Surgical Timing and Safety of Breast Cancer Operations After COVID-19 - A Prospective-Only Meta-Analysis of Cohort Studies

Sep 30, 2026

Background: The COVID-19 pandemic introduced uncertainty about the safe timing of breast cancer surgery following SARS‑CoV‑2 infection, while strong prospective data remained scarce. Methods: A systematic review and meta-analysis pooled prospective cohort studies (2020–2024) comparing postoperative outcomes in patients with confirmed SARS‑CoV‑2 infection ≤90 days before surgery versus non-infected contemporaneous controls treated at the same institutions. PROSPERO CRD420251174613 was used. Results: Twelve studies (n=7812) showed higher 30-day complications and increased venous thromboembolism after recent infection, with the greatest risk for surgery 14 days after infection. Conclusions: Excess perioperative risk occurs mainly within the first two weeks; delaying to ~six weeks reduces complications and VTE without compromising short-term safety.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages20

Reading Time50 min

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Abstract

Introduction

Methods

Results

Conclusions

Systematic Review Surgical Timing and Safety of Breast Cancer Operations After COVID-19: A Prospective-Only Meta-Analysis of Cohort Studies Ioana-Georgiana Cotet 1,2, Diana-Maria Mateescu 1, Dragos-Mihai Gavrilescu 3,*, Andrei Marginean 4,*, Stefania Serban 1, Adrian-Cosmin Ilie 5, Cristina Guse 1, Ana-Maria Pah 6, Marius Badalica-Petrescu 6, Stela Iurciuc 6, Maria-Laura Craciun 6, Adina Avram 6 and Cristina Tudoran 2,7,8 Academic Editor: Emmanuel Favaloro Received: 17 November 2025 Revised: 28 December 2025 Accepted: 30 December 2025 Published: 2 January 2026 Copyright: © 2026 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license. 1 Department of General Medicine, Doctoral School,“Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania; [ioana.cotet@umft.ro](ioana.cotet@umft.ro) (I.-G.C.); [diana.mateescu@umft.ro](diana.mateescu@umft.ro) (D.-M.M.); [stefania.serban@umft.ro](stefania.serban@umft.ro) (S.S.); [cristina.marin@umft.ro](cristina.marin@umft.ro) (C.G.) 2 Centre of Molecular Research in Nephrology and Vascular Disease, University of Medicine and Pharmacy“Victor Babes” Timisoara, Eftimie Murgu Square, Nr. 2, 300041 Timisoara, Romania; [tudoran.cristina@umft.ro](tudoran.cristina@umft.ro) [3](3 Department of Orthodontics)[ Department of Orthodontics](3 Department of Orthodontics), [Dental District](Dental District), [Strada Z](Strada Z)ă[gazului Nr](gazului Nr). 3, One Floreasca Vista, Sector 1, 014261 Bucharest, Romania 4 Department of Surgery,“Dr. Victor Popescu” Emergency Military Hospital, 9 Gheorghe Lazăr Street, 300080 Timis, oara, Romania 5 Department of Public Health and Sanitary Management,“Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania; [ilie.adrian@umft.ro](ilie.adrian@umft.ro) 6 Cardiology Department,“Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania; [anamaria.pah@umft.ro](anamaria.pah@umft.ro) (A.-M.P.); [iurciuc.stela@umft.ro](iurciuc.stela@umft.ro) (S.I.); [laura.craciun@umft.ro](laura.craciun@umft.ro) (M.-L.C.) 7 Department VII, Internal Medicine II, Discipline of Cardiology,“Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Square, Nr. 2, 300041 Timisoara, Romania 8 County Emergency Hospital “Pius Brinzeu”, L. Rebreanu, Nr. 156, 300723 Timisoara, Romania * Correspondence: [dr.gavrilescu@outlook.com](dr.gavrilescu@outlook.com) (D.-M.G.); [andreivmarginean@yahoo.com](andreivmarginean@yahoo.com) (A.M.) Abstract Background: The COVID-19 pandemic raised uncertainties regarding the safe timing of breast cancer surgery after SARS-CoV-2 infection, and robust prospective evidence has remained limited. Methods: We conducted a systematic review and meta-analysis of prospective cohort studies (2020–2024) investigating postoperative outcomes in breast cancer patients with confirmed SARS-CoV-2 infection ≤90 days before surgery versus contemporaneous non-infected controls treated at the same institutions and in the same period. PROSPERO CRD420251174613 . Random-effects models (DerSimonian–Laird with Hartung–Knapp adjustment) were used to pool odds ratios (ORs) and 95% confidence intervals (CIs) . Study quality was assessed with the Newcastle–Ottawa Scale, and certainty of evidence was rated using GRADE. Results: Twelve prospective cohort studies, including 7812 patients, compared breast cancer surgery after recent confirmed SARS-CoV-2 infection over 90 days with contemporaneous non-infected controls treated at the same centres. Overall, recent infection was associated with higher 30-day postoperative complications (Clavien–Dindo ≥ II) compared to. non-infected patients (OR 2.01, 95% CI 1.44–2.81) and increased venous thromboembolism (3.6%vs. 1.2%; OR 3.12, 95% CI 1.29–7.55) . Early surg

FAQs

What research question does the study address?

It evaluates the optimal timing and perioperative safety of breast cancer surgery after recent SARS-CoV-2 infection, focusing on complications, venous thromboembolism, and 30-day mortality.

How were included studies selected?

Prospective cohort studies from 2020–2024 were included, comparing patients with confirmed SARS-CoV-2 infection ≤90 days before surgery to non-infected contemporaneous controls treated at the same centers.

What timing after infection showed the highest complication risk?

Early surgery at about 14 days after infection carried the highest risk of complications (OR 4.38, 95% CI 2.31–8.30).

Does delaying surgery reduce risk compared with operating soon after infection?

Operations performed ≥6 weeks after infection had outcomes comparable to non-infected controls, with reduced complications and venous thromboembolism without compromising short-term safety.

Sep 30, 2026

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