Axillary surgery in node-positive breast cancer

Maggi, Nadia; Nussbaumer, Rahel; Holzer, Liezl Ingrid; Weber, Walter

doi:10.1016/j.breast.2021.08.018

Cited by 19 publications

(14 citation statements)

References 23 publications

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“…Furthermore, both chronic pain and impairment of shoulder mobility did however not lead to a delay in adjuvant treatment. [11,23,24] Our results concerning the postoperative complication rate following NST con rm the conclusion of a recently published systematic review and meta-analysis by Lorentzen et al [25] They searched the literature for studies assessing the impact of NST on postoperative complications, comparing a group of patients receiving NST to a control group. According to Lorentzen et al NST is not associated with increased postoperative complications.…”

Section: Discussionsupporting

confidence: 82%

The Impact of Neoadjuvant Systemic Treatment on Postoperative Complications in Breast Cancer Surgery

Maggi

Nussbaumer

Castrezana

et al. 2022

Preprint

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Purpose: The aim of the study was to analyse the impact of neoadjuvant systemic treatment (NST) on postoperative complications and the beginning of adjuvant treatment. Methods: This study includes data from a prospectively maintained database including patients with breast cancer (BC) stage I-IV with or without NST undergoing breast cancer surgery between January 2010 and September 2021. Results: Out of 517 enrolled patients, 77 received NST, 440 had primary breast surgery. After NST patients underwent surgery after a meantime of 34 days (26.5 – 40 days). No statistical significance could be found comparing the complication grading according to the Clavien Dindo classification. The complications were most frequently rated as grade 3b. There were no complications with grade 4 or higher. When differentiating into short and long-term, the overall rate of short-term complications was 20.3% with no significant difference between the two groups (20.8% vs. 20.2%). Regarding long-term complications, there was more impairment of shoulder mobility (26.0% vs. 9.5%, p = < 0.001) and chronic pain (42.9% vs. 28.6%, p = < 0.016) for patients with NST. The beginning of the administration of the adjuvant treatment was comparable in both groups (46.3 days vs. 50.5 days). Conclusion: In our cohort, complications between both groups were comparable according to Clavien Dindo. This study shows that NST has no negative impact on postoperative short-term complications and most importantly did not lead to a delay of the beginning of adjuvant treatment. Therefore, NST can be safely admitted, even when followed by extensive breast reconstruction surgery.

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Section: Discussionsupporting

confidence: 82%

The Impact of Neoadjuvant Systemic Treatment on Postoperative Complications in Breast Cancer Surgery

Maggi

Nussbaumer

Castrezana

et al. 2022

Preprint

Self Cite

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“…This should be taken into account for perioperative patient management such as physiotherapy and pain management. Furthermore, both chronic pain and impairment of shoulder mobility did however not lead to a delay in adjuvant treatment [ 11 , 23 , 24 ].…”

Section: Discussionmentioning

confidence: 99%

The impact of neoadjuvant systemic treatment on postoperative complications in breast cancer surgery

Nussbaumer

Maggi

Castrezana

et al. 2022

Breast Cancer Res Treat

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Purpose The aim of the study was to analyze the impact of neoadjuvant systemic treatment (NST) on postoperative complications and the beginning of adjuvant treatment. Methods This study includes data from a prospectively maintained database including patients with breast cancer (BC) stage I–IV with or without NST undergoing breast cancer surgery between January 2010 and September 2021. Results Out of 517 enrolled patients, 77 received NST, 440 had primary breast surgery. After NST patients underwent surgery after a meantime of 34 days (26.5–40 days). No statistical significance could be found comparing the complication grading according to the Clavien Dindo classification. The complications were most frequently rated as grade 3b. There were no complications with grade 4 or higher. When differentiating into short and long-term, the overall rate of short-term complications was 20.3% with no significant difference between the two groups (20.8% vs. 20.2%). Regarding long-term complications, there was more impairment of shoulder mobility (26.0% vs. 9.5%, p ≤ 0.001) and chronic pain (42.9% vs. 28.6%, p ≤ 0.016) for patients with NST. The beginning of the administration of the adjuvant treatment was comparable in both groups (46.3 days vs. 50.5 days). Conclusion In our cohort, complications between both groups were comparable according to Clavien Dindo. This study shows that NST has no negative impact on postoperative short-term complications and most importantly did not lead to a delay of the beginning of adjuvant treatment. Therefore, NST can be safely admitted, even when followed by extensive breast reconstruction surgery.

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“…This has been shown to down-stage breast cancer to allow for less invasive surgery [ 80 ], namely BCT instead of a mastectomy, or a sentinel lymph node biopsy instead of an axillary lymph node dissection. For example, neoadjuvant systemic therapy has allowed patients who become node-negative to undergo sentinel lymph node biopsy to evaluate nodal pathological complete response [ 81 ]. However, even with less invasive surgery, patients are at risk of morbidity, including chronic pain and lymphedema [ 82 , 83 , 84 , 85 ].…”

Section: De-escalation Of Surgery After Neoadjuvant Systemic Therapymentioning

confidence: 99%

De-Escalating the Management of In Situ and Invasive Breast Cancer

Angarita

Brumer

Castelo

et al. 2022

Cancers

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It is necessary to identify appropriate areas of de-escalation in breast cancer treatment to minimize morbidity and maximize patients’ quality of life. Less radical treatment modalities, or even no treatment, have been reconsidered if they offer the same oncologic outcomes as standard therapies. Identifying which patients benefit from de-escalation requires particular care, as standard therapies will continue to offer adequate cancer outcomes. We provide an overview of the literature on the de-escalation of treatment of ductal carcinoma in situ (DCIS), local treatment of breast cancer, and surgery after neoadjuvant systemic therapy. De-escalation of breast cancer treatment is a key area of investigation that will continue to remain a priority. Improvements in understanding the natural history and biology of breast cancer, imaging modalities, and adjuvant treatments will expand this even further. Future efforts will continue to challenge us to consider the true role of various treatment modalities.

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Axillary surgery in node-positive breast cancer

Cited by 19 publications

References 23 publications

The Impact of Neoadjuvant Systemic Treatment on Postoperative Complications in Breast Cancer Surgery

The Impact of Neoadjuvant Systemic Treatment on Postoperative Complications in Breast Cancer Surgery

The impact of neoadjuvant systemic treatment on postoperative complications in breast cancer surgery

De-Escalating the Management of In Situ and Invasive Breast Cancer

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