Timing of Lymph Node Dissection Studied in Breast Cancer
Number of lymph nodes recovered, long-term complications similar
THURSDAY, July 24 (HealthDay News) -- The timing of axillary lymph node dissection does not affect the number of lymph nodes recovered or long-term complications in patients with breast cancer that has metastasized to the sentinel lymph nodes, according to a report in the July 20 issue of the Journal of Clinical Oncology.
John A. Olson, Jr., M.D., Ph.D., from Duke University Medical Center in Durham, N.C., and colleagues examined outcomes in 1,003 breast cancer patients with metastases to the sentinel lymph nodes, of whom 425 underwent immediate completion axillary lymph node dissection (cALND) and 578 underwent delayed cALND.
The researchers found that both groups had similar median numbers of sentinel and axillary lymph nodes removed. Patients who underwent immediate cALND tended to have larger tumors and a higher pathologic stage, and two or more positive sentinel lymph nodes that were often found during surgery, the report indicates. The immediate cALND group had more axillary paresthesia, seroma and impaired extremity range of motion shortly after surgery but not at later time points. Lymphedema was similar in the two groups at all time points, the authors note.
"The results force us to ask -- if immediate cALND is not better, then why bother with intraoperative examination of sentinel lymph nodes?" Harry D. Bear, M.D., Ph.D., of Virginia Commonwealth University in Richmond, writes in an accompanying editorial. "The quick answer is that avoidance of a second operation (and a second anesthetic) has rather obvious benefits not measured in this study, such as decreased patient anxiety, lower costs, less time away from work, and less delay to the start of adjuvant therapy."
Bear reports receiving honoraria from Genentech and Genomic Health.