Impact of Surgical Delay on Breast Cancer Prognosis: Systematic Review and Meta-analysis

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Abstract
Timely surgery is a key determinant of breast cancer outcomes; however, prior studies are inconsistent due to heterogeneous treatment pathways and inclusion of neoadjuvant therapy populations. The prognostic impact of delays to upfront surgery remains unclear. We evaluated the association between time from diagnosis to upfront surgery and survival in invasive breast cancer. A systematic search of MEDLINE, Embase, CENTRAL, and additional sources was conducted through April 25, 2025. Quantitative studies in English or French assessing time to upfront surgery and prognosis were included; neoadjuvant cohorts were excluded. Two reviewers independently screened studies. Random-effects meta-analyses and meta-regression were performed. The primary outcome was overall survival; secondary outcomes included cancer-specific survival, recurrence, and pathologic upstaging. Twenty-six studies involving 4,921,120 patients were included. Compared with surgery within 30 days, delays of 30-59 days were associated with increased mortality (hazard ratio [HR] 1.08; p = 0.02), 60-89 days with a 12% higher risk (HR 1.12; p < 0.001), and 90-120 days with a 37% higher risk (HR 1.37; p = 0.002). Each additional 30-day delay increased mortality risk by 15% (HR 1.15; p < 0.001). Findings were robust after adjustment, with low publication bias. Delays as early as 30 days from diagnosis to upfront surgery are associated with progressively worse survival. Incorporating defined surgical timing benchmarks into clinical guidelines may improve quality of care and patient outcomes.

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