4/16/2023 0 Comments Lymph nodes under armpitModerate-quality evidence suggests that patients who have no axillary lymph nodes removed at all are at increased risk of locoregional recurrence (regrowth of cancer, in the breast, mastectomy scar area or underarm glands). If survival is assumed to be 81% five years after surgery with ALND, then the evidence suggests it would be between 77% and 81% after treatment with radiotherapy alone. Moderate-quality evidence indicates that overall survival is slightly reduced in patients who receive radiotherapy (but no axillary surgery) when compared with ALND. Moderate-quality evidence suggests that patients treated with approaches involving lesser axillary surgery (such as axillary sampling or SLNB) do not have a reduced chance of survival compared with those treated with ALND. Four trials including 2585 patients compared ALND (with or without radiotherapy) with radiotherapy alone. Seven trials including 9426 patients compared ALND with sentinel lymph node biopsy (SLNB). Six trials including 1559 patients compared ALND with axillary sampling. Ten trials including 3849 patients compared ALND with no axillary surgery. Patients in these trials had operable primary breast cancer, and some trials included patients with palpably enlarged axillary lymph nodes. The review identified 26 randomised controlled trials that compared axillary lymph node dissection (ALND) with alternative approaches involving less axillary surgery. Some studies have explored alternative approaches such as no surgical treatment to the underarm nodes. For patients with cancer in the sentinel nodes (or sample), complete removal of all underarm lymph nodes (axillary lymph node dissection) is usually recommended however, radiotherapy to the axilla can also be given to obliterate any cancer cells in the lymph nodes. Alternatively, surgeons can use sentinel node techniques to identify those nodes most likely to contain cancer, leading to removal of as few nodes as possible. This first stage can consist of ‘random’ axillary sampling, whereby the surgeon removes a small number of nodes (typically four) that can be felt. Modern strategies use a stepwise approach by first removing a small number of nodes and removing the others only if cancer is found at the first stage. Surgical removal of lymph nodes can lead to short-term surgical complications (such as infection and wound healing problems) and long-term problems (such as shoulder stiffness, pain and arm swelling (lymphoedema)) when fluid accumulation causes restricted function and discomfort. If cancer has not spread to these lymph nodes, patients are spared extra treatments (with extra side effects). If cancer has spread to these lymph nodes, patients are advised to undergo additional treatments, such as chemotherapy or radiotherapy, to help treat their disease. Surgical removal of underarm (axillary) lymph nodes is often part of the initial surgical treatment for patients with operable breast cancer. The review also aimed to learn whether complete removal of all underarm nodes could be replaced by procedures that remove only a small number of lymph nodes. This review aimed to compare the benefits of surgical removal of underarm lymph nodes with the potential harms associated with this surgical procedure.
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