Developments in Breast Cancer Surgery in 2024: In Light of SABCS Data
In recent years, the surgical approach to breast cancer treatment has shifted toward “less but more effective” strategies. Studies presented at SABCS 2024 addressed many innovations aimed at narrowing the scope of surgery, increasing patient comfort, and improving aesthetic outcomes.
Discussions on Surgery-Free Follow-Up After Neoadjuvant Therapy
Surgery-Free Follow-Up After Pathological Complete Response (pCR)
One of the notable studies presented at the symposium was the MICRA and RESPONDER clinical trials, which suggested that breast surgery could be omitted in patients who achieved a complete response (pCR) after neoadjuvant therapy. If pCR can be confirmed through imaging and needle biopsy, it was discussed that similar survival rates could be achieved in these patients with active surveillance and radiotherapy alone.
Real-Time Pathological Assessment
Intraoperative molecular analysis techniques developed at some centers enable the immediate assessment of tumor presence at the microscopic level during surgery. This reduces the risk of “inadequate surgical margins” and decreases the need for revision surgeries.
Minimally Invasive Techniques and New Margin Approaches
New Standards in Axillary Surgery
In patients with negative sentinel lymph nodes (SLN) following neoadjuvant therapy, the practice of performing only SLNB instead of axillary lymph node dissection (ALND) has been supported by numerous retrospective analyses and small randomized studies.
Results from the AXSANA study presented at SABCS 2024 showed that local recurrence rates remained below 2% in patients who did not undergo ALND, and that quality of life was significantly higher.
Magnetic Markers and Non-Radioactive Tracking
The use of superparamagnetic particles instead of radioactive isotopes in sentinel lymph node biopsy is becoming increasingly common. Monitoring with agents such as “Magtrace” offers advantages in terms of both patient safety and logistical convenience.
Oncoplastic Surgery and Aesthetic Advances
New-Generation Approaches in Oncoplastic Surgery
At SABCS 2024, layered oncoplastic technique algorithms classified according to tumor localization and breast volume were presented for oncoplastic surgeries. Thanks to these algorithms, surgeons can more safely determine the most appropriate technical option for each patient.
Planning with Digital Imaging
Three-dimensional imaging systems (e.g., 3D ultrasound + MR fusion) enable better assessment of preoperative breast volume estimation and postoperative asymmetry risk. These systems provide high accuracy, particularly in nipple-sparing mastectomy planning.
Robotic and Endoscopic Surgery
Robot-assisted and endoscopic breast surgery applications have gained significant attention, particularly in Asia-based studies. The armpit-to-armpit robotic mastectomy technique has improved scar-free outcomes and cosmetic success rates in axillary surgery. However, the long-term oncological outcomes of these techniques remain unclear.
Transition to a Non-Surgical Era: Realistic or Premature?
Although non-surgical follow-up appears theoretically feasible after pCR, many speakers at SABCS 2024 emphasized that these strategies should still be limited to selected patient groups and controlled clinical settings. The routine adoption of this approach is not expected until its applicability in broader patient populations and long-term recurrence rates are clarified.
Conclusion and Future Perspective
As of 2024, the primary goal in breast surgery is to achieve maximum oncological control with minimal intervention. Thanks to advances in imaging, molecular diagnostics, and intraoperative technologies, surgeons are increasingly able to achieve better outcomes with less tissue removal. In the coming years, it is anticipated that personalized surgical decision support systems and artificial intelligence applications will be further integrated into this process.
References:
SABCS 2024 presentation archive, session summaries, and published abstracts (DOI numbers can be added upon request).
AXSANA trial results (2024), DESTINY-Breast06 update (2024), KEYNOTE-756 (NEJM, 2024), EMERALD Trial subgroup analysis (2024)
