title: Impact on regional recurrence and survival of axillary surgery in women with node-negative primary breast cancer.
abstract: BACKGROUND
  This study examined whether axillary lymph node dissection (ALND) with removal of many normal lymph nodes resulted in a reduced rate of axillary recurrence and better survival, as reported in recent studies.
  
  
  METHODS
  The follow-up analyses were based on 8657 patients with node-negative primary breast cancer treated solely by surgery. Median follow-up was 9 years.
  
  
  RESULTS
  The number of lymph nodes removed correlated with a reduction in the rate of subsequent axillary recurrence (from 2.1 to 0.4 per cent; P = 0.037), local recurrence (from 7.4 to 3.8 per cent; P < 0.001) distant metastases (from 15.0 to 10.3 per cent; P < 0.001) and death as first event (from 7.5 to 5.5 per cent; P = 0.012).
  
  
  CONCLUSIONS
  When ALND is indicated, at least ten axillary lymph nodes should be retrieved. The role of ALND as primary treatment has decreased significantly during the past decade. The findings leave the concept of the sentinel node biopsy intact, as a highly specific procedure compared to ALND.
authors.affiliation: Department F of Breast Surgery, Herlev University Hospital, Copenhagen, Denmark. cax@dadlnet.dk
authors.forename: C K
authors.initials: CK
authors.lastname: Axelsson
authors.forename: M
authors.initials: M
authors.lastname: Düring
authors.forename: P M
authors.initials: PM
authors.lastname: Christiansen
authors.forename: P A
authors.initials: PA
authors.lastname: Wamberg
authors.forename: K L
authors.initials: KL
authors.lastname: Søe
authors.forename: S
authors.initials: S
authors.lastname: Møller
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001365:Axilla; D001943:Breast Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000601:surgery*; D017024:Chemotherapy, Adjuvant; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008197:Lymph Node Excision / Q000401:mortality; D008207:Lymphatic Metastasis; D008408:Mastectomy / Q000379:methods / Q000401:mortality; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality; D011182:Postoperative Care / Q000379:methods; D011446:Prospective Studies; D016896:Treatment Outcome