Consequences of axillary recurrence after conservative breast surgery

Fredriksson, Irma; Liljegren, Göran; Arnesson, Lars-Gunnar; Emdin, SO; Palm-Sjövall, M; Fornander, Tommy; Holmqvist, Marit; Holmberg, Lars; Frisell, Jan

doi:10.1046/j.1365-2168.2002.02117.x

Cited by 38 publications

(19 citation statements)

References 23 publications

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“…Oncological safety might, however, be compromised as port-site metastases occurred in two patients (4%), one of whom suffered concomitantly from an axillary recurrence (2%). Current medical literature describes a similar axillary recurrence rate between 0 and 2% after open ALND [22]. In the above mentioned study from our institution an axillary recurrence rate of 1.3% after standard ALND of level l and II was observed [10].…”

Section: Discussionmentioning

confidence: 78%

Long-term outcomes of breast cancer patients after endoscopic axillary lymph node dissection: a prospective analysis of 52 patients

Langer

Kocher

Güller

et al. 2005

Breast Cancer Res Treat

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SummaryBackground. Reports on long-term outcomes after endoscopic axillary lymph node dissection (ALND) of breast cancer patients are still lacking in the medical literature. The objective of this prospective study was to assess the oncological and functional outcomes in breast cancer patients after endoscopic ALND.Methods. Fifty-five breast cancer patients were prospectively enrolled, of whom 52 were available for follow-up with a median of 71.9 months (range 11-96). The following oncological and functional endpoints were evaluated during follow-up at several time points: occurrence of local, axillary and distant metastases, seroma or infection, shoulder mobility (range of motion), numbness, pain, presence of lymphoedema as well as restriction in activities of daily living.Results. In 52 patients endoscopic ALND of level I and II was successfully performed. Two port-site metastases (2/52, 4%) occurred, one of which in a patient with negative axillary lymph nodes. The same patient suffered from the only axillary recurrence (1/52, 2%). Three patients (3/52, 6%) developed lymphoedema. No other functional adverse events (shoulder mobility, pain, numbness, hypertrophic scar) were noticed at the end of the observation period.Conclusion. The present investigation with long-term follow-up after endoscopic ALND -the first one in the literature -reveals minor morbidity, good functional and cosmetic results. In contrary to conventional surgery, the endoscopic procedure is associated with the occurrence of port-site metastases, not seen in the open approach. Axillary recurrences do not appear more frequently when compared with results after conventional ALND. In the meantime the less invasive sentinel lymph node (SLN) biopsy is the established standard technique in evaluating the axillary lymph node status.

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Section: Discussionmentioning

confidence: 78%

Long-term outcomes of breast cancer patients after endoscopic axillary lymph node dissection: a prospective analysis of 52 patients

Langer

Kocher

Güller

et al. 2005

Breast Cancer Res Treat

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“…[30][31][32] On the other hand, axillary recurrence usually occurs after a median time of 24 months after surgery. 33,34 Of particular note is the randomized trial conducted by Naik et al 35 comparing the risk of axillary relapse after sentinel lymph node biopsy for breast cancer with axillary LR, according to which relapse ranged from 0% to 1.4% after 14-46 months of follow-up, with comparably good results (0.12% axillary recurrence rate) in patients with a negative SLNB and no ALND. Interestingly, Kingsmore et al 36 found recently that axillary recurrence was more than twice as likely after inadequate treatment of the axilla than after adequate treatment, despite endocrine therapy, chemotherapy, or radiotherapy (clearance 4%; sampling 10%; no procedure 13%).…”

Section: Discussionmentioning

confidence: 98%

Re-evaluation of Axillary Skip Metastases in the Era of Sentinel Lymph Node Biopsy in Breast Cancer

et al. 2006

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“…Axillary lymph node status has been considered to be the most important independent prognostic factor, after primary tumor DOI 10.1080/02841850701305440 # 2007 Taylor & Francis status, for recurrence and survival (4,6). The procedure is fairly simple, but ALND is associated with considerable morbidity, including lymphedema of the arm, and numbness, stiffness, impaired shoulder movement, and pain (9).…”

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confidence: 99%

Lymph drainage studied by lymphoscintigraphy in the arms after sentinel node biopsy compared with axillary lymph node dissection following conservative breast cancer surgery

et al. 2007

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ndal E, Svensson L, Danielsson R. Lymph drainage studied by lymphoscintigraphy in the arms after sentinel node biopsy compared with axillary lymph node dissection following conservative breast cancer surgery. Acta Radiol 2007;48:488-495.Purpose: To investigate lymphatic drainage as measured by lymphoscintigraphy in the arms of patients undergoing either sentinel lymph node biopsy (SNB) or axillary lymph node dissection (ALND). Material and Methods: From January 2001 to December 2002, 30 patients with unilateral invasive breast carcinoma underwent breast-conserving surgery with SNB and 30 patients with ALND. All patients received radiotherapy to the breast. Lymphoscintigraphy was performed, and skin circulation, skin temperature, and arm volume were measured 2-3 years after radiotherapy. Results: None of the 30 patients who underwent SNB showed any clinical manifestation of lymphedema. Of the 30 patients undergoing ALND, six (20%) had clinical lymphedema, with an arm volume that was w10% larger on the operated than on the non-operated side (Pv0.01). Scintigraphically, visual analysis revealed lymphatic dysfunction in three patients, manifested as forearm dermal back flow. Two of these patients also had an increased arm volume. Quantitative analysis showed no differences between the groups, apart from a smaller amount of isotope in the axilla in the ALND group. There was no difference in skin circulation or skin temperature. Conclusion: Our study shows that lymph drainage in the operated arm compared with the non-operated arm was less affected by SNB than by ALND, and that morbidity associated with SNB was lower than with ALND. However, the results do not confirm our hypothesis that lymphoscintigraphy can reveal differences in lymph circulation that are not evident clinically in the form of manifest lymphedema. The most sensitive clinical method of assessing lymph drainage seems to be measurement of arm volume.

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Consequences of axillary recurrence after conservative breast surgery

Abstract: Axillary recurrence is rare, although more common in younger women with large tumours. Radiotherapy to the breast was protective. Tumour size and node status were the most important prognostic factors in women with axillary recurrence.

Cited by 38 publications

References 23 publications

Long-term outcomes of breast cancer patients after endoscopic axillary lymph node dissection: a prospective analysis of 52 patients

Long-term outcomes of breast cancer patients after endoscopic axillary lymph node dissection: a prospective analysis of 52 patients

Re-evaluation of Axillary Skip Metastases in the Era of Sentinel Lymph Node Biopsy in Breast Cancer

Lymph drainage studied by lymphoscintigraphy in the arms after sentinel node biopsy compared with axillary lymph node dissection following conservative breast cancer surgery

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