Ann Surg Treat Res.  2020 Jun;98(6):283-290. 10.4174/astr.2020.98.6.283.

Omission of axillary lymph node dissection in patients who underwent total mastectomy with 1 or 2 metastatic lymph nodes

Affiliations
  • 1Department of Surgery, Daejeon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
  • 2Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
  • 3Department of Surgery, Inha University Hospital, Inha University School of Medicine, Incheon, Korea
  • 4Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
  • 5Department of Surgery, Chonnam National University Hwasun Hospital, Hwasun, Korea
  • 6Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
  • 7Breast-Thyroid Center, Saegyaero Hospital, Busan, Korea

Abstract

Purpose
Sentinel lymph node biopsy (SLNB) is the standard axillary procedure in early breast cancer patients. In a randomized trial, the survival rates were not different when axillary lymph node dissection (ALND) was omitted in patients with 1 or 2 lymph node metastases who underwent breast conserving surgery. This study aimed to compare the outcomes in patients who underwent total mastectomy (TM) with 1 or 2 metastatic nodes according to the types of axillary surgery.
Methods
In total, 79,058 patients registered in the Korean Breast Cancer Society database who underwent TM were included in the analysis. The inclusion criteria were history of TM and SLNB, pathologic T stage 1 or 2, clinically negative axillary lymph nodes, 1 or 2 metastatic axillary lymph nodes, no radiation therapy, and no neoadjuvant therapy. We divided the patients into the SLNB only and SLNB + ALND groups. The groups were matched by propensity scores. We retrospectively analyzed the differences in the overall survival (OS) between the 2 groups.
Results
A total of 883 patients were matched in a 1:4 ratio for the SLNB only and SLNB + ALND groups in the cohort from 1999 to 2014. There were no significant differences in OS between the 2 groups (P = 0.413). Subgroup analysis revealed a significant survival benefit in the SLNB + ALND group in the T2 subgroup (P = 0.013).
Conclusion
OS did not differ between the 2 groups in early breast cancer patients with 1 or 2 metastatic axillary lymph nodes who underwent TM. Omission of ALND may be considered in selected patients.

Keyword

Lymph node dissection; Mastectomy; Sentinel lymph node biopsy; Survival analysis
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