| Sumario: | Background: Triple‐negative breast cancer (TNBC) is an aggressive subtype with poor prognosis. Neoadjuvant immunochemotherapy (NAIC) combining chemotherapy and pembrolizumab is now standard for Stage II‐III TNBC. This study evaluates the impact of NAIC on surgical outcomes versus neoadjuvant chemotherapy (NAC). Methods: A retrospective cohort study included 117 Stage II‐III TNBC patients treated with NAIC or NAC (October 2019–May 2023). Surgical complications, time to surgery, time to radiotherapy, and pathologic response were assessed. Complications were classified using the Clavien–Dindo scale; immune‐related adverse events (irAEs) followed the 2017 CTCAE criteria. Results: Among 117 patients, 59 received NAIC and 58 NAC. Chemotherapy‐related adverse events were similar (NAIC: 78.0%, NAC: 75.9%). irAEs occurred in 50.8% of NAIC patients, with 8.5% experiencing severe irAEs. Surgical complications were more frequent in NAIC (27.1%) than NAC (17.2%), though not statistically significant; seroma was the most common. Delays > 12 weeks in initiating radiotherapy were more frequent in NAIC (10.7%) than NAC (0%). Conclusion: NAIC did not significantly increase postoperative complications compared to NAC. However, irAEs and potential treatment delays warrant careful management. Despite these risks, NAIC remains a viable option for early TNBC with manageable surgical outcomes.
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