Lower axillary dissection for early breast cancer

Abstract

In order to know the mast limited axillary lymph node dissection, we evaluated the lower axillary lymph node dissection (ALND) in the lower part of level I for primary breast cancer patients with no clinical regional lymph node metastasis (N0). In performing the lower ALND, we dissectied axillary lymph nodes below the level of second intercostobrachial nerve of the level I. A total of 1043 patients with N0 breast cancer treated with the lower ALND between Jan. 2001 and Dec. 2008 were enrolled in the analysis. Another 1084 patients with N0 breast cancer treated by lymph node dissection over the level I from 1994 to 2000 were served as control. These two patients groups were comparatively analyzed for pathological axillary lymph node metastasis, survival and relapse-free survival rates, and postoperative complications. The frequency of pathological axillary lymph node metastasis was 21.3% (222/1043) in the lower ALND patient group. The median follow-up time was 72 months and 99.2% of the patients were followed for 5 years. The five-year overall survival and relapse-free survival rates in the lower ALND group were 95.3% and 88.3%, respectively, which were as good as those after the previous standard ALND. Only 6 (0.6%) patients clinically developed axillary lymph node metastasis among 101 (9.7%) recurrent breast cancer cases in the lower ALND group. After the lower ALND, the seroma in the axillary region was remarkably decreased compared with the previous standard ALND, and lymph edema of the ipsilateral upper extremity has not occurred at all. We conclude that the lower ALND in lower part of level I is a useful approach for axillary management of N0 breast cancer patients.