Axillary dissection in women with invasive breast cancer and sentinel node metastasis: is the extent of axillary surgery critical to the cure of breast cancer?

摘要

What is the functional role/consequences of axillary dissection? Historically, breast cancer patients underwent axillary lymph node dissection (ALND) to achieve accurate staging and regional control. However, removing all axillary lymph nodes comes at a cost as the procedure is associated with morbidity, including wound infections, paresthesias, decreased range of motion and lymphedema. The introduction of sentinel lymph node dissection (SLND) was a significant advancement for the population of patients presenting with clinically node-netative disease. Multiple studies confirmed the accuracy of SLND, allowing patients with a negative sentinel lymph node (SLN) to avoid ALND. For patients with metastases in their SLN, standard practive has been to perform completion ALND; however, with an increasing number of patients presenting with early-stage disease and small-volume metastases, the need for routine ALND has been questioned.