Chemotherapy before breast conserving surgery in breast cancer – is there an increased risk of complications?

This study investigated the effect of neoadjuvant chemotherapy (NAC; chemotherapy before surgery) in patients undergoing oncoplastic breast-conserving surgery (OBCS). 

They found that NAC did not affect the rate of complications in OBCS. 

Breast cancer (BC) can be treated using a number of strategies. Neoadjuvant chemotherapy (NAC) may be used to kill cancer cells before surgery. There are a number of surgical options. Mastectomy involves total removal of the breast. Breast-conserving surgery (BCS) involves removing just the cancerous tissue. One issue with BCS is that the shape of the breast may be significantly different after surgery. This can have a negative impact on patients. 

Oncoplastic BCS (OBCS) involves esthetic surgery combined with tumor removal in order to achieve a normal breast shape. OBCS is becoming increasingly popular. There may be some risk of surgery complications in patients that received NAC prior to surgery. This may include issues with wound healing. It is unclear if NAC increases the risk of complications after OBCS.

This study included 429 patients with breast cancer. All patients underwent OBCS. 122 patients also had NAC before surgery. The rate of complications was compared between NAC and non-NAC patients. 

The rate of complications for all patients was 25.9%. Major complications were reported for 9.1% of patients. Most complications were related to the breast where the tumor originated (10.9% vs 2.4% in the opposite breast).

Higher body weight and diabetes were associated with a higher rate of complications. The risk of major complications was higher in women with higher body weight and higher white blood cell count. NAC did not increase the rate of complications or major complications in OBCS.

The authors concluded that NAC did not affect the rate of complication in OBCS.

This study was based on medical records. Treatment and surgery protocols varied. This makes it more difficult to compare the data. It is unclear how NAC and OBCS may affect long-term breast cancer survival. More investigation is needed.