Surgery of the axilla: indications decrease

Next, the panel zoomed in on the benefit of (omitting) axillary surgery. Referring to the - recently updated - results of the AMAROS trial [1], suggesting equal outcomes between axillary surgery and axillary radiotherapy in terms of recurrence and/or disease-free survival but with less morbidity after radiotherapy, the majority of the panellists voted for omitting complementary axillary surgery as long as radiotherapy of the axilla and positive sentinel nodes was planned. This was the case both for patients (T1-2 with 1 or 2 positive sentinel nodes) who had undergone breast-conserving surgery (73% of the panellists voted for omitting axillary surgery) and patients who had a mastectomy (83% of the panellists voted for omitting axillary surgery). However, in case of patients with 1 or 2 positive sentinel nodes undergoing mastectomy and for whom no regional node irradiation was planned, 66% of the panellists voted against omitting axillary surgery. In addition, a majority (61%) of the panellists voted against omitting axillary surgery in patients with tumours greater than 5 cm with 1 or 2 positive sentinel nodes undergoing breast-conserving therapy and whole breast irradiation.

Almost all panellists (92%) were in favour of omitting axillary surgery in patients who had lymph node-positive disease before neoadjuvant systemic therapy, who were downstaged to cN0 after neoadjuvant systemic therapy, and who had at least 3 negative sentinel nodes after the neoadjuvant therapy. Exactly the same percentage of the panellists voted for omitting axillary surgery in patients had lymph node-positive disease before neoadjuvant systemic therapy, who were downstaged to cN0 after neoadjuvant systemic therapy, and who had 1 clipped lymph node-negative or 1 or 2 negative sentinel nodes after the neoadjuvant therapy.

1. Rutgers EJ, et al. SABCS 2018; abstr GS4-01.

Posted on 21 May 201915 March 2021