Comparison of excised breast volume, re-excision rate and margin positivity in breast-conserving surgery in breast cancer patients using and not using neoadjuvant chemotherapy

Abstract

Background/Aim: One of the purposes of using neoadjuvant chemotherapy (NAC) is to evaluate the patients according to tumor-to-gland ratio, save them from mastectomy by reducing tumor dimension, and get more beautiful results cosmetically with less volume excision during breast-conserving surgery (BCS). Is it possible to achieve the goal of less volume excision after NAC? We aimed to compare the excised volume with BCS, margin positiveness and re-excision rates between the patients who received NAC and the ones who didn’t receive NAC in patients with breast cancer and to calculate the increase in BCS performability with NAC. Methods: Among 306 patients diagnosed with breast cancer between 2013 and 2021 at Gaziosmanpasa Training and Research Hospital, 105 patients who underwent BCS were included in this retrospective cohort study. Excised breast volume, surgical margin positiveness, re-excision and mastectomy rates were retrospectively compared in breast cancer patients underwent BCS with and without NAC. The patients who received BCS following NAC were named the primary chemotherapy (PC), and the patients whose treatment was initiated with BCS were named the primary surgery (PS) groups. Results: BCS was performed to 105 breast cancer patients, of which 28 (26.7%) received NAC, and 77(73.7%) started the treatment with surgery. There were no significant differences between the PC and PS groups with respect to excision volume (755.86 (725.69) and 709 (637.36), P=0.822). Re-excision was more common in PS than in the PC group (39.0% vs 10.7%, P=0.008). Fourteen patients who were candidates for mastectomy at the beginning, became eligible for BCS by receiving NAC, which caused a 15.38% increase in BCS applicability. Surgical margin positivity was seen in only 3 patients, which is why a statistical comparison wasn’t made. Conclusions: Although the tumor size was higher in the PC group, the excised breast volume did not show a significant difference between the two groups. PC decreased the re-excision rates in the chemotherapy candidate group. This data shows that patients who are candidates for adjuvant chemotherapy might be considered for PC to increase BCS success with lower re-excision rates and equivalent excised breast volume.