Impact on regional recurrence and survival of axillary surgery in women with node-negative primary breast cancer.
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.
Axelsson
C K
CK
Department F of Breast Surgery, Herlev University Hospital, Copenhagen, Denmark. cax@dadlnet.dk
Düring
M
M
Christiansen
P M
PM
Wamberg
P A
PA
Søe
K L
KL
Møller
S
S
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