-
Veterinary and Comparative Oncology Sep 2022The axillary lymph center drains a large area; however, axillary lymphadenectomy is rarely reported in series detailing lymph node extirpation in dogs. No surgical...
The axillary lymph center drains a large area; however, axillary lymphadenectomy is rarely reported in series detailing lymph node extirpation in dogs. No surgical technique has yet been described for axillary and superficial axillary lymphadenectomy. This study describes a technique for excision of nodes in the axillary lymph center of the dog. Two male neutered and two male intact cadavers weighing between 6.3 and 36.1 kg were used. With cadavers in dorsal recumbency and the shoulder extended, an incision was made in the caudal axillary region. Blunt dissection was used to separate the pectoralis profundus and latissimus dorsi muscles and loose connective tissue was dissected until the axillary lymph node was identified caudal to the brachial vein. The axillary lymphatic trunk was followed caudad from the axillary lymph node to identify the accessory axillary lymph node, deep to the lateral border of the pectoralis profundus muscle, for subsequent extirpation. Axillary lymph nodes were successfully removed in all axillae, and accessory axillary lymph nodes were located in 6/7 axillae and could not be visualized within the axillary lymphatic trunk in the remaining axilla. The described surgical technique allowed consistent identification of the axillary lymph node and the lymphatic trunk associated with the accessory axillary lymph node. This technique description provides a guide for surgeons to facilitate axillary and accessory axillary lymphadenectomy in the dog. While anatomic variation must be considered, the use of the axillary lymphatic trunk as a landmark may simplify identification of the small and inconsistent accessory axillary lymph node.
Topics: Animals; Axilla; Cadaver; Dog Diseases; Dogs; Lymph Node Excision; Lymph Nodes; Lymphatic Metastasis; Male; Sentinel Lymph Node Biopsy
PubMed: 35411711
DOI: 10.1111/vco.12820 -
Seminars in Oncology Dec 2020This historical surgical retrospection focuses on the temporal de-escalation axillary surgery, focusing on the unceasing efforts of researchers toward new challenges, as... (Review)
Review
This historical surgical retrospection focuses on the temporal de-escalation axillary surgery, focusing on the unceasing efforts of researchers toward new challenges, as documented by extensive studies and trials. Axillary surgery has evolved, aiming to offer the best oncologic treatment and improve the quality of life of women. Axillary lymph-node dissection (ALND) has been replaced by sentinel lymph-node biopsy (SLNB) in women with early clinically node-negative breast cancer, providing adequate axillary nodal staging information with minimal morbidity, and becoming the standard of care in the management of breast cancer. However, this is only the beginning. Strategies in defining systemic and radiotherapeutic treatments have gradually been optimized, offering increasingly refined and targeted breast cancer treatment tools. In recent years, the paradigm of completion ALND after a positive SLNB has been questioned, and several studies have led to revolutionary changes in clinical practice. Moreover, the increasingly pivotal role played by neoadjuvant chemotherapy (NAC) has had a profound effect on the extent of axillary surgery, paving the way to a more finite "targeted" procedure in women with node-positive breast cancer who convert to negative nodes clinically after NAC. The utility of SLNB itself and its subsequent omission in women with negative nodes clinically and breast conservative surgery is also under scientific evaluation. The changes over time in the surgical approach to breast cancer have been numerous and significant. The novel emerging perspective characterized by recent advances in biology and genetics, in dedicated axillary ultrasound imaging and chemotherapy regimens, is the present reality that points to the future of axillary node treatment in breast cancer.
