Can We Avoid Axillary Lymph Node Dissection (ALND) in Patients with 1–2 Positive Sentinel/Low Axillary Lymph Nodes (SLN/LAS+) in the Indian Setting?

2021 ◽  
Author(s):  
A. Reddy ◽  
Nita S. Nair ◽  
Smruti Mokal ◽  
V. Parmar ◽  
T. Shet ◽  
...  
Keyword(s):  
Lymph Node ◽  
Lymph Nodes ◽  
Axillary Lymph Node Dissection ◽  
Lymph Node Dissection ◽  
Axillary Lymph Node ◽  
Axillary Lymph Nodes ◽  
Axillary Lymph ◽  
Node Dissection ◽  
Indian Setting

Evaluation of simplified lymphatic microsurgical preventing healing approach (SLYMPHA) for the prevention of breast cancer-related clinical lymphedema after axillary lymph node dissection.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 563-563
Author(s):  
Tolga Ozmen ◽  
Mesa Lazaro ◽  
Yan Zhou ◽  
Alicia Vinyard ◽  
Eli Avisar
Keyword(s):  
Multivariate Analysis ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Axillary Lymph Node Dissection ◽  
Lymph Node Dissection ◽  
Axillary Lymph Node ◽  
Axillary Lymph ◽  
Complication Rates ◽  
Node Dissection

563 Background: Lymphedema (LE) is a serious complication of axillary lymph node dissection (ALND) with an incidence rate of 16%. Lymphatic Microsurgical Preventing Healing Approach (LYMPHA) has been proposed as an effective adjunct to ALND for the prevention of LE. This procedure however requires microsurgical techniques. The aim of this study was to assess the efficiency of Simplified-LYMPHA (SLYMPHA) in preventing LE in a prospective cohort of patients. Methods: All patients, undergoing ALND with or without SLYMPHA between January 2014 and December 2016 were included in the study. SLYMPHA is a slightly modified and simplified version of LYMPHA. It is performed by the operating surgeon performing the ALND. One or more lymphatic channels identified by reverse arm mapping are inserted using a sleeve technique into the cut end of a neighboring vein. During follow-up visits, tape-measuring limb circumference method was used to detect clinical LE. Demographic, clinical, surgical and pathologic factors were recorded. The incidence of clinical LE was compared between ALND with and without SLYMPHA. Univariate and multivariate analysis were used to assess the role of other factors in the appearance of clinical LE. Results: 406 patients were included in the study. SLYMPHA procedure was attempted in 81 patients and was completed successfully in 90% of patients. Early complication rates were similar between patients who underwent SLYMPHA and who did not (4% vs. 4.13%; p = 0.948). Median follow-up time was 15±13.73 [1-32] months. Patients, who underwent SLYMPHA, had a significantly lower rate of clinical LE both in univariate and multivariate analysis (3% vs 19%; p = 0.001; OR 0.12 [0.03-0.5]). Excising > 22 lymph nodes and a co-diagnosis of diabetes were also correlated with higher clinical LE rates on univariate analysis, but only excising > 22 lymph nodes remained to be significant on multivariate analysis. Conclusions: SLYMPHA is a safe and relatively simple method, which decreases incidence of clinical LE dramatically. It should be considered as an adjunct procedure to ALND for all patients during initial surgery.

Sentinel lymph node status and axillary lymph node dissection in the surgical treatment of breast cancer

2014 ◽  
Vol 155 (6) ◽  
pp. 203-215 ◽  
Author(s):  
Gábor Cserni
Keyword(s):  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Lymph Nodes ◽  
Sentinel Node ◽  
Axillary Lymph Node Dissection ◽  
Lymph Node Dissection ◽  
Axillary Lymph Node ◽  
Axillary Lymph ◽  
Node Dissection ◽  
Axillary Clearance

Axillary lymph node dissection has been traditionally perceived as a therapeutic and a staging procedure and unselectively removes all axillary lymph nodes. There still remains some controversy as concerns the survival benefit associated with axillary clearance. Sentinel lymph node biopsy removes the most likely sites of regional metastases, the lymph nodes directly connected with the primary tumour. It allows a more accurate staging and a selective indication for clearing the axilla, restricting this to patients who may benefit of it. Axillary dissection was performed in all patients during the learning phase of sentinel lymphadenectomy, but later only patients with metastasis to a sentinel node underwent this operation. Currently, even some patients with minimal sentinel node involvement, including some with macrometastasis may skip axillary clearance. This review summarizes the changes that have occurred in the surgical management of the axilla, the evidences and controversies behind these changes, along with current recommendations. Orv. Hetil., 2014, 155(6), 203–215.

scholarly journals Potential impact of application to the Z0011 trial on the omission of axillary lymph node dissection in women undergoing sentinel node biopsy: a retrospective cohort study

2020 ◽  
Author(s):  
Julia Yoriko Shinzato ◽  
Katia Piton Serra ◽  
Caroline Eugeni ◽  
Cesar Cabello ◽  
Cassio Cardoso Filho ◽  
...  
Keyword(s):  
Lymph Node ◽  
Lymph Nodes ◽  
Axillary Lymph Node Dissection ◽  
Lymph Node Dissection ◽  
Axillary Lymph Node ◽  
Sentinel Lymph Nodes ◽  
Axillary Lymph ◽  
Node Dissection ◽  
Acosog Z0011 ◽  
Z0011 Trial

Abstract Background To evaluate the number of patients with early-stage breast cancer, undergoing axillary lymph node dissection for metastatic sentinel lymph nodes, who could benefit from the omission of axillary surgery following the application of ACOSOG Z0011 trial criteria. Methods A retrospective cohort study conducted in the Women’s Hospital of the State University of Campinas. The study population included 384 women diagnosed with early-stage invasive breast cancer, clinically negative axilla, treated with breast-conserving surgery and sentinel lymph node biopsy, radiation therapy, chemotherapy and/or endocrine therapy, from January 2005 to December 2010. ACOSOG Z0011 trial criteria were applied to this population and statistical analysis was carried out to make a comparison between populations. Results A total of 384 patients underwent breast-conserving surgery and sentinel lymph node biopsy. Of the total number of patients, 86 women underwent axillary lymph node dissection for metastatic sentinel lymph nodes. One patient underwent axillary node dissection due to a suspicious SLN intra-operatively. Among these patients, 82/87 (94.3%) had one to two involved sentinel lymph nodes and met criteria for the ACOSOG Z0011 trial with the omission of axillary lymph node dissection. Among the 82 eligible women, there were only 13 cases (15.9%) of lymphovascular invasion and 62 cases (75.6%) of tumors measuring up to 2cm in diameter (T1). Conclusions When eligibility for ACOSOG Z0011 trial criteria was retrospectively exported to our study population, 94.3% of the patients with one to two positive sentinel lymph nodes would benefit from the omission of axillary lymph node dissection. The high rate in our study may be explained by the large number of patients with tumors up to 2.0 cm in size and the small rate of lymphovascular invasion, which are indicative of a favorable prognosis.

Sign in / Sign up

Export Citation Format

Share Document