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Axillary dissection

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Subclavian and axillary vessels; dissection
Subclavian and axillary vessels; dissection

Axillary dissection is surgery to remove lymph nodes under the arm.

Other names

Also called axillary lymph node dissection.

Anatomy

The axillary lymph nodes run from the breast tissue into the armpit.

Early theories on breast cancer spread

  • Early theories of breast-cancer metastasis held that cancer cells that had broken free from the main tumor would first travel through these lymph nodes on their way to other organs.
  • That led doctors to believe that removing the axillary lymph nodes could reduce the risk of both cancer recurrence and metastases.
  • However, more-recent research has suggested that breast cancer may metastasize to other areas of the body through several different routes
  • Also, modern treatment for early-stage breast cancer typically includes radiation therapy—which targets some of the same lymph nodes—along with breast-conserving surgery, Dr. Giuliano added.
  • Most patients additionally receive some sort of systemic treatment, such as hormone therapy, chemotherapy, and, more recently, targeted therapy, all of which can kill cancer cells throughout the body.

Less Lymph Node Surgery, Equivalent Survival

  • The trial, called ACOSOG Z0011, was designed to compare whether sentinel lymph node biopsy (SLNB) alone provided equivalent survival benefits to axillary lymph node biopsy (ALND) after breast-conserving surgery among a subset of women who also received radiation and systemic therapy.
  • The research team enrolled 891 participants into the study from 1999 to 2004.
  • Women who had stage I or II cancer and metastases in only one or two sentinel nodes were eligible to join the study.

All women had undergone SLNB at the time of breast-conserving surgery.

  • Half of the trial participants received no further surgery, and the other half underwent ALND.
  • Almost 90% of women in both groups had radiation therapy after surgery, and almost all received some type of systemic therapy.
  • In the initial results from the trial, published in 2010 and 2011, women who had only SLNB did not have worse overall survival than women who underwent full ALND.
  • The two groups also had similar rates of disease-free survival and cancer recurrence in the lymph nodes leading to practice changing guidance when it comes to not doing routine axillary dissection.

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