Axillary Surgery and Other Regional Lymph Nodes

  • BBSG – Brazilian Breast Study Group


Surgery to remove axillary lymph nodes composes the classic treatment of breast cancer since the first description of radical mastectomy.


Axillary dissection Sentinel node biopsy SNB Neoadjuvant chemotherapy Lymphedema 

Recommended Reading

  1. 1.
    Fisher B, Jeong JH, Anderson S, Bryant J, Fisher ER, Wolmark N. Twenty-five-year follow-up of a randomized trial comparing radical mastectomy, total mastectomy, and total mastectomy followed by irradiation. N Engl J Med. 2002;347(8):567–75. Classic study that randomized 1079 women with clinically negative axilla to undergo simple mastectomy, radical mastectomy or simple mastectomy with axillary radiotherapy. After a 25 years follow-up the prognosis was equal in the 3 groups and the axillary recurrences were lower than expected (18% versus 40%). CrossRefGoogle Scholar
  2. 2.
    Galimberti V, Cole BF, Zurrida S, Viale G, Luini A, Veronesi P, et al. Axillary dissection versus no axillary dissection in patients with sentinel-node micrometastases (IBCSG 23–-01): a phase 3 randomised controlled trial. Lancet Oncol. 2013;14(4):297–305. Randomized study encompassing females diagnosed with micro-metastasis by the sentinel lymph node randomized to undergo radical axillary lymphadenectomy or simple observation. Axillar conservation did not impact the prognosis and axillary recurrences were not significant. CrossRefGoogle Scholar
  3. 3.
    Galimberti V, Ribeiro Fontana SK, Maisonneuve P, Steccanella F, et al. Sentinel node biopsy after neoadjuvant treatment in breast cancer: five-year follow-up of patients with clinically node-negative or node-positive disease before treatment. Eur J Surg Oncol. 2016;42(3):361–8. Retrospective analysis of 396 women diagnosed with cT 1–4 cN0/1–2 tumors that underwent SLNB after neoadjuvant chemotherapy and did not perform radical axillary lymphadenectomy in cases of negative sentinel. After a 61 months follow-up, global survival rate was 90.7% (95% CI: 87.7% - 93.7%) in the cohort. There was no difference in the survival of cN0 women (93.3%; 95% CI: 90.0% - 96.6%) compared with the cN1–2 women (86.3%; 95% CI: 80.6% - 92.1%; p = 0.12). CrossRefGoogle Scholar
  4. 4.
    Giuliano AE, Ballman K, McCall L, Beitsch P, Whitworth PW, Blumencranz P, et al. Locoregional recurrence after sentinel lymph node dissection with or without axillary dissection in patients with sentinel lymph node metastases: long-term follow-up from the American College of Surgeons Oncology Group (Alliance) ACOSOG Z0011 Randomized Trial. Ann Surg. 2016;264(3):413–20. Randomized study encompassing 891 women diagnosed with early stage tumors (cT1–2 cn0) subjected to conservative surgery and radiotherapy that presented positive sentinel lymph node. The analysis compared the radical axillary lymphadenectomy versus simple observation. Global survival rate, disease-free time-lapse and axillary recurrences were similar in the 2 groups. CrossRefGoogle Scholar
  5. 5.
    Krag DN, Anderson SJ, Julian TB, Brown AM, Harlow SP, Costantino JP, et al. Sentinel-lymph-node resection compared with conventional axillary-lymph-node dissection in clinically node-negative patients with breast cancer: overall survival findings from the NSABP B-32 randomised phase 3 trial. Lancet Oncol. 2010;11(10):927–33. Main study on SLNB in early stage tumors (cT1–2 cn0) that demonstrated that the preservation of the axilla whenever facing a negative SLN did not impact the prognosis and the axillary recurrences were not significant (0.5%). These results occurred despite a 9.8% FNR. CrossRefGoogle Scholar

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© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • BBSG – Brazilian Breast Study Group
    • 1
  1. 1.BBSGSao PauloBrazil

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