Axillary lymphadenectomy—just how radical should it be?

Association between extent of axillary lymph node dissection and patient, tumor, surgeon, and hospital factors in patients with early breast cancer

“…However, several studies in which a median (or mean) of >10 lymph nodes was examined also show an association with survival, even though there should be fewer patients understaged in these studies [25,37]. The negative studies are no more helpful in elucidating the cause of this relationship, as the number of nodes excised varies greatly [31,34,35,38]. For patients with positive lymph nodes, a therapeutic benefit from a more extensive axillary dissection leading to improved survival or recurrence makes biologic sense, but again the evidence for a causal relationship is conflicting [16,25,29,31,35].…”

“…This makes it difficult to distinguish the role of the surgeon and the extent of dissection from these possible confounding variables in this retrospective study. However, the number of lymph nodes examined has been used as a surrogate measure for the extent of axillary dissection in many studies [22,25,[28][29][30][31][32]34,35,37] and is considered acceptable for this purpose.…”

“…For example, several studies have shown no association between the number of nodes examined and local recurrence [34] or survival [31,35], whereas a number of studies demonstrated significant associations between more extensive axillary dissection (as judged by the number of nodes examined) and reduced local axillary recurrence [28,32,36], as well as improved disease-free and overall survival [25,28,29,37]. A recent study reported that the number of nodes examined was not associated with recurrence or survival in patients treated with systemic therapy, while in those not receiving systemic therapy the number of nodes was associated significantly with recurrence and near-significantly with survival [38].…”

Management of the axilla in early breast cancer: is it time to change tack?

“…10 This effect seems to disappear when a more complete dissection is performed. 13 The inclusion of level III nodes in an axillary dissection for a clinically negative axilla rarely provides additional staging information because the occurrence of ‘skip’ metastases (metastases that do not also involve lower echelon nodes) is exceedingly unusual (< 0.5%). 14 In patients with clinically involved nodes, excision of all axillary lymph nodes, including Rotter’s (interpectoral nodes) nodes, might be expected to improve local control although there is no information available to confirm this supposition.…”