Is Surgery Justifiable in Residual locally advance breast cancer after neo-adjuvant systemic treatment?

Background: Management of locally advanced disease is a challenge. In women with significant residual disease after neoadjuvant therapy when subjected to surgery wounds cannot be closed primarily and require myo-cutaneous flap, Latismus dorsi being the easiest one. The purpose of this study is to look at the recurrence rate, time to recurrence and is surgery needed in this group of patients. Material and Methods: This is a hospital-based retrospective study conducted at Liaquat National Hospital and Medical College, Karachi. Pakistan. From 2006 to 2015, 15 patients with locally advanced breast cancer, who still had significant residual disease after adequate neo-adjuvant therapy that after Modified radical mastectomy wound could not be closed and latismus dorsi flap was used to close the defect. The age, histopathology report, margin of clearance, ER, PR, Her2 status and ki67 was noted. These patients were followed up to look for any local or systemic recurrence and time to recurrence and local or site of any systemic recurrence was recorded. Results: A total of 15 female patients with a mean age of 42.73±9.66 years with a mean follow up of 33.93±26.78 months were seen. In all patients, margins were histologically negative. Mean nodes removed and involved were 12.53±8.04 and 5.46±7.15 respectively. Meantime to recurrence was 16.00±14.92 months. In our study, recurrence was observed in 11 (73.3%) patients with 7(64 %) local and 4(36%) systemic recurrence. All 5 triple-negative and 4 patients stage IV 4 had local recurrence. Patients with poor prognostic markers like higher residual nodal involvement, large tumor size, higher Ki 67, aggressive tumor biology (triple-negative and HER2 Positive tumors) had a high and early recurrence. Conclusion: In patients with high residual tumor burden and aggressive biology has high chances of disease recurrence. Surgery in these patients should be offered to keep quality of life, disease biology and recurrence rate in mind.