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  • Tigecycline br Figure Gross views after surgery for ALNs A

    2019-09-23


    Figure 3 Gross views after surgery for ALNs. (A) After conventional ALN dissection, the axillary vein is exposed superiorly and the long thoracic nerve and thoracodorsal nerve are exposed medially and laterally, respectively. (B) After targeted axillary sampling, the axillary vein, long thoracic nerve and thoracodorsal nerve are not fully exposed, even if a bunch of ALNs are removed. ALN, axillary Tigecycline node.
    then, many physicians have considered resection of only a
    few metastatic LNs by AS, SLND, or partial or limited ALND.7e11 
    Although AS can significantly reduce postoperative complications, many surgeons still cannot fully accept the procedure because of the lack of evidence for its
    Axillary sampling in breast cancer 685
    Table 1 Clinical characteristics and oncologic outcomes of patients with pN1 breast cancer who underwent the axillary lymphnodes dissection or targeted axillary sampling.
    Axillary lymph nodes dissection Targeted axillary sampling p-
    Invasive ductal carcinoma
    Invasive lobular carcinoma
    Mucinous carcinoma
    Metaplastic carcinoma
    Hospital stay (mean SD, days)
    Pathologic