Which surgery for breast cancer after neoadjuvant chemotherapy

Neoadjuvant chemotherapy (NAC) is the standard practice in locally advanced breast cancer cases and in some biological subtypes. There is still no consensus on whether breast-conserving surgery or mastectomy should be performed after NAC and there is no certain point about how the axilla should be approached. These problems stem from concerns about survival.

We retrospectively evaluated the 10-year survival results of 251 patients who either had breast-conserving surgery (BCS) or mastectomy after NAC.

Better loco-regional control was achieved when pathologic axillary node positivity was below %50. Best disease-free (DFS) and overall survival (OS) results were obtained when the breast had a complete response after NAC regardless of axillary response. Clinic N2/3 tumors were negatively associated with DFS while cT3/4 were negatively associated with OS and multifocality was negatively associated with both.

When BCS was performed, local recurrence rates were negatively affected in multifocal cases, but no adverse effects were found on survival of avoiding mastectomy in patients who became eligible for BCS.