Topics: Axilla; Breast Neoplasms; Chemotherapy, Adjuvant; History, 15th Century; History, 16th Century; History, 17th Century; History, 18th Century; History, 19th Century; History, 20th Century; History, 21st Century; History, Ancient; History, Medieval; Humans; Lymph Node Excision; Sentinel Lymph Node Biopsy
PubMed: 33131896
DOI: 10.1053/j.seminoncol.2020.09.001 -
Breast Disease 2015Various methods are currently used during axillary lymphadenectomy. Our systematic review aims to investigate the potential benefits of bipolar vessel sealing systems... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Various methods are currently used during axillary lymphadenectomy. Our systematic review aims to investigate the potential benefits of bipolar vessel sealing systems (EBVS) over conventional suture ligation during the axillary dissection of breast cancer patients.
METHODS
We searched Medline (1966-2014), Scopus (2004-2014), Popline (1973-2014) Cochrane CENTRAL (1999-2014) and ClinicalTrials.gov (2000-2014) together with reference lists from included studies Statistical meta-analysis was performed using the RevMan 5.1 software.
RESULTS
Four studies were finally included, involving 352 patients. Usage of EBVS significantly increased the number of retrieved axillary lymph nodes (MD 1.67 nodes, 95% CI 0.21, 3.13). Intraoperative times were not affected by these new technique, when compared to traditional suture ligation (MD -10.82 minutes, 95% CI -23.27, 2.70). Neither the volume of postoperative axillary drainage (MD -38.47 ml, 95% CI -110.26, 32.59) nor the duration of drainage (MD -0.49 days, 95% CI -1.23, 0.25) were significantly affected by EBVS application. We observed, however, that bipolar systems may be associated with an increased risk of postoperative seroma formation (OR 2.04, 95% CI 1.13, 3.70).
CONCLUSION
Electrosurgical bipolar vessel sealing systems seem to increase the accuracy of axillary dissection and are equally safe compared to conventional suture ligation regarding intraoperative and postoperative blood loss. They are associated, however, with and increased incidence of seroma formation. Further randomized trials are needed in the field in order to obtain firm conclusions.
Topics: Axilla; Breast Neoplasms; Electrosurgery; Female; Hemostasis, Surgical; Humans; Lymph Node Excision; Lymph Nodes; Lymphatic Metastasis; Mastectomy
PubMed: 25159187
DOI: 10.3233/BD-140383 -
Journal of Clinical Oncology : Official... Apr 2023The European Organisation for Research and Treatment of Cancer 10981-22023 AMAROS trial evaluated axillary lymph node dissection (ALND) versus axillary radiotherapy... (Randomized Controlled Trial)
Randomized Controlled Trial
PURPOSE
The European Organisation for Research and Treatment of Cancer 10981-22023 AMAROS trial evaluated axillary lymph node dissection (ALND) versus axillary radiotherapy (ART) in patients with cT1-2, node-negative breast cancer and a positive sentinel node (SN) biopsy. At 5 years, both modalities showed excellent and comparable axillary control, with significantly less morbidity after ART. We now report the preplanned 10-year analysis of the axillary recurrence rate (ARR), overall survival (OS), and disease-free survival (DFS), and an updated 5-year analysis of morbidity and quality of life.
METHODS
In this open-label multicenter phase III noninferiority trial, 4,806 patients underwent SN biopsy; 1,425 were node-positive and randomly assigned to either ALND (n = 744) or ART (n = 681).
RESULTS
Per intention-to-treat analysis, 10-year ARR cumulative incidence was 0.93% (95% CI, 0.18 to 1.68; seven events) after ALND and 1.82% (95% CI, 0.74 to 2.94; 11 events) after ART (hazard ratio [HR], 1.71; 95% CI, 0.67 to 4.39). There were no differences in OS (HR, 1.17; 95% CI, 0.89 to 1.52) or DFS (HR, 1.19; 95% CI, 0.97 to 1.46). ALND was associated with a higher lymphedema rate in updated 5-year analyses (24.5% 11.9%; < .001). Quality-of-life scales did not differ by treatment through 5 years. Exploratory analysis showed a 10-year cumulative incidence of second primary cancers of 12.1% (95% CI, 9.6 to 14.9) after ART and 8.3% (95% CI, 6.3 to 10.7) after ALND.
