Breast Center, Integrated Surgical Institute, Cleveland Clinic, Cleveland, OH.
Breast Center, Integrated Surgical Institute, Cleveland Clinic, Cleveland, OH.
Clin Breast Cancer. 2024 Jul;24(5):385-391. doi: 10.1016/j.clbc.2024.04.009. Epub 2024 Apr 20.
Surgical de-escalation of the axilla has evolved over the past 28 years since the emergence of sentinel lymph node surgery. Well-documented complications of the once standard of care axillary lymph node dissection (ALND), including lymphedema, led physician scientists towards a progressive push to study and incorporate less invasive techniques in the axilla. Many trials have justified oncologic safety of axillary de-escalation in patients who are spared neoadjuvant treatment. The applicability in the neoadjuvant setting, however, is less clear and axillary surgical approaches in this patient population have evolved at a slower pace. This review aims to analyze current data in axillary management for patients undergoing neoadjuvant treatment and to discuss current surgical approaches based on nodal pathologic response.
自前哨淋巴结手术出现以来，腋窝手术的降级已在过去 28 年中不断发展。曾经的标准治疗腋窝淋巴结清扫术（ALND）存在诸多有据可查的并发症，包括淋巴水肿，这促使医师科学家们积极研究并采用侵袭性更小的腋窝技术。许多试验证实了腋窝降级在避免新辅助治疗的患者中的肿瘤学安全性。然而，在新辅助治疗环境中的适用性尚不清楚，并且该患者人群的腋窝手术方法的发展速度较慢。本文旨在分析新辅助治疗患者的腋窝管理中的当前数据，并根据淋巴结病理反应讨论当前的手术方法。
