In a recent ESSO Research Academy survey led by Carmela Caballero and co-authored by Prof. Isabel T. Rubio, Prof. Evandro de Azambuja, and Prof. Stuart A. McIntosh, both clinicians and patients were asked about omitting surgery after complete response to neoadjuvant systemic therapy (NST).
While surgical de-escalation is gaining attention, the findings show persistent hesitation. Most clinicians still favor surgery, citing the lack of definitive clinical trials and concerns over imaging reliability. Patients reported fears of regret, limited communication, and uncertainty about the safety of skipping surgery. The study highlights the urgent need for high-quality evidence and improved decision-making support before changing standard practice.
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