The end of axillary lymph node dissection

Traditionally, axillary dissection involved removing a large number of lymph nodes from the armpit to assess cancer spread. However, this procedure has been associated with significant complications such as lymphedema, chronic pain, and limited arm mobility all of which can severely impact a patient’s quality of life.

One of the main reasons for reducing the use of axillary dissection is the effectiveness of less invasive detection methods, such as the sentinel lymph node biopsy. This technique targets and analyzes the first lymph node(s) likely to be affected by cancer, eliminating the need to remove multiple nodes if the sentinel node is cancer-free.

Clinical studies have also shown that, for many patients, omitting axillary dissection does not negatively affect survival or recurrence rates. For example, the ACOSOG Z0011 trial demonstrated that early-stage breast cancer patients with positive sentinel nodes did not benefit from additional axillary surgery if they received radiation therapy and systemic treatment.

This less invasive approach significantly improves post-operative quality of life. Patients experience less pain, swelling, and functional limitation, enabling a faster return to daily and professional activities, and reducing the overall burden of treatment.

Additionally, fewer axillary dissections allow for more efficient use of healthcare resources fewer major surgeries mean lower healthcare costs and more streamlined hospital logistics.

Thanks to ongoing medical advances, several alternatives to axillary dissection now exist, offering comparable efficacy with fewer complications:

Sentinel lymph node biopsy

Currently the preferred method for evaluating lymphatic spread in breast cancer. This minimally invasive technique analyzes the first potentially affected lymph node and avoids complete dissection if the node is negative.

Axillary radiotherapy

An effective alternative, especially in patients with low-volume nodal involvement. Radiotherapy can target residual cancer cells without surgery, reducing the risk of lymphedema and chronic pain.

Systemic treatments

Treatments such as hormone therapy, chemotherapy, and immunotherapy may eliminate the need for surgical lymph node removal by targeting cancer cells throughout the body. These approaches are tailored to each patient’s clinical profile and help maximize therapeutic outcomes.

In conclusion, the decline in axillary dissection for breast cancer treatment is a major advancement. It is supported by strong clinical evidence, improved detection techniques, and a focus on preserving quality of life.

This shift toward less invasive yet effective approaches reflects the commitment of modern medicine to deliver optimal care while minimizing risks and discomfort for patients.