Neoadjuvant therapy and breast cancer surgery: a closer look at postoperative complications

Am J Surg. 2013 Dec;206(6):894-8; discussion 898-9. doi: 10.1016/j.amjsurg.2013.09.004. Epub 2013 Oct 1.

Abstract

Background: Neoadjuvant therapy is important in the treatment of advanced breast cancer.

Methods: Postoperative complications in neoadjuvant patients were analyzed.

Results: One hundred forty patients underwent 148 breast cancer surgeries after neoadjuvant therapy: 28% breast-conserving therapy procedures, 36% mastectomies, 28% mastectomies with immediate reconstruction, and 8% mastectomies with delayed reconstruction. Forty-seven patients (34%) suffered 59 complications: 18% of those undergoing breast-conserving therapy, 30% of those undergoing mastectomy, 44% of those undergoing mastectomy with immediate reconstruction, and 67% of those undergoing mastectomy with delayed reconstruction. Major complications occurred in 18% of patients. Skin loss occurred in 6% of patients. One patient had partial nipple necrosis. Three patients suffered implant loss. One patient had deep inferior epigastric artery perforator flap loss. Eleven hematomas and 5 infectious complications required reoperation.

Conclusions: Surgery after neoadjuvant therapy is safe, but careful counseling is warranted given that 18% of patients experienced major complications. Complications rates are higher with reconstruction, but feared complications of skin, nipple, implant, or flap loss were infrequent.

Keywords: Breast cancer surgery; Neoadjuvant; Postoperative complications.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Arizona / epidemiology
  • Breast Neoplasms / diagnosis
  • Breast Neoplasms / therapy*
  • Female
  • Follow-Up Studies
  • Humans
  • Incidence
  • Mastectomy / adverse effects*
  • Middle Aged
  • Neoadjuvant Therapy
  • Postoperative Care / methods*
  • Postoperative Complications / epidemiology*
  • Prognosis
  • Prospective Studies
  • Survival Rate / trends
  • Time Factors
  • Young Adult