Original Scientific ArticlesAxillary dissection in breast-conserving surgery for stage i and ii breast cancer: a national cancer data base study of patterns of omission and implications for survival1
Section snippets
Methods
The National Cancer Data Base is a joint resource maintained by the American College of Surgeons and the American Cancer Society. Its primary goal is to lower the morbidity and mortality of cancer by compiling and analyzing data about cancer management and outcomes. The methods of the NCDB have been described previously.4 The American Cancer Society and the American College of Surgeons provide core support for the NCDB. The total cost associated with maintaining this national resource cannot be
Results
There was a trend toward increasing use of BCS, both with and without AND, over the 3 time periods encompassed within the study, and a decreased reliance on modified radical mastectomy (Table 1). A trend toward increased use of multimodality therapy, rather than surgery alone, was noted over time (Table 2).
Discussion
The first effective treatment for breast cancer was surgical. Radical mastectomy with extensive regional lymphadenectomy served to control local disease at a time when early detection was not possible and no other treatment modalities were available. This cosmetically mutilating operation was associated with an incidence of lymphedema approaching 40%.7 Molecular biologic techniques were unknown. Clinical and pathologic observations were the only tools available to predict tumor behavior. Cancer
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Cited by (117)
Surgical Oncology and Geriatric Patients
2019, Clinics in Geriatric MedicineCitation Excerpt :If however, the SLNB proves the presence of axillary disease, the management is still controversial; recent studies have favored conservative operative approaches in the elderly in order to reduce postoperative complications. Studies using the National Cancer Database have found that axillary lymph node dissection (ALND) is routinely omitted in patients older than 80 years.15 Based on the ACS Oncology Group Z0011 trial,16 patients with T1-2N0M0 breast cancer undergoing breast-conserving surgery and adjuvant whole-breast radiotherapy who were found to have 1 to 2 positive SLNs can forgo completion ALND.
Clinico-pathological features of breast carcinoma in elderly Egyptian patients: A comparison with the non-elderly using population-based data
2013, Journal of the Egyptian National Cancer InstituteAdjuvant radiotherapy on older and oldest breast cancer patients after conservative surgery: A retrospective analysis
2012, Archives of Gerontology and GeriatricsPrinciples of Surgical Oncology in the Elderly
2012, Clinics in Geriatric MedicineCitation Excerpt :The true value of ALND in clinically N0 elderly patients is nevertheless obscure; a recent study from Milan by Martelli and colleagues60 showed no advantage, confirming the findings of the ACOSOG Z011 trial, where the omission of ALND did not impact on local recurrence, distant recurrence, or overall survival in older patient cohorts. A further influencing factor away from more routine ALND is the presumption that older patients have a higher rate of postoperative lymphoedema,61 although this too is controversial; Bland and co-workers56 showed in a large patient cohort (84,877 women treated for stage I breast cancer) that in every clinical scenario involving breast-conserving surgery where ALND was omitted, there was a significantly lower rate of survival and that the addition of systemic therapy did not overcome the adverse effect of ALND omission. There does not seem to be any advantage for ALND in early T1N0 tumors in older patients for overall mortality, breast cancer-specific mortality, or the crude cumulative incidence of breast events (including local recurrence or metachronous cancer), where the incidence of axillary recurrence appears to be very low if a full ALND is not performed62,63 and where sentinel lymph node biopsy in the elderly has been shown to be just as effective as in younger patient cohorts.64
Early primary breast cancer in the elderly - Pattern of presentation and treatment
2011, Surgical OncologyCitation Excerpt :This finding contrasts with the previous studies which have found that elderly patients are less likely to be offered and therefore receive breast-conserving surgery [13]. They were also less likely to have axillary surgery when compared to younger patients [8, 12, 22]. The lack of axillary surgery could impact on the accuracy of the staging of the cancer and limit the prognostic information, subsequently decreasing the treatment options available to them [8].
Predictors of persistent pain after breast cancer surgery: A systematic review and meta-analysis of observational studies
2016, CMAJCitation Excerpt :Women who underwent axillary lymph node dissection experienced a 21% increase in the absolute risk of chronic postoperative pain. Although axillary staging is associated with persistent pain, the risks of omitting axillary nodal sampling include increasing the number of patients who are understaged and undertreated and who experience reduced survival.65 Thus, omission of axillary staging is not an appropriate approach to modifying pain risk.
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No competing interests declared.