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Axillary surgery in oncologic breast surgery: a narrative review
1Department of Breast Surgery, Gentofte Hospital, Hellerup, Denmark.
Gland Surgery
|January 17, 2024
Summary
Breast cancer patients can benefit from de-escalated axillary surgery, reducing arm morbidity. Further research is needed to refine axillary staging and systemic treatment strategies.
Area of Science:
- Oncology
- Surgical Oncology
- Breast Cancer Research
Background:
- Improved breast cancer survival necessitates a focus on post-treatment quality of life.
- Axillary surgery poses risks of arm morbidity, a significant patient concern.
- Evidence supports de-escalation of axillary surgery in various clinical scenarios.
Purpose of the Study:
- To review new techniques and procedures for de-escalating axillary surgery in breast cancer.
- To explore the implications of axillary surgery de-escalation on adjuvant systemic treatment.
- To provide an overview of current advancements in axillary staging and treatment.
Main Methods:
- Narrative review of English-language publications from January 2018 to June 2023.
- Focused on high-impact publications, particularly meta-analyses.
- Included searches of ClinicalTrials.gov for ongoing studies.
Main Results:
- Description of novel tracer techniques for axillary staging.
- Evidence of reduced axillary lymph node dissection (ALND) in node-positive patients.
- Exploration of axillary staging post-neoadjuvant treatment and in recurrent disease.
Conclusions:
- Routine ALND is increasingly not recommended for node-positive patients.
- Cooperative studies are essential to avoid systemic treatment escalation due to uncertain axillary status.
- Further investigation into axillary imaging for staging is required.
