Reevaluating Axillary Lymph Node Dissection in Total Mastectomy for Low Axillary Burden Breast Cancer: Insights from...

Area of Science:

• Oncology
• Surgical Oncology
• Breast Cancer Research

Background:

• Complete axillary lymph node dissection (cALND) was standard for breast cancer (BC) with axillary node involvement.
• Significant morbidity associated with cALND prompted a shift towards selective approaches, like sentinel lymph node biopsy (SLNB).
• Prior studies, such as ACOSOG Z0011, demonstrated cALND omission safety in breast-conserving therapy but its relevance in total mastectomy (TM) remained unclear.

Purpose of the Study:

• To evaluate the survival outcomes of omitting cALND in breast cancer patients with low axillary nodal burden undergoing total mastectomy.
• To determine if cALND provides a survival advantage over SLNB in this specific patient population.

Main Methods:

• A systematic literature search up to September 2023 identified 6 relevant studies with 4184 patients.
• Meta-analysis and pooled results were used to compare survival between cALND and SLNB groups.
• Inclusion criteria focused on T1-T2 breast cancer with 1-3 positive sentinel lymph nodes (pN1) undergoing total mastectomy.

Main Results:

• No significant difference in overall survival was observed between patients who underwent cALND and those who had SLNB only.
• Follow-up averaged 7.2 years, with similar rates of postmastectomy radiotherapy in both groups.
• Pooled analysis confirmed no survival advantage for cALND in this cohort.

Conclusions:

• Complete axillary lymph node dissection can be safely omitted in T1-T2 breast cancer patients with 1-3 positive sentinel lymph nodes undergoing total mastectomy.
• This selective approach, following multidisciplinary evaluation, appears equivalent to cALND in terms of survival.
• Further prospective trials are recommended to definitively validate these findings and explore other influencing factors.