Axillary lymphadenectomy for breast cancer. Paradigm shifts and pragmatic surgeons.

Abstract

THE STRATEGY of axillary management in operable breast cancer—clearance, sampling, irradiation, observation—remains a hardy item on the surgical debating agenda. Off the agenda and resolved is the issue of whether the pectoral muscles should be removed en bloc with the breast and axillary content (radical mastectomy), as this approach fell to randomized controlled trials after nearly a century. 1-3 The management of the breast itself now lies much lower on the agenda than it once did as surgeons, guided by clinical trials and having learned of the equivalence of the options, are adopting a more pragmatic approach using total removal of the breast or wide cancer excision with radiotherapy, where appropriate. 4,5 These approaches are scientifically robust and have been confirmed by the mature trial results. 6-8 The debate now revolves, as in many other cancer sites, around the lymphadenectomy. PREVALENCE OF AXILLARY METASTASES More information is known about this