J.Jpn. Surg. Soc.. 125(5): 394-398, 2024

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Feature topic

CLINICAL TRIALS FOR SURGICAL DEESCALATION

Preoperative chemotherapy for primary breast cancer has achieved high rates of complete response in recent years, potentially enabling deescalation of breast and axillary surgery. Several clinical trials have been performed aiming to improve breast aesthetics and quality of life. Based on previous trial results, the current consensus suggests that surgical removal of the primary tumor remains standard therapy, even after complete response is achieved after preoperative chemotherapy. However, those studies also indicated the existence of a low-risk subgroup that might not need surgery. Results from ongoing clinical trials should be awaited. Radiofrequency ablation and cryoablation therapy are promising procedures for primarily low-risk cases in which chemotherapy is unnecessary. Regarding the possibility of deescalating axillary surgery, combining targeted axillary dissection with sentinel lymph node biopsy in cases when lymph node metastasis clinically disappears after preoperative chemotherapy is also promising. However, unresolved issues postsurgery include long-term prognosis and establishment of follow-up frequency and modalities. Accumulation of evidence confirming the oncological safety of surgical deescalation aimed to improve aesthetics and reduce invasiveness is essential.

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