DE-ESCALATION OF SURGERY IN BREAST CARCINOMA PATIENTS FOLLOWING NEOADJUVANT CHEMOTHERAPY

Background: Breast carcinoma remains a major cause of cancer-related morbidity among women, particularly in settings where patients often present with advanced disease. Neoadjuvant chemotherapy has become an important treatment approach because it can reduce tumor burden before surgery and increase the feasibility of breast-conserving procedures. Evaluating its role in surgical de-escalation is clinically relevant for improving oncological safety, cosmetic outcomes, recovery, and patient-centered breast cancer care. Objective: To evaluate the role of neoadjuvant chemotherapy in facilitating surgical de-escalation among patients with breast carcinoma. Methods: This comparative observational study was conducted in the Department of Surgery, Khyber Teaching Hospital, Peshawar, from 1 December 2025 to 31 May 2026. A total of 213 adult female patients with histologically confirmed breast carcinoma who received neoadjuvant chemotherapy followed by definitive surgery were included through consecutive sampling. Data regarding age, body mass index, symptom duration, laterality, clinical stage, histopathological type, tumor grade, response to neoadjuvant chemotherapy, and type of surgery were collected using a structured proforma. Data were analyzed using SPSS version 26.0. Associations were assessed using Chi-square or Fisher’s exact test, and binary logistic regression was used to identify predictors of breast-conserving surgery. A p-value of <0.05 was considered statistically significant. Results: The mean age was 41.5 ± 10.7 years, and the mean body mass index was 24.5 ± 3.1 kg/m². Most patients were aged ≤40 years (55.4%), presented within 3 months of symptoms (57.7%), and had Stage III disease (39.9%). Invasive ductal carcinoma Grade II was the most common histological type (57.3%), followed by invasive ductal carcinoma Grade III (41.3%). Complete response to neoadjuvant chemotherapy was observed in 28.6%, partial response in 58.2%, and no response in 13.1%. Breast-conserving surgery was performed in 57.3%, while 42.7% underwent mastectomy. Complete response was strongly associated with breast-conserving surgery, as 78.7% of complete responders underwent breast conservation compared with 14.3% of non-responders. On regression analysis, complete response, earlier clinical stage, younger age, shorter symptom duration, and Grade II tumors were independently associated with breast-conserving surgery. Conclusion: Neoadjuvant chemotherapy supported surgical de-escalation by increasing the feasibility of breast-conserving surgery in selected patients with breast carcinoma. Treatment response, especially complete response, remained the most important factor guiding conservative surgical management. Careful patient selection, response assessment, and multidisciplinary planning may help reduce unnecessary mastectomy while maintaining oncological safety. Keywords: Breast Carcinoma; Breast-Conserving Surgery; Clinical Stage; Mastectomy; Neoadjuvant Chemotherapy; Surgical De-escalation; Treatment Response.