Gervasoni J E, Taneja C, Chung M A, Cady B
Department of Surgical Oncology, Roger Williams Hospital, Providence, Rhode Island, USA.
Am J Surg. 2000 Oct;180(4):278-83. doi: 10.1016/s0002-9610(00)00455-4.
Modern breast surgery, as the primary treatment of invasive breast carcinoma, has been evolving over the last century. Aggressive radical surgery, which included chest wall resection, complete axillary clearance and internal mammary node dissection, has slowly changed to a less aggressive approach. This has been based on an improved understanding of the biology of the disease. Over the years, randomized prospective trials, performed at centers all over the world, have demonstrated that axillary dissection does not impact on the overall survival while it helps with loco-regional control of breast cancer. Its major role, at the present time, is limited to staging and prognostication; functions that are equally well served by the limited approach of a sentinel node biopsy.
This review is based on the available medical literature involving the biology and organ specificity of the metastatic process, not only in breast cancer but also in other malignancies. In addition, studies pertaining to clinical breast cancer, and the role of surgery in its treatment, were reviewed. The ongoing trials on the role of sentinel node biopsy in the management of the clinically node negative patients are discussed.
This review covers the history, pathophysiology, and clinical basis of the current role of axillary dissection for invasive breast cancer. From the data presented we hope that the medical community will agree that there is no therapeutic role for extended axillary dissection at the current time.
现代乳腺癌手术作为浸润性乳腺癌的主要治疗方法，在过去一个世纪中不断发展。包括胸壁切除、腋窝彻底清扫和内乳淋巴结清扫的根治性手术，已逐渐转变为一种侵袭性较小的手术方式。这是基于对该疾病生物学特性的深入理解。多年来，世界各地的中心进行的随机前瞻性试验表明，腋窝清扫虽有助于乳腺癌的局部区域控制，但对总体生存率并无影响。目前，其主要作用仅限于分期和预后评估；而前哨淋巴结活检这种有限的方法同样能很好地发挥这些功能。
本综述基于现有的医学文献，这些文献涉及转移过程的生物学特性和器官特异性，不仅包括乳腺癌，还包括其他恶性肿瘤。此外，还回顾了有关临床乳腺癌以及手术在其治疗中的作用的研究。讨论了目前正在进行的关于前哨淋巴结活检在临床腋窝淋巴结阴性患者管理中的作用的试验。
本综述涵盖了腋窝清扫在浸润性乳腺癌当前作用的历史、病理生理学和临床基础。从所呈现的数据来看，我们希望医学界能够认同目前扩大腋窝清扫并无治疗作用。
