Ballal Helen, Hunt Catherine, Bharat Chrianna, Murray Kevin, Kamyab Roshi, Saunders Christobel
Breast Unit, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia.
National Drug and Alcohol Research Centre, The University of New South Wales, Sydney, New South Wales, Australia.
ANZ J Surg. 2018 Sep;88(9):917-921. doi: 10.1111/ans.14382. Epub 2018 Feb 2.
Staging of axillary lymph nodes in breast cancer is important for prognostication and planning of adjuvant therapy. The traditional practice of proceeding to axillary lymph node dissection (ALND) if sentinel lymph node biopsy (SLNB) is positive is being challenged and clinical trials are underway. For many centres, this will mean a move away from intra-operative SLNB assessment and utilization of a second procedure to perform ALND. It is sometimes perceived that a delayed ALND results in increased tissue damage and thus increased morbidity. We compared morbidity in those undergoing SLNB only, or ALND as a one- or two-stage procedure.
A retrospective review of a prospectively collected institutional database was used to review rates of lymphoedema and shoulder function in women undergoing breast cancer surgery between 2008 and 2012.
The overall lymphoedema rate in 745 patients was 8.2% at 12 months. There was no difference in lymphoedema rates between those undergoing immediate or delayed ALND (17.8 and 8.6%, respectively, P = 0.092). Post-operative shoulder elevation, odds ratio (OR) = 0.390, 95% confidence interval (CI) = (0.218, 0.698) and abduction, OR = 0.437 (95% CI = (0.271, 0.705)) were reduced if an ALND was performed although there was no difference between immediate or delayed.
ALND remains a risk factor for post-operative morbidity. There is no increased risk of lymphoedema or shoulder function deficit with a positive SLNB and delayed ALND compared to immediate ALND.
乳腺癌腋窝淋巴结分期对于预后评估及辅助治疗方案的制定至关重要。若前哨淋巴结活检（SLNB）结果为阳性则进行腋窝淋巴结清扫术（ALND）的传统做法正受到挑战，相关临床试验正在进行。对许多中心而言，这意味着不再采用术中SLNB评估以及利用二次手术进行ALND。有时人们认为延迟进行ALND会导致组织损伤增加，进而使发病率上升。我们比较了仅接受SLNB或接受一期或二期ALND手术患者的发病率。
回顾性分析一个前瞻性收集的机构数据库，以评估2008年至2012年间接受乳腺癌手术女性的淋巴水肿发生率及肩部功能。
745例患者在术后12个月时的总体淋巴水肿发生率为8.2%。即刻或延迟进行ALND的患者之间淋巴水肿发生率无差异（分别为17.8%和8.6%，P = 0.092）。若进行了ALND，术后肩部抬高的比值比（OR） = 0.390，95%置信区间（CI） = （0.218，0.698），外展的OR = 0.437（95% CI = （0.271，0.705））降低，不过即刻或延迟手术之间并无差异。
ALND仍然是术后发病的一个危险因素。与即刻进行ALND相比，SLNB结果为阳性且延迟进行ALND时，淋巴水肿或肩部功能缺陷的风险并未增加。
