Grade 3 or 4 postoperative adverse events and deaths within 28 days after surgery were more common in the primary-surgery group than in the primary-chemotherapy group ( 60 [ 24 % ] of 252 women vs 30 [ 14 % ] of 209 , p = 0.0007 , and 14 women [ 6 % ] vs 1 woman [ < 1 % ] , p = 0.001 ) .