Senofsky G M, Moffat F L, Davis K, Masri M M, Clark K C, Robinson D S, Sabates B, Ketcham A S
Department of Surgery, University of Miami School of Medicine, FL 33101.
Arch Surg. 1991 Nov;126(11):1336-41; discussion 1341-2. doi: 10.1001/archsurg.1991.01410350026004.
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.
乳腺癌患者腋窝清扫的最佳范围仍不明确。我们报告了对264例接受密切随访的私立患者进行的278例全腋窝淋巴结清扫术（包括Ⅰ、Ⅱ、Ⅲ级以及Rotter淋巴结[胸肌间淋巴结]）。迄今为止尚无腋窝复发情况（平均随访时间为50个月）。如果仅切除Ⅰ级和Ⅱ级淋巴结，假阴性分期错误率仅为2.6%。然而，在92例病理检查发现淋巴结阳性的腋窝中，有29例（31.5%）存在腋窝顶部和/或Rotter淋巴结转移。并发症发生率与部分淋巴结清扫术的报告结果相当。6%未接受放疗的患者出现了上肢淋巴水肿；术后放疗和明显的淋巴结疾病是淋巴水肿的重要危险因素。只要避免对区域淋巴结进行放疗，全腋窝淋巴结清扫术在很大程度上可预防腋窝复发，消除部分淋巴结清扫术固有的小分期错误，且发病率可接受。
