ADVANCES IN BREAST CANCER DIAGNOSIS AND TREATMENT: ESSENTIALS

Advances in breast cancer diagnosis and treatment Essentials_kapak

BREAST AND AXILLARY SURGERY AFTER NEOADJUVANT SYSTEMIC TREATMENT

Ufuk Tali1 Hakan Balbaloğlu2 Güldeniz Karadeniz Çakmak3

1Bülent Ecevit University, Faculty of Medicine, Department of General Surgery, Zonguldak, Türkiye
2Bülent Ecevit University, Faculty of Medicine, Department of General Surgery, Zonguldak, Türkiye
3Bülent Ecevit University, Faculty of Medicine, Department of General Surgery, Zonguldak, Türkiye

Tali U, Balbaloğlu H, Karadeniz Çakmak G. Breast and Axillary Surgery After Neoadjuvant Systemic Treatment. In: Citgez B editor. Advances in Breast Cancer Diagnosis and Treatment Essentials. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.79-90.

ABSTRACT

Breast cancer surgery has transformed into a dynamic process in which personalised approaches are prominent and guided by artificial intelligence and evidence-based medicine. Patient-specific biology and shared decision-making form the basis of the modern treatment approach. Although significant progress has been made in favour of reducing surgery, a dilemma arises due to high-risk patients or patients who require more extensive surgery. Furthermore, a reduction in surgery may lead to an increase in adjuvant therapies. This can also be considered as a suggestion of other treatments instead of surgery. This change in surgical approaches started with the understanding of the determining effect of tumour biology on prognosis. While it is accepted that local surgery does not change the biology, systemic therapies are planned according to the receptor subtype and improve the results. Therefore, physicians should evaluate treatment decisions on a case-by-case basis based on disease burden, biology and systemic response. Accurate diagnosis, staging and personalised planning are essential. Ultimately, an evidence-based, biology-driven and patient-centred shared decision-making process should be adopted. Today, the era of neoadjuvant therapy (NST) has started for all adjuvant treatment candidates. NST, which was initially recommended only in advanced stage patients to alleviate surgery and prevent complications such as lymphedema, is now also used in early stage HER2 positive and triple negative patients. However, the debate on overor under-treatment in the management of the breast and axilla after NST continues. For the last 30 years, reducing axillary surgery and decreasing patient morbidity has been one of the main goals of research. Currently, SLNB is the standard staging method both before primary surgery and after NST in cN0 and cN1 patients. However, advances in axillary imaging and genomic testing may reduce the need for axillary surgery, especially in early stage (cT1-2N0) patients. Routine axillary imaging in early-stage breast cancer may further reduce the reliance on surgical staging. As treatment decisions are based on tumour biology rather than anatomy, SLNB may eventually become unnecessary. In advanced patients, the extent of axillary treatment will be largely determined by the response to systemic therapy.

Keywords: Breast cancer; Neoadjuvant; Systemic therapy; Radiation therapy; Breast and axillary surgery

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