Fentiman I S, Mansel R E
ICRF Clinical Oncology Unit, Guy's Hospital, London, UK.
Lancet. 1991 Jan 26;337(8735):221-3. doi: 10.1016/0140-6736(91)92172-x.
Many surgeons, particularly in the UK, give inadequate primary treatment to patients with operable breast cancer. For spurious reasons they regard axillary clearance as unnecessarily extensive surgery and rely instead upon total mastectomy or tumour excision and node sampling, with or without postoperative radiotherapy. But it is now clear that relapse-free and overall survival can be improved by appropriate adjuvant therapy. Thus inadequate exploration of the axilla is doubly unjustified. Not only is there the obvious risk of failure to remove nodes that contain metastases--so that some patients are deprived of cure by primary treatment--but the extent of tumour spread will be inadequately assessed in many more patients, with the risk that they may not receive appropriate adjuvant treatment.
许多外科医生，尤其是在英国，对可手术乳腺癌患者的初始治疗不够充分。出于一些不合理的原因，他们认为腋窝清扫是不必要的广泛手术，而是依赖于全乳房切除术或肿瘤切除及淋巴结取样，无论是否进行术后放疗。但现在很清楚，通过适当的辅助治疗可以提高无复发生存率和总生存率。因此，对腋窝进行不充分的探查是双重不合理的。不仅存在未能切除含有转移灶的淋巴结的明显风险——以至于一些患者被初始治疗剥夺了治愈的机会——而且在更多患者中，肿瘤扩散的程度将得不到充分评估，存在他们可能无法接受适当辅助治疗的风险。
