Chemotherapy-Related Toxicity and Preoperative Physiologic Reserve as Risk Markers for Complications After Immediate...

Despite advances in neoadjuvant chemotherapy (NACT) for breast cancer, surgical outcomes following immediate breast reconstruction (IBR) remain inconsistent, and institutional protocols vary widely. Although patients exhibit heterogeneous physiological responses to chemotherapy, few studies have evaluated treatment-related toxicity as an objective risk marker of postoperative complications. The aim of this study was to assess whether patient-specific responses to NACT can serve as clinically relevant markers of complication risk and guide individualized surgical planning.

A retrospective analysis was conducted of 299 patients who underwent IBR, including 47 who underwent NACT. Chemotherapy-related toxicities and preoperative laboratory values were reviewed to determine the physiological burden. Postoperative complications and delays in the initiation of adjuvant therapy were assessed, and multivariate logistic regression was performed to identify independent factors associated with surgical morbidity.

NACT and smoking were significantly associated with an increased risk of complications. NACT was also strongly associated with major wound complications. Patients with hematologic toxicity during NACT or preoperative hypoalbuminemia had substantially higher odds of developing major wound complications. In addition, NACT and diabetes were associated with delayed initiation of adjuvant therapy. NACT was not associated with minor wound complications, such as hematoma or seroma formation.

This study suggests that treatment-related toxicity and preoperative physiological reserve may serve as clinically relevant, response-based markers for risk stratification after NACT. This approach provides a conceptual framework for future studies with larger sample sizes and well-controlled designs.