CONCLUSION
This 10-year analysis confirms a low ARR after both ART and ALND with no difference in OS, DFS, and locoregional control. Considering less arm morbidity, ART is preferred over ALND for patients with SN-positive cT1-2 breast cancer.
Topics: Humans; Female; Lymphatic Metastasis; Breast Neoplasms; Axilla; Quality of Life; Sentinel Lymph Node Biopsy; Lymph Node Excision; Lymph Nodes
PubMed: 36383926
DOI: 10.1200/JCO.22.01565 -
Annals of Plastic Surgery Sep 2018The most common method of breast reconstruction in the United States today is implant-based reconstruction. However, reported complication rates are high, from 30% to...
BACKGROUND
The most common method of breast reconstruction in the United States today is implant-based reconstruction. However, reported complication rates are high, from 30% to 50%. Thus, it is important for reconstructive surgeons to identify factors associated with or contributing to wound complications after breast reconstruction. This study sought to identify associations between axillary lymph node dissection and postoperative wound complications in implant-based breast reconstruction.
METHODS
A retrospective chart review was performed of subjects undergoing breast oncologic and reconstructive surgery by a single breast surgeon and reconstructive surgeon, respectively, from 2013 to 2016. Medical records were reviewed of 273 subjects with 338 reconstructed breasts. Data were recorded on the extent of axillary node dissection and subsequent wound complications including seroma requiring percutaneous drainage, seroma requiring open drainage, wound dehiscence requiring local wound care, wound dehiscence requiring operative revision, implant exposure, and implant loss.
RESULTS
Analysis of the data demonstrated an increase in complication rates with extent of axillary lymph node dissection; however, these rates did not reach statistical significance. Statistically significant associations, however, were identified between wound complication rates and other known risk factors including increasing age and body mass index, as well as smoking status.
CONCLUSIONS
Although an association between increasing complication rates and the extent of lymph node dissection has previously been reported, this study failed to demonstrate a statistically significant association with logistic regression analysis.
Topics: Axilla; Breast Implantation; Female; Follow-Up Studies; Humans; Logistic Models; Lymph Node Excision; Postoperative Complications; Retrospective Studies; Risk Factors
PubMed: 29781858
DOI: 10.1097/SAP.0000000000001515 -
Breast Disease 2023Standard operative management for breast carcinoma has significantly shifted from extensive procedures to minor interventions.Although axillary dissection was a... (Review)
Review
Standard operative management for breast carcinoma has significantly shifted from extensive procedures to minor interventions.Although axillary dissection was a fundamental component of operative management, sentinel biopsy is an actual process for axillary staging. Axillary dissection may be postponed for cases that have negative SLNs or 1 or 2 infiltrated lymph nodes undergoing breast or axillary radiation. Contrarily, axillary dissection is still the conventional management for patients with clinically positive nodes.Arm lymphedema is a frequent and overwhelming complication of axillary dissection, with a worse impact on the patient's life.Axillary reverse mapping was recently introduced to map and conserve the lymph drain of the upper limb throughout axillary dissection or sentinel biopsy. A technique based on the theory that the breast's lymphatic drainage differs from those that drain the arm, so preserving lymphatic drainage of the upper limb can prevent lymphedema, thereby not raising the risk of axillary recurrence.Therefore, this technique is the reverse of sentinel biopsy, which remove the lymph nodes that drain the breast.
Topics: Humans; Female; Breast Neoplasms; Sentinel Lymph Node Biopsy; Lymphatic Metastasis; Lymph Node Excision; Lymph Nodes; Lymphedema; Axilla
PubMed: 37154174
DOI: 10.3233/BD-220040 -
Breast (Edinburgh, Scotland) Mar 2022Long-term follow-up data from multicenter phase III non-inferiority trials confirmed the safety of omission of axillary dissection in selected patients with clinically...
