Total axillary lymphadenectomy in the management of breast cancer
G. M. Senofsky, F. L. Moffat Jr, K. Davis, M. M. Masri, K. C. Clark, D. S. Robinson, B. Sabates and A. S. Ketcham
Department of Surgery, University of Miami School of Medicine, FL 33101.
The optimal extent of axillary dissection in patients with breast cancer
remains unclear. We report 278 total axillary lymphadenectomies (levels I,
II, and III and Rotter's [interpectoral] nodes) that were performed in 264
closely followed up private patients. There have been no axillary
recurrences to date (mean follow-up, 50 months). If only level I and II
nodes had been removed, the false-negative staging error would have been
only 2.6%. However, 29 (31.5%) of 92 pathological node-positive axillae
contained apical and/or Rotter's metastases. The incidence of complications
was comparable with that reported for partial lymphadenectomy. Arm
lymphedema developed in 6% of nonirradiated patients; postoperative
radiotherapy and gross nodal disease were significant risk factors for
lymphedema. Total axillary lymphadenectomy largely prevents axillary,
recurrence, eliminates the small staging error inherent in partial
lymphadenectomy, and has acceptable morbidity, provided radiotherapy to the
regional nodal areas is avoided.
