To investigate the effect of neoadjuvant chemotherapy (NCT) on the complications and coagulation function after modified radical mastectomy.

A retrospective analysis was performed on the clinical data of 110 patients who underwent modified radical mastectomy in the Department of Breast Surgery, Cancer Hospital of Guangxi Medical University from September 2016 to December 2019. Fifty-three patients received 8 cycles of NCT (doxorubicin and cyclophosphamide followed by docetaxel, AC-T) (NCT group) and 57 patients underwent modified radical mastectomy but received no NCT (control group). The operation parameters (operation time, intraoperative hemorrhage and total drainage volume) were compared between two groups by t-test of two independent samples. The incidences of lymph node metastasis postoperative complications (subcutaneous hydrops, skin flap necrosis, edema of affected limb, infection and venous thrombosis) were compared between two groups by χ² test or Fisher exact probability test. The related parameters of coagulation function[platelet count (PLT), prothrombin time (PT), activated partial thrombin time (APTT), thrombin time (TT), fibrinogen (FIB) and D-dimer]were compared at different time points (1 day before operation, 1 day and 7 days after operation) by ANOVA analysis of repeated measurements.

(1)There was no significant difference in operation time, intraoperative hemorrhage, total drainage and lymph node metastasis rate between two groups (t=0.164, P=0.870; t=-0.584, P=0.560; t=-0.340, P=0.734; χ²=0.182, P=0.669). (2)There was no significant difference in the incidences of postoperative subcutaneous hydrops, flap necrosis, limb edema, infection and venous thrombosis between two groups(χ²=0.036, P=0.849; P=1.000; χ²=0.182, P=0.670; P=1.000; P=0.230). (3) PLT, PT, APTT, TT, FIB and D-dimer showed a significant difference between different time points (F=8.826, P<0.001; F=3.210, P=0.044; F=3.491, P=0.032; F=24.811, P<0.001; F=72.847, P<0.001; F=267.238, P<0.001). APTT, FIB and D-dimer showed a significant difference between groups (F=5.854, P=0.017; F=4.616, P=0.034; F=7.761, P=0.006). There was no significant interaction between time factors and grouping factor for all parameters (F=2.045, P=0.134; F=0.998, P=0.372; F=1.340, P=0.264; F=0.302, P=0.740; F=0.305, P=0.737; F=1.703, P=0.187).

Eight cycles of NCT (AC-T) do not increase the incidence of complications after modified radical mastectomy, but they can shorten APTT and increase FIB and D-dimer levels in the blood, leading to postoperative hypercoagulability in the blood of breast cancer patients.