Axillary Dissection vs. no Axillary Dissection in Breast Cancer Patients With Positive Sentinel Lymph Node: A Single Institution Experience

Abstract

Background/Aim: Axillary surgery of breast cancer patients is undergoing a paradigm shift, as axillary lymph node dissection's (ALND) usefulness is being questioned in the treatment of patients with tumor-positive sentinel lymph node biopsy (SLNB). The aim of this study was to investigate the overall survival (OS) and relapse-free survival (RFS) of patients with positive SLNB treated with ALND or not. Patients and Methods: We investigated 617 consecutive patients with cN0 operable breast cancer with positive SLNB undergoing mastectomy or conservative surgery. A total of 406 patients underwent ALND and 211 were managed expectantly. Results: No significant difference in OS and RFS was found between the two groups. The incidence of loco-regional recurrence in the SLNB-only group and the ALND group was low and not significant. Conclusion: The type of breast cancer surgery and the omission of ALND does not improve OS or RSF rate in cases with metastatic SLN. Sentinel lymph node biopsy (SLNB) is the standard technique used for nodal staging in all patients with invasive breast cancer and clinically-negative axillary lymph nodes. Nowadays, SLNB has replaced conventional axillary lymph node dissection (ALND) as a standard procedure (1-4). For years, axillary dissection was considered the standard procedure in cases with positive SLNB for macrometastasis (>2 mm) (5-6). The rationale behind this procedure is the control of local recurrence and the increase of overall survival (OS). However, several authors have questioned the actual role of ALND in cases with positive SLNB. This procedure can lead to severe side effects such as lymphedema and reduction of limb and/or shoulder function in 5-39% of cases (7-9). The American College of Surgeons Oncology Groups (ACOSOG) Z0011 Study showed that there was no statistically significant difference in local recurrence-free survival patients undergoing breast-conserving surgery and avoiding ALND at 6.3 years and at 9.25 years of follow-up compared with patients treated with ALND (10-12). Similar results were observed in the AMAROS trial (13) and in the IBCSG 23-01 trial (14). A recent meta-analysis that included the above-mentioned trials (ACOSOG Z011, IBCSG 23-01, AMAROS) and two other studies (OTOSAOR and AATRM-048-13-2000) did not show differences in survival or recurrence between ALND, SLNB or axillary RT, observing more local complications in patients treated with ALND (15). Bilimoira et al. (16) reviewed 20,075 SLNB-positive breast cancer patients from the National Cancer Database and Yi et al. (17) reviewed 26,986 SLNB-positive breast cancer patients from the surveillance, epidemiology and end results (SEER) database: both Authors did not show any significant differences in OS rates between patients treated with SLNB only and SLNB plus ALND. However, 1941 This article is freely accessible online.

Thematic trends and knowledge structure map of sentinel lymph node biopsy for breast cancer: a bibliometric analysis from 2010 to 2019

“…Because of SLNB involves less nerve damage and lymphatic tissue damage, it might be a better choice ( 61 ). According to research findings, lymphoedema with arm swelling and restriction of movement causing a substantial decrease in quality of life occurs in 20% of patients undergoing ALND versus <5% after SLNB ( 62 , 63 ). From several previous trials, including the NSABP-B32 trial, patients who received SLNB had lower morbidity and better quality of life compared with ALND, and had no adverse effects on survival at long-term follow-up ( 64 ).…”

Effect of non-sentinel metastasis on adjuvant treatment decisions and survival in Z0011 eligible non-screened detected breast cancer population

“…In a survey of axillary management practice amongst surgeons of India, only 15.8% of the respondents have reported omission of ALND in Z0011 trial eligible patients [ 19 ]. In contrast, many oncologists from the developed countries have accepted the Z0011 results and are moving further by extrapolating Z0011 results in mastectomy patients with 1–2 metastatic SLNs [ 20 , 21 ].…”

Interest of the Padding in the Prevention of Lymphocele Production after Mastectomy with Axillary Dissection for Breast Cancer at Joliot Curie Cancer Center

“…In Senegal, it represents the second most frequent type of women cancer [1]. In many cases, patient treatment may require carrying out a mastectomy with axillary dissection [2] [3] [4]. The principal complication of this surgery is the lymphocele that can last several months after the surgery.…”