The impact of sugammadex versus neostigmine reversal on return to intended oncological therapy-related outcomes after breast cancer surgery: a retrospective cohort study.

Background: Early return to intended oncological therapy (RIOT) after cancer resection is a determinant for long-term oncological outcomes. Sugammadex is increasingly used to reverse the muscle relaxant effect of rocuronium during general anesthesia. It has been shown to improve early postoperative outcomes, but its impact on RIOT is unknown. This study tested the hypothesis that the administration of sugammadex during mastectomy for nonmetastatic breast cancer resection would be associated with better RIOT-related outcomes compared with neostigmine.

Methods: Women ≥ 18 years who required mastectomy for nonmetastatic breast cancer resection from 2015 to 2022 were included in the retrospective study. They were grouped according to the administration of sugammadex or neostigmine. The study outcomes included time to RIOT, the incidence of RIOT at 90 and 180 days, length of hospital stay, and rate of 30-day hospital readmission. A multivariate analysis was conducted to test the association between sugammadex use and RIOT-related outcomes.

Results: Of 888 patients who met the study criteria, 319 received neostigmine and 569 received sugammadex. Sugammadex patients achieved RIOT at 90 days in 81.9% of the cases, whereas 70.8% of neostigmine patients were able to achieve RIOT (P < 0.001). Similar results were found for RIOT at 180 days (85.8% vs. 76.8%, respectively; P < 0.001). Sugammadex patients achieved RIOT faster than neostigmine patients (37 days, 95% CI: 35-41 days; P < 0.001). However, the multivariate analysis for RIOT initiation and time to RIOT did not show statistically significant differences.

Conclusion: The administration of sugammadex, compared with neostigmine, is not associated with significant improvements in RIOT-related variables after breast cancer surgery.