Long-term follow-up data from multicenter phase III non-inferiority trials confirmed the safety of omission of axillary dissection in selected patients with clinically node-negative, sentinel node-positive breast cancer. Several ongoing trials investigate extended eligibility of the Z0011 protocol in the adjuvant setting. De-escalation of axillary surgery in patients with clinically node-positive breast cancer is currently limited to the neoadjuvant setting, where the sentinel procedure is used to determine nodal pathological complete response. Targeted axillary dissection lowers the false-negative rate of the sentinel procedure, which, however, is consistently associated with a very low risk of axillary recurrence in several recent single-center series. Axillary dissection remains standard care in patients with residual disease after neoadjuvant chemotherapy while the results of Alliance A011202 are pending. The TAXIS trial investigates the role of tailored axillary surgery in patients with clinically node-positive breast cancer, a novel concept designed to selectively remove positive nodes in the adjuvant and neoadjuvant setting.
Topics: Axilla; Breast Neoplasms; Female; Humans; Lymph Node Excision; Lymph Nodes; Neoadjuvant Therapy; Sentinel Lymph Node Biopsy
PubMed: 34511332
DOI: 10.1016/j.breast.2021.08.018 -
Surgery Sep 2023
Operative standards for sentinel lymph node biopsy and axillary lymphadenectomy for breast cancer: review of the American College of Surgeons commission on cancer standards 5.3 and 5.4.
Topics: Female; Humans; Axilla; Breast Neoplasms; Lymph Node Excision; Lymph Nodes; Sentinel Lymph Node; Sentinel Lymph Node Biopsy; Surgeons
PubMed: 37202308
DOI: 10.1016/j.surg.2023.04.007 -
Journal of Plastic, Reconstructive &... Dec 2016Despite numerous studies over the past few decades, the optimum strategy for deciding when to remove drains following axillary lymphadenectomy remains unknown. This... (Review)
Review
When should axillary drains be removed? A meta-analysis of time-limited versus volume controlled strategies for timing of drain removal following axillary lymphadenectomy.
BACKGROUND
Despite numerous studies over the past few decades, the optimum strategy for deciding when to remove drains following axillary lymphadenectomy remains unknown. This meta-analysis aims to compare time-limited and volume-controlled strategies for drain removal.
METHODS
A total of 584 titles were identified following a systematic literature search of EMBASE, MEDLINE, Cinahl and the Cochrane library; 6 titles met our eligibility criteria. Data were extracted and independently verified by two authors. Time-limited drain removal was defined as drain removal at <5 days; volume-controlled strategies ranged from <20 ml/24 h to <50 ml/24 h.
RESULTS
In all the studies, the time-limited approach resulted in earlier drain removal. Development of a seroma is 2.54 times more likely with early drain removal (Mantel-Haenszel Fixed Odds Ratio (OR) 2.54, p < 0.00001). However, there is no difference in infection rates between early and late drain removal (OR = 1.07, p = 0.76).
CONCLUSIONS
This meta-analysis demonstrates that a strategy of early drain removal following axillary lymphadenectomy is safe, with no difference in infection rates; however, the incidence of seroma is significantly higher, which may necessitate more demanding outpatient care. There is a need for further well-designed clinical trials to address the clinical equipoise in this common area of surgical practice.
Topics: Axilla; Breast Neoplasms; Device Removal; Drainage; Female; Humans; Lymph Node Excision; Lymphatic Metastasis; Seroma; Surgical Wound Infection; Time-to-Treatment
PubMed: 27777176
DOI: 10.1016/j.bjps.2016.09.027 -
Journal of Visceral Surgery Feb 2023
Topics: Humans; Female; Lymph Node Excision; Lymph Nodes; Breast Neoplasms; Sentinel Lymph Node Biopsy; Neoplasm Staging; Axilla
PubMed: 36192307
DOI: 10.1016/j.jviscsurg.2022.08.006