Conservative Axillary Surgery May Prevent Arm Lymphedema Without Increasing Axillary Recurrence in the Surgical Management of Breast Cancer

Overview

Journal Cancers (Basel)

Publisher MDPI

Specialty Oncology

Date 2023 Nov 25

PMID 38001613

Authors

Masakuni Noguchi

Masafumi Inokuchi

Miki Yokoi-Noguchi

Emi Morioka

Yusuke Haba

Affiliations

Soon will be listed here.

Abstract

Axillary lymph node dissection (ALND) has been associated with postoperative morbidities, including arm lymphedema, shoulder dysfunction, and paresthesia. Sentinel lymph node (SLN) biopsy emerged as a method to assess axillary nodal status and possibly obviate the need for ALND in patients with clinically node-negative (cN0) breast cancer. The majority of breast cancer patients are eligible for SLN biopsy only, so ALND can be avoided. However, there are subsets of patients in whom ALND cannot be eliminated. ALND is still needed in patients with three or more positive SLNs or those with gross extranodal or matted nodal disease. Moreover, ALND has conventionally been performed to establish local control in clinically node-positive (cN+) patients with a heavy axillary tumor burden. The sole method to avoid ALND is through neoadjuvant chemotherapy (NAC). Recently, various forms of conservative axillary surgery have been developed in order to minimize arm lymphedema without increasing axillary recurrence. In the era of effective multimodality therapy, conventional ALND may not be necessary in either cN0 or cN+ patients. Further studies with a longer follow-up period are needed to determine the safety of conservative axillary surgery.

References

Gennaro M, Maccauro M, Mariani L, Listorti C, Sigari C, De Vivo A . Occurrence of breast-cancer-related lymphedema after reverse lymphatic mapping and selective axillary dissection versus standard surgical treatment of axilla: A two-arm randomized clinical trial. Cancer. 2022; 128(24):4185-4193. PMC: 10092060. DOI: 10.1002/cncr.34498. View

Caudle A, Yang W, Krishnamurthy S, Mittendorf E, Black D, Gilcrease M . Improved Axillary Evaluation Following Neoadjuvant Therapy for Patients With Node-Positive Breast Cancer Using Selective Evaluation of Clipped Nodes: Implementation of Targeted Axillary Dissection. J Clin Oncol. 2016; 34(10):1072-8. PMC: 4933133. DOI: 10.1200/JCO.2015.64.0094. View

Mamtani A, Barrio A, King T, Van Zee K, Plitas G, Pilewskie M . How Often Does Neoadjuvant Chemotherapy Avoid Axillary Dissection in Patients With Histologically Confirmed Nodal Metastases? Results of a Prospective Study. Ann Surg Oncol. 2016; 23(11):3467-3474. PMC: 5070651. DOI: 10.1245/s10434-016-5246-8. View

Savolt A, Peley G, Polgar C, Udvarhelyi N, Rubovszky G, Kovacs E . Eight-year follow up result of the OTOASOR trial: The Optimal Treatment Of the Axilla - Surgery Or Radiotherapy after positive sentinel lymph node biopsy in early-stage breast cancer: A randomized, single centre, phase III, non-inferiority trial. Eur J Surg Oncol. 2017; 43(4):672-679. DOI: 10.1016/j.ejso.2016.12.011. View

Mittendorf E, Caudle A, Yang W, Krishnamurthy S, Shaitelman S, Chavez-MacGregor M . Implementation of the american college of surgeons oncology group z1071 trial data in clinical practice: is there a way forward for sentinel lymph node dissection in clinically node-positive breast cancer patients treated with neoadjuvant.... Ann Surg Oncol. 2014; 21(8):2468-73. DOI: 10.1245/s10434-014-3775-6. View

Veronesi U, Paganelli G, Viale G, Luini A, Zurrida S, Galimberti V . A randomized comparison of sentinel-node biopsy with routine axillary dissection in breast cancer. N Engl J Med. 2003; 349(6):546-53. DOI: 10.1056/NEJMoa012782. View

Kodama H, Mise K, Kan N . Partial lower axillary dissection for patients with clinically node-negative breast cancer. J Int Med Res. 2013; 40(6):2336-45. DOI: 10.1177/030006051204000632. View

Morrow M . Is Axillary Staging Obsolete in Early Breast Cancer?. Surg Oncol Clin N Am. 2023; 32(4):675-691. DOI: 10.1016/j.soc.2023.05.002. View

Boughey J, Suman V, Mittendorf E, Ahrendt G, Wilke L, Taback B . Sentinel lymph node surgery after neoadjuvant chemotherapy in patients with node-positive breast cancer: the ACOSOG Z1071 (Alliance) clinical trial. JAMA. 2013; 310(14):1455-61. PMC: 4075763. DOI: 10.1001/jama.2013.278932. View

10.

