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MINERVA CHIRURGICA

A Journal on Surgery


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Minerva Chirurgica 2018 Mar 28

DOI: 10.23736/S0026-4733.18.07728-3

Copyright © 2018 EDIZIONI MINERVA MEDICA

language: English

Axillary surgery in breast cancer: the beginning of the end

Dorin DUMITRU 1 , Ayesha KHAN 1, Giuseppe CATANUTO 2, 3, Nicola ROCCO 3, 4, Maurizio B. NAVA 3, 5, John R. BENSON 1, 6

1 Cambridge University Hospitals, NHS Foundation Trust, Cambridge, UK; 2 Multidisciplinary Breast Unit, Azienda Ospedaliera Cannizzaro, Catania, Italy; 3 G.RE.T.A. Group for Recontructive and Therapeutic Advancements, Milan, Naples, Catania, Italy; 4 Department of Clinical Medicine and Surgery, University of Naples, “Federico II”, Naples, Italy; 5 Department of Plastic Surgery, University of Milan, Milan, Italy; 6 School of medicine, Anglia Ruskin University, Cambridge, UK


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Axillary surgery in breast cancer patients has shifted from more extensive to minimalist approaches with re-evaluation of the risks versus benefits of available treatment options which are increasingly tailored to individual patient characteristics.A radical axillary node dissection is rarely indicated nowadays due to several factors including screening with detection of small node negative cancers, introduction of targeted node sampling, less reliance on information from nodal staging for adjuvant therapy decision making and evidence that non-surgical treatments such as systemic therapies (chemotherapy, hormonal therapy, biological therapy) together with radiotherapy can safely treat low burden axillary disease. Sentinel lymph node biopsy (SLNB) alone with omission of further axillary surgery for nodal macrometastases (>2mm) might be sufficiently extirpative to achieve local control when combined with adjuvant treatments. There remain unanswered questions on the safety of SLNB post chemotherapy in patients with biopsy proven nodal disease at presentation and whether omission of axillary node dissection is feasible in selected cases. Emerging evidence suggests that a complete radiological response with removal of at least 3 nodes (including clipped nodes at time of biopsy) can yield false negative rates of <10% and be a safe option. New technologies involving percutaneous biopsy of sentinel nodes under radiological guidance are under investigation and could potentially replace surgical staging of the axilla in the future. Moreover, omission of any type of node biopsy might be a potential option in more favourable tumoursand could herald the beginning of the end for histological axillary sampling in selected cases.


KEY WORDS: Axillary surgery - Breast surgery - Sentinel lymph node biopsy

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Publication History

Article first published online: March 28, 2018
Manuscript accepted: March 21, 2018
Manuscript received: March 16, 2018

Cite this article as

Dumitru D, Khan A, Catanuto G, Rocco N, Nava MB, Benson JR. Axillary surgery in breast cancer: the beginning of the end. Minerva Chir 2018 Mar 28. DOI: 10.23736/S0026-4733.18.07728-3

Corresponding author e-mail

drdumitrudorin@gmail.com