Effect of Surgical Delay After Neoadjuvant Chemotherapy on Survival Outcomes in Breast Cancer: A Systematic Review and Meta-Analysis.

Abstract

Timely surgery after neoadjuvant chemotherapy (NAC) is essential in breast cancer management, yet delays remain common, particularly in low- and middle-income countries. Evidence on the impact of these delays is inconsistent. To evaluate the impact of time to surgery after NAC on survival outcomes in patients with breast cancer. This systematic review and meta-analysis was conducted in accordance with PRISMA guidelines. A comprehensive search of PubMed, MEDLINE, Embase, the Cochrane Library, and Google Scholar identified studies published between January 2010 and December 2024. Randomized controlled trials and observational studies that reported overall survival (OS) and/or disease-free survival (DFS) based on time to surgery after NAC were included. Study selection and data extraction were performed by two independent reviewers. Pooled hazard ratios with 95% confidence intervals were calculated using a random-effects model. Heterogeneity was assessed using the I2 statistic. Thirteen studies, comprising thousands of patients, were included. Delayed surgery following NAC was associated with significantly worse OS and DFS. Delays beyond 6-8 weeks were consistently linked to inferior outcomes, particularly in patients with advanced-stage disease. Moderate heterogeneity was observed across studies. Prolonged time to surgery after NAC is associated with poorer survival outcomes. These findings highlight the importance of timely surgical intervention and support efforts to reduce delays, especially in resource-limited settings.