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Panminerva Medica 2001 June;43(2):103-7

Copyright © 2009 EDIZIONI MINERVA MEDICA

lingua: Inglese

Impact of axillary level I and II lymphnode dissection on the therapy of stage I and II breast cancer

Tocchi A., Mazzoni G., Bettelli E., Miccini M., Giuliani A., Cassini D.

From the 1st Department of Surgery University of Rome «La Sapienza», Rome, Italy


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Background. Routine per­for­mance of axil­lary ­node dis­sec­tion (AND) in the treat­ment of ­stage I and II ­breast ­cancer has ­become con­tro­ver­sial ­because of pre­tended mor­bidity of ­this pro­ce­dure and pro­gressing con­sent for sen­tinel lym­phad­e­nec­tomy.
Methods. Ninety-­four con­sec­u­tive ­patients who under­went AND for clin­ical ­stage I and II ­breast ­cancer ­were eval­u­ated for a ­range of 48.3 ­months ­after sur­gery for move­ment and sen­sory alter­a­tions and arm ­swelling. Arm cir­cum­fer­ence was meas­ured in all ­patients at the ­same ­four ­sites on ­both the oper­ated and non oper­ated ­sides pre­op­er­a­tively and in the imme­diate and ­late post­op­er­a­tive ­course. Capacity for move­ment ­was ­assessed pre- and post­op­er­a­tively as ­active ­ranging at the ­shoulder ­joint. Postoper­a­tive numb­ness and pares­the­sias ­were ­assessed by stan­dard ques­tions.
Results. No ­patient had axil­lary recur­rence. None of the ­detected dif­fer­ences ­between the preoper­a­tive and ­postoper­a­tive arm cir­cum­fer­ences ­reached sta­tis­tical sig­nif­i­cance. No per­sis­tent ­motion lim­i­ta­tion was ­observed. Pain, numb­ness, pares­thesia ­were ­detected in ­almost all ­patients in the imme­diate post­op­er­a­tive ­period but ­resolved spon­ta­ne­ously in all ­cases ­within 6 ­months. The ­obese ­body ­habit was ­detected on mul­ti­var­iate anal­ysis as the ­only sig­nif­i­cant pre­dictor of ­edema.
Conclusions. No sig­nif­i­cant mor­bidity and no axil­lary recur­rence ­were ­observed in cur­rent expe­ri­ence to ­follow AND. These find­ings sug­gest ­that axil­lary ­level I and II dis­sec­tion ­remains an effec­tive and ­safe ­tool for diag­nostic, as ­well ther­a­peutic, pur­poses in the treat­ment of ­stage I and II ­breast ­cancer. Further ­studies are nec­es­sary ­before it can ­safely be reported ­that axil­lary ­node dis­sec­tion is an ­optional ­part of the treat­ment of ­stage I and II ­breast ­cancer.

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