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Evaluating the effect of neoadjuvant chemotherapy on surgical outcomes after breast conserving surgery
Author(s) -
Woeste Matthew R.,
Bhutiani Neal,
Donaldson Marilyn,
McMasters Kelly M.,
Ajkay Nicolás
Publication year - 2021
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.26301
Subject(s) - medicine , cosmesis , breast cancer , neoadjuvant therapy , breast conserving surgery , surgery , chemotherapy , surgical margin , adjuvant , univariate analysis , oncology , cancer , multivariate analysis , mastectomy
Background Neoadjuvant chemotherapy (NAC) increases breast‐conserving surgery (BCS) rates with comparable locoregional control and survival outcomes to adjuvant therapy. More women are receiving NAC and achieving pathologic complete responses (pCR). This study sought to evaluate the effect of NAC on surgical outcomes after the adoption of a “no‐ink‐on‐tumor” margin policy in patients undergoing primary BCS (PBSC). Methods An IRB approved database was queried for women undergoing BCS for invasive breast cancer after March 2014. We compared patients who underwent NAC followed by BCS versus PBCS. Demographic, tumor, treatment, and outcome variables were compared using both univariate and multivariable analysis. Results A total of 162 patients were evaluated. NAC patients had significantly lower re‐excision rates (0% NAC vs. 9% PBCS, p = .03), margin positivity (0% NAC vs. 5% PBCS, p = .01), and greater patient satisfaction with breast cosmesis (97 NAC vs. 77 PBCS, p = .01). On multivariable analysis, NAC was not an independent predictor of lower final resection volume, total complications, or greater satisfaction with breasts when controlling for age and T category at diagnosis. Conclusion NAC followed by BCS may offer less margin positivity, lower re‐excision rates, and greater patient satisfaction when compared to a contemporary PBCS cohort in the “no‐ink‐on‐tumor” era.