Evaluating the best timing of surgery after chemotherapy in patients with breast cancer

This study evaluated the impact of different times after chemotherapy until breast cancer surgery on complications after surgery and survival outcomes. The data showed the optimal time to surgery (TTS) was between 21 and 28 days after chemotherapy in these patients. 

Breast cancer (BC) is one of the most common forms of cancer in women. Treatments for BC usually involve a combination of surgery, chemotherapy, and radiotherapy. Chemotherapy is commonly given before the surgical treatment to reduce tumor size. This is called neoadjuvant chemotherapy (NAC). This allows surgeons to use breast-conserving surgery (BCS) instead of breast-removal surgery (mastectomy). BCS is associated with better psychological outcomes for patients.

Studies suggest that the length of time (TTS) between surgery and NAC may affect response to treatment and long-term survival. However, the optimal TTS after NAC and the impact of TTS on long-term outcomes in patients treated with NAC before surgery are still not clear.

This study analyzed data from 422 women with stage II-III BC. The patients were divided into 3 groups based on TTS. Group 1 included 119 women who had surgery within 21 days of their last dose of NAC. Group 2 included 152 women who had surgery between 21 -28 days of their last dose of NAC. Group 3 included 151 women who had surgery after 28 days of their last dose of NAC. The average follow-up time was 42 months.

19.4% of the patients achieved a pathologically complete response (no signs of cancer remained after surgery). The 3-year overall survival (OS) rate was 95.8% for patients in group 1 compared with 96.7% for those in group 2 and 90.1% for those in group 3.

The OS and disease-free survival (DFS) were significantly different among the three groups. Patients in group 3 were 2.33 times more likely to have a shorter DFS and 2.78 times more likely to have a shorter OS compared to the other 2 groups.

Complications after surgery occurred in 22.7% of the patients. These included poor healing after surgery, infection, bleeding, or blood accumulation. Group 1 had significantly worse complications compared to the other 2 groups. Groups 2 and 3 had similar complication rates. 

This study concluded that longer or shorter TTS after NAC affected outcomes and surgical complications in patients with BC. The authors suggested that the patients who had surgery between 21 and 28 days after NAC benefited the most.

This study was based on medical records. The follow-up time was very short and was conducted at a single medical institution.