title: Sentinel lymph node based management or routine axillary clearance? Three-year outcomes of the RACS sentinel node biopsy versus axillary clearance (SNAC) 1 trial.
abstract: OBJECTIVE
  To determine whether the benefits of sentinel node based management (SNBM) over routine axillary clearance (RAC) at 1 year persisted to 3 years of follow-up.
  
  
  METHODS
  A total of 1,088 women with clinically node-negative breast cancer were randomly assigned to the SNBM or RAC group. Upper limb volume, symptoms, and function were assessed at 1, 6, 12, 24, and 36 months after surgery objectively with upper limb measurements by clinicians and subjectively by patients' using validated self-rating scales.
  
  
  RESULTS
  Upper limb volume increased in both groups over the first 2 years and differed between the two groups all time points beyond 1 month (P < 0.02) but then plateaued. Upper limb swelling was no worse in women who had axillary clearance as a two-stage procedure than in women assigned RAC as a one-stage procedure. Upper limb volume had increased 15 % or more in 6.0 % at 6 months and 17.6 % at 3 years in those assigned RAC versus 4.2 and 11.9 % in those assigned SNBM. Reductions in upper limb movement were also greater, with RAC than SNBM over 6 months, but improved and were similar in the two groups from 1 to 3 years. Subjective ratings of upper limb swelling, symptoms, dysfunction, and disability over 3 years were worse in the RAC group. Upper limb swelling at 3 years was rated severe by few women (1.1 %) but was rated as moderate by 9.4 % in the RAC group and 2.5 % in the SNBM group (P < 0.001).
  
  
  CONCLUSIONS
  The benefits of SNBM over RAC persist 3 years after surgery.
authors.affiliation: Wesley Medical Centre, Brisbane, QLD, Australia, wetzigsng@bigpond.com.
authors.forename: Neil
authors.initials: N
authors.lastname: Wetzig
authors.forename: Peter Grantley
authors.initials: PG
authors.lastname: Gill
authors.forename: Diana
authors.initials: D
authors.lastname: Zannino
authors.forename: Martin R
authors.initials: MR
authors.lastname: Stockler
authors.forename: Val
authors.initials: V
authors.lastname: Gebski
authors.forename: Owen
authors.initials: O
authors.lastname: Ung
authors.forename: Ian
authors.initials: I
authors.lastname: Campbell
authors.forename: R John
authors.initials: RJ
authors.lastname: Simes
mesh_terms: D000328:Adult; D001365:Axilla; D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery*; D019468:Disease Management; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology / Q000601:surgery*; D008408:Mastectomy; D009367:Neoplasm Staging; D011379:Prognosis; D021701:Sentinel Lymph Node Biopsy