Noguchi , Miwa , Michigishi , Yokoyama , Nishijima , Takanaka . The Role of Axillary Lymph Node Dissection in Breast Cancer Management. Breast Cancer. 2000; 4(3):143-153. DOI: 10.1007/BF02967068. View

11.

Boughey J, McCall L, Ballman K, Mittendorf E, Ahrendt G, Wilke L . Tumor biology correlates with rates of breast-conserving surgery and pathologic complete response after neoadjuvant chemotherapy for breast cancer: findings from the ACOSOG Z1071 (Alliance) Prospective Multicenter Clinical Trial. Ann Surg. 2014; 260(4):608-14. PMC: 4159769. DOI: 10.1097/SLA.0000000000000924. View

12.

Boneti C, Korourian S, Diaz Z, Santiago C, Mumford S, Adkins L . Scientific Impact Award: Axillary reverse mapping (ARM) to identify and protect lymphatics draining the arm during axillary lymphadenectomy. Am J Surg. 2009; 198(4):482-7. DOI: 10.1016/j.amjsurg.2009.06.008. View

13.

Beek M, Gobardhan P, Klompenhouwer E, Menke-Pluijmers M, Steenvoorde P, Merkus J . A patient- and assessor-blinded randomized controlled trial of axillary reverse mapping (ARM) in patients with early breast cancer. Eur J Surg Oncol. 2019; 46(1):59-64. DOI: 10.1016/j.ejso.2019.08.003. View

14.

Krag D, Weaver D, Alex J, Fairbank J . Surgical resection and radiolocalization of the sentinel lymph node in breast cancer using a gamma probe. Surg Oncol. 1993; 2(6):335-9; discussion 340. DOI: 10.1016/0960-7404(93)90064-6. View

15.

Faisal M, Sayed M, Antonious K, Abo Bakr A, Farag S . Prevention of lymphedema via axillary reverse mapping for arm lymph-node preservation following breast cancer surgery: a randomized controlled trial. Patient Saf Surg. 2019; 13:35. PMC: 6857341. DOI: 10.1186/s13037-019-0217-1. View

16.

Noguchi M, Yokoi M, Nakano Y . Axillary reverse mapping with indocyanine fluorescence imaging in patients with breast cancer. J Surg Oncol. 2010; 101(3):217-21. DOI: 10.1002/jso.21473. View

17.

Montagna G, Mamtani A, Knezevic A, Brogi E, Barrio A, Morrow M . Selecting Node-Positive Patients for Axillary Downstaging with Neoadjuvant Chemotherapy. Ann Surg Oncol. 2020; 27(11):4515-4522. PMC: 7501229. DOI: 10.1245/s10434-020-08650-z. View

18.

Yue T, Zhuang D, Zhou P, Zheng L, Fan Z, Zhu J . A Prospective Study to Assess the Feasibility of Axillary Reverse Mapping and Evaluate Its Effect on Preventing Lymphedema in Breast Cancer Patients. Clin Breast Cancer. 2015; 15(4):301-6. DOI: 10.1016/j.clbc.2015.01.010. View

19.

Fisher B, Jeong J, Anderson S, Bryant J, Fisher E, 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. DOI: 10.1056/NEJMoa020128. View

20.

Burstein H, Curigliano G, Thurlimann B, Weber W, Poortmans P, Regan M . Customizing local and systemic therapies for women with early breast cancer: the St. Gallen International Consensus Guidelines for treatment of early breast cancer 2021. Ann Oncol. 2021; 32(10):1216-1235. PMC: 9906308. DOI: 10.1016/j.annonc.2021.06.023. View