A comprehensive analysis involving more than 20,000 women with early breast cancer revealed that the extent of axillary surgery does not significantly affect the 10-year rates of locoregional recurrence or mortality.
This large-scale meta-analysis, presented at the 2023 San Antonio Breast Cancer Symposium, suggested that opting for less extensive surgery fails to impact recurrence rates and reduces the risk of lymphedema for patients.
According to Medscape, Dr Andrea V Barrio, a breast surgeon at Memorial Sloan Kettering Cancer Centre in New York City, emphasised that more extensive axillary lymph node dissection doesn’t enhance outcomes for many women in the early stages of breast cancer.
The study by Gurdeep S Mannu and his team from the University of Oxford analysed 29 randomised trials spanning six decades. It concluded that the optimal approach to managing the axilla in this patient group remains uncertain.
The analysis revealed that while more extensive surgery seemed to benefit a subgroup experiencing isolated axillary or other local recurrences, it didn’t show significant advantages for those with recurrences in the breast or multiple sites.
After a median follow-up of 10 years, differences in locoregional recurrence rates were negligible between patients who underwent more or less extensive axillary surgery.
The study found similar outcomes for distant recurrence, breast cancer mortality and overall mortality regardless of the extent of axillary surgery.
However, there was a considerable difference in the occurrence of lymphoedema, with more extensive surgery resulting in significantly higher rates than less invasive procedures.
The comparison between axillary dissection and axillary radiotherapy across multiple trials didn’t yield significant differences in terms of recurrence rates or mortality.
Yet, once again, lymphoedema rates were notably higher in the group undergoing axillary dissection than those receiving radiotherapy.
Dr Barrio highlighted that the study underscores situations where extensive axillary lymph node dissection remains crucial, particularly in cases of advanced cancer such as inflammatory breast cancer or in women who, despite upfront chemotherapy, still have positive nodes after surgery.
This comprehensive meta-analysis, funded by Cancer Research UK, British Heart Foundation, and the Medical Research Council, offers critical insights into tailoring surgical approaches for early-stage breast cancer, emphasising the balance between effective treatment and minimising postoperative complications like lymphedema.
