotherapy practice. Conflict of Interest: No significant relationships.
P138 Evaluation of the impact of the COVID-19 pandemic on the practice of axillary node dissection