Department of Surgery and Cancer, Imperial College London, London, UK.
Imperial College Healthcare NHS Trust, St. Mary's Hospital, London, UK.
Ann Surg Oncol. 2023 Nov;30(12):7036-7045. doi: 10.1245/s10434-023-13966-7. Epub 2023 Jul 28.
We suspect that morbidity from both sentinel lymph node biopsy (SLNB) and axillary lymph node dissection (ALND) has been inadequately evaluated to date. Current methodologies are subjective and susceptible to bias. Objective assessment using wearable activity monitors (WAMs) would allow quantitative analysis of recovery by measuring physical activity (PA) and could provide evidence for axillary de-escalation.
A prospective, single center, observational study was conducted from February 2020 to May 2022. Consecutive patients undergoing breast and/or reconstructive surgery and axillary surgeries were identified from the operating schedules. Patients wore WAMs for an average of 3 days prior to surgery and up to 2 weeks following surgery. In total, 56 patients with breast cancer were recruited, of whom 35 underwent SLNB and 21 ALND.
Patients who underwent ALND experienced significantly worse PA compared with those who underwent SLNB in week 2 (median 66.4% versus 72.7%, p = 0.015). Subgroup analysis revealed significantly lower PA in simple mastectomy (Mx)-ALND versus Mx-SLNB (median 90.3% versus 70.5%, p = 0.015) in week 2. The PA for SLNB did not return to baseline at 2 weeks after surgery.
Compared with SLNB, ALND results in a lower PA level in week 2. The findings also indicate that SLNB has a protracted effect on PA levels, which extend to 2 weeks postoperatively. Monitoring recovery objectively following breast cancer surgery provides patients and surgeons with more information regarding the predicted outcomes of their surgery, which can drive the development of a personalized rehabilitation program.
我们怀疑，迄今为止，前哨淋巴结活检（SLNB）和腋窝淋巴结清扫（ALND）的发病率评估都不够充分。目前的方法是主观的，容易受到偏见的影响。使用可穿戴活动监测器（WAMs）进行客观评估可以通过测量身体活动（PA）来对恢复情况进行定量分析，并为腋窝降级提供证据。
这是一项前瞻性、单中心、观察性研究，于 2020 年 2 月至 2022 年 5 月进行。从手术安排中确定了连续接受乳房和/或重建手术以及腋窝手术的患者。患者在手术前平均佩戴 WAMs 3 天，术后最多佩戴 2 周。共有 56 例乳腺癌患者入组，其中 35 例行 SLNB，21 例行 ALND。
接受 ALND 的患者在术后第 2 周的 PA 明显低于接受 SLNB 的患者（中位数分别为 66.4%和 72.7%，p=0.015）。亚组分析显示，在简单乳房切除术（Mx）-ALND 与 Mx-SLNB 中，第 2 周的 PA 明显更低（中位数分别为 90.3%和 70.5%，p=0.015）。SLNB 的 PA 在术后 2 周内未恢复到基线水平。
与 SLNB 相比，ALND 在第 2 周导致 PA 水平更低。研究结果还表明，SLNB 对 PA 水平的影响持续时间较长，可延伸至术后 2 周。客观监测乳腺癌手术后的恢复情况可为患者和外科医生提供更多关于其手术预期结果的信息，从而推动个性化康复方案的制定。
