Linda Adwall

I am a senior consultant at the Breast Unit, Department of Surgery at Södersjukhuset, Stockholm. I defended my PhD thesis,  Complications after Breast Cancer Surgery and Oncological Outcomes, at Uppsala University on 7 February 2025. The thesis concluded that postoperative surgical site infection is not associated with poorer oncological outcomes; however, it demonstrated an association between major systemic infections and adverse oncological outcomes. In Studies III and IV, we used the population‑based national research database BCBaSe 3.0. This work initiated a close collaboration with Irma Fredriksson and Helena Sackey, and following my dissertation I have joined Irma’s research group at the Department of Molecular Medicine and Surgery at Karolinska Institutet.

During my residency, I conducted a project examining surgical site infections (SSI) following breast surgery, which subsequently led me to investigate whether antibiotic prophylaxis could reduce the risk of SSI across different types of breast cancer surgery. Over time, my interest grew in understanding whether postoperative complications might adversely affect oncological outcomes, and, if so, through which mechanisms. This became a central focus of my doctoral thesis. The fourth study in the thesis was a national population‑based cohort study including patients operated for breast cancer between 2008 and 2019, demonstrating that major systemic infections within 90 days postoperatively were significantly associated with an increased risk of distant metastasis as well as breast cancer–specific and overall death.

Infectious complications after surgery have thus been shown to correlate with poorer oncological outcomes. However, it remains unclear whether this association is driven by the inflammatory response induced by the infection itself, or whether it is mediated through delayed or omitted adjuvant therapy. In forthcoming studies, we aim to explore these mechanisms further and to identify risk factors for postoperative infection. We will also consider patients’ general health status and age, factors that may influence their ability to receive adjuvant treatment. The overarching goal is to improve surgical outcomes and potentially oncological outcomes as well.

I am also deeply interested in investigating and reducing complications after breast cancer surgery. Several studies have shown that prophylactic negative pressure wound therapy (NPWT) can reduce the risk of wound complications, particularly in high‑risk patients undergoing reconstruction or breast-conserving surgery through reduction incisions. We therefore plan to evaluate the effect of prophylactic NPWT in a pragmatic randomized clinical trial comparing NPWT with standard dressings for wound complications after high‑risk breast cancer surgery (primary reconstruction and oncoplastic breast‑conserving surgery) in patients with at least one risk factor for complications.

In addition, I serve as the local principal investigator at Södersjukhuset for the AXSANA study (AXillary Surgery After NeoAdjuvant treatment), a large international prospective observational study including breast cancer patients with initial nodal metastasis undergoing neoadjuvant therapy.

I also introduced, and for several years was responsible for, the journal clubs at our breast unit at Södersjukhuset.