Omitting Axillary Surgery in Patients with Ipsilateral Breast Tumor Recurrence After Breast-Conserving Surgery

Area of Science:

• Oncology
• Surgical Oncology
• Breast Cancer Research

Background:

• Ipsilateral breast tumor recurrence (IBTR) after breast-conserving surgery (BCS) presents a clinical challenge.
• The necessity and impact of axillary surgery in IBTR cases with clinically node-negative disease are not well-defined.
• This study investigates the role of axillary surgery in managing IBTR.

Purpose of the Study:

• To evaluate the impact of axillary surgery on oncologic outcomes in patients with ipsilateral breast tumor recurrence (IBTR).
• To determine if axillary surgery is required for patients experiencing IBTR who are clinically node-negative.
• To inform clinical decision-making regarding axillary staging in recurrent breast cancer.

Main Methods:

• Retrospective analysis of 200 breast cancer patients with invasive IBTR as the first recurrence event.
• Exclusion of patients with clinically node-positive disease or distant metastasis at recurrence.
• Comparison of recurrence-free survival (RFS) using Kaplan-Meier and log-rank tests based on axillary surgery status.

Main Results:

• Among 200 IBTR patients, 60 (30%) underwent axillary surgery.
• No significant difference in 5-year second RFS was observed between patients who had axillary surgery (61.0%) and those who did not (68.4%) (P = 0.308).
• Axillary surgery was more common in patients undergoing salvage mastectomy or those not previously operated on in the axilla.

Conclusions:

• Axillary surgery does not significantly impact oncologic outcomes for patients with clinically node-negative IBTR.
• Omission of axillary surgery may be a safe consideration for selected IBTR patients.
• Further research may explore de-escalation of axillary treatment in recurrent breast cancer.