Oncological Outcomes of Omitting Breast Surgery in Patients Achieving Complete Response after Neoadjuvant Therapy

Winantyo, V.I. Idelia; Wihandono, A.; Winantyo, P.D. Daniswara

doi:10.58209/hehp.14.2.415

Oncological Outcomes of Omitting Breast Surgery in Patients Achieving Complete Response after Neoadjuvant Therapy

Document Type : Systematic Review

Authors

V.I. Idelia Winantyo ¹

A. Wihandono ¹

P.D. Daniswara Winantyo ²

¹ Department of Surgery, Faculty of Medicine, Airlangga University, Surabaya, Indonesia

² Department of Cardiology and Vascular Medicine, Faculty of Medicine, Airlangga University, Surabaya, Indonesia

10.58209/hehp.14.2.415

Abstract

Aims: This study aimed to evaluate the oncological outcomes of omitting breast surgery in patients with breast cancer who achieve a pathological complete response after neoadjuvant systemic treatment and to assess how response assessment methods influence treatment safety.
Information & Methods: This systematic review and meta-analysis were conducted in accordance with the PRISMA 2020 guidelines. PubMed/MEDLINE, Scopus, Web of Science, Embase, Cochrane CENTRAL, and ScienceDirect were searched without date restrictions. We included studies evaluating oncological outcomes in patients with breast cancer who achieved a complete response after neoadjuvant systemic treatment and did not undergo definitive breast surgery. Risk ratios with 95% confidence intervals were calculated using a Mantel–Haenszel random-effects model. Heterogeneity in response assessment methods was considered a priori.
Findings: Eight studies published between 1986 and 2021 were included: comparative cohorts, prospective phase II trials, a database study, and a case series. Comparative meta-analysis showed no significant differences at 5 years between the surgery-omission and surgery groups in disease-free survival (risk ratio: 0.92, 95% CI 0.78–1.08), overall survival (risk ratio: 1.08, 95% confidence interval: 0.97–1.21), or metastasis-free survival (risk ratio: 1.08, 95% confidence interval: 0.97–1.20), with low heterogeneity (I²=0%). Locoregional recurrence showed a nonsignificant trend favoring surgery. Contemporary studies using vacuum-assisted biopsy to confirm pathological complete response reported 0% ipsilateral breast tumor recurrence, whereas older studies relying on clinical or imaging criteria reported higher recurrence rates.
Conclusion: Omitting breast surgery remains investigational and is not standard care, despite potential feasibility in carefully selected patients.

Keywords

Breast Cancer

Neoadjuvant Chemotherapy

Surgery

Biopsy

Meta-Analysis

Subjects

Health Care

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