Optimal time for breast-conserving surgery after neoadjuvant chemotherapy in patients with stage II or III breast cancer

Awad, Kerolos B.A.; Kirollos, Andrew M.A.; Awad, Philobater B.A.; Hassan, Basma H.A.; Shehab, Mohammed H.; Fahmy, Karim; Ahmed, Dina H.

doi:10.4103/ejs.ejs_62_22

Optimal time for breast-conserving surgery after neoadjuvant chemotherapy in patients with stage II or III breast cancer

Authors

Abstract

Background
During past decades, neoadjuvant chemotherapy was limited to inoperable breast cancer; however, nowadays, neoadjuvant chemotherapy has led to an increase in the rates of breast-conserving therapy, a decrease in the extent of local treatment (e.g. axillary dissection), and as a result, better cosmetic outcomes. Other benefits of neoadjuvant chemotherapy that made this method popular include prognostic and therapeutic information based on in vivo tumor response, turning inoperable tumors into operable ones, and providing enough time for genetic testing and breast reconstruction.
Objective
To evaluate the effect of time to surgery after preoperative chemotherapy in patients with stage II or III breast cancer who were candidates for breast-conserving surgery according to the primary objective of the locoregional recurrence (include the affected breast and its involved lymph nodes) and the secondary objective of the assessment of postoperative complications and healing process of the wound.
Patients and methods
This is a prospective randomized study conducted on 60 patients with stage II or III breast cancer indicated for breast-conserving surgery after neoadjuvant chemotherapy at the General Surgery Department at Ain Shams University Hospitals starting from October 2019 to October 2021. Approval of the ethical committee and written informed consent from all participants were obtained. We divided the study sample into two groups: 30 female patients who underwent breast-conserving surgery after neoadjuvant chemotherapy within 3 weeks from the last chemotherapy session (group A) and 30 female patients who underwent breast-conserving surgery after 3 weeks from the last chemotherapy session but not more than 4 weeks (group B).
Results
In our study, the first group included patients who underwent operation within 3 weeks from ending the neoadjuvant chemotherapy and the second group included those who underwent operation within 4 weeks. We followed up them and analyzed different variables like local recurrence, intraoperative blood loss, operative time, delayed wound healing, and seroma formation. All of these variables were found to be statistically nonsignificant.
Conclusion
There is no difference in doing operations after neoadjuvant chemotherapy either within 3 or 4 weeks as it does not affect the outcomes clinically or statistically.

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