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

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 ۲۰۲۰ 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 ۹۵% 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 ۱۹۸۶ and ۲۰۲۱ were included: comparative cohorts, prospective phase II trials, a database study, and a case series. Comparative meta-analysis showed no significant differences at ۵ years between the surgery-omission and surgery groups in disease-free survival (risk ratio: ۰.۹۲, ۹۵% CI ۰.۷۸–۱.۰۸), overall survival (risk ratio: ۱.۰۸, ۹۵% confidence interval: ۰.۹۷–۱.۲۱), or metastasis-free survival (risk ratio: ۱.۰۸, ۹۵% confidence interval: ۰.۹۷–۱.۲۰), with low heterogeneity (I²=۰%). Locoregional recurrence showed a nonsignificant trend favoring surgery. Contemporary studies using vacuum-assisted biopsy to confirm pathological complete response reported ۰% 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.

کلیدواژه ها:

Breast Cancer ، Neoadjuvant Chemotherapy ، Surgery ، Biopsy ، Meta-Analysis