by André Pfob, Joerg Heil
The Breast:
Published:January 22, 2022
Breast and axillary surgery after neoadjuvant systemic
treatment for women with breast cancer has undergone multiple paradigm changes
within the past years. In this review, we provide a state-of-the-art overview
of breast and axillary surgery after neoadjuvant systemic treatment from both,
a clinical routine perspective and a clinical research perspective. For
axillary disease, axillary lymph node dissection, sentinel lymph node biopsy,
or targeted axillary dissection are nowadays recommended depending on the lymph
node status before and after neoadjuvant systemic treatment. For the primary
tumor in the breast, breast conserving surgery remains the standard of care.
The clinical management of exceptional responders to neoadjuvant systemic treatment
is a pressing knowledge gap due to the increasing number of patients who
achieve a pathologic complete response to neoadjuvant systemic treatment and
for whom surgery may have no therapeutic benefit. Current clinical research
evaluates whether less invasive procedures can exclude residual cancer after
neoadjuvant systemic treatment as reliably as surgery to possibly omit surgery
for those patients in the future.
