Dados do Trabalho

Título

CIRURGIA CONSERVADORA APOS QUMIOTERAPIA NEOADJUVANTE NAS PACIENTES COM ESTADIO II E III TRATADAS NO SUS

Título em Inglês

BREAST-CONSERVING SURGERY AFTER NEOADJUVANT CHEMOTHERAPY IN PATIENTS WITH STAGE II AND III TREATED IN THE PUBLIC HEALTH SYSTEM

Introdução

In the last few decades, neoadjuvant chemotherapy (NCT) has played an increasing role in the management of breast cancer. It allows to evaluate the tumour reponse in vivo and may afford a de-escalation of surgery. Despite advances in neoadjuvant treatment, evidence shows that rates of breast-conserving surgeries (BCT) after NCT are low (51% - 68%) even when the patient is eligible for less agressive surgery.

Objetivos

To analyze the surgical treatment performed in patients who underwent NCT with clinical stage (CS) II or III in a public service in Brazil.

Métodos

A cross-sectional study was conducted with statistical analysis in the database of a public hospital in São Paulo with 11.073 patients treated from January 2009 to December 2020.

Resultados

A total of 11.073 patients with breast cancer were treated in this period and 9.526 surgeries were performed, of which 4.613 (48.4%) BCT and 4.913 (51.6%) mastectomies. Among these procedures, 2.231 patients underwent NCT before surgical treatment, 275 (12%) were submitted to BCT and 1.956 (88%) to mastectomy. When compared by clinical stage: 641 were CS II, BCT was performed in 143 (22.3%) and mastectomy in 498 (77.7%), and 1. 590 were CS III, of which 132 (8.3%) were submitted to BCT and 1458 (91.7%) to mastectomy after neoadjuvant treatment.

Conclusões

We observed that the rate of BCT after NCT in patients with CS II or III in our service was even lower than that found in the international literature. Some of the factors that may have influenced this result are: patient preference, anatomical extension of the tumor with skin ulceration (T4b), physician insecurity in performing a less aggressive treatment or difficulty accessing radiotherapy for patients from distant cities. This suggests that the potential surgical benefits of NCT are not being fully understood or explored. There is a need to resolve the uncertainties that are are holding back surgical teams from adopting more conservative surgeries.

Palavras Chave

breast-conserving surgery, neoadjuvante chemotherapy, quadrantectomy, lumpectomy

Área

TREATMENT - Surgery and Reconstruction