How Surgical Strategies Are Modified by Novel Neoadjuvant Treatments in Breast Surgery
Seance of wednesday 20 may 2026 (L'Académie reçoit la Société Francophone de Chirurgie Oncologique)
DOI number : 10.26299/kr3r-4n69/emem.2026.21.06
Abstract
Neoadjuvant therapy (NAT) now plays a central role in breast cancer management, applying to 20–30% of cases. The emergence of targeted anti-HER2 therapies, immunotherapy (pembrolizumab, KEYNOTE-522), and preoperative endocrine therapy has substantially improved pathological complete response (pCR) rates, reaching 50–70% depending on the molecular subtype.
These outcomes have driven a major reconfiguration of surgical strategy. In the breast, NAT enables meaningful surgical de-escalation, increasing breast conservation rates and broadening indications for oncoplastic surgery. In the axilla, targeted axillary dissection (TAD) post-NAT allows sentinel lymph node biopsy alone in initially cN1 patients achieving axillary pCR, provided strict criteria are met, as validated by the ACOSOG Z1071, SENTINA, and SN FNAC trials.
These advances require surgical involvement from the initial multidisciplinary team meeting, systematic tumor and nodal clipping before NAT, and early oncoplastic planning. Emerging perspectives include surgical omission, currently under investigation in several trials (NRG BR005, PROSPECT), but still considered experimental. Neoadjuvant treatment response has become the primary determinant of surgical strategy in breast oncology.
These outcomes have driven a major reconfiguration of surgical strategy. In the breast, NAT enables meaningful surgical de-escalation, increasing breast conservation rates and broadening indications for oncoplastic surgery. In the axilla, targeted axillary dissection (TAD) post-NAT allows sentinel lymph node biopsy alone in initially cN1 patients achieving axillary pCR, provided strict criteria are met, as validated by the ACOSOG Z1071, SENTINA, and SN FNAC trials.
These advances require surgical involvement from the initial multidisciplinary team meeting, systematic tumor and nodal clipping before NAT, and early oncoplastic planning. Emerging perspectives include surgical omission, currently under investigation in several trials (NRG BR005, PROSPECT), but still considered experimental. Neoadjuvant treatment response has become the primary determinant of surgical strategy in breast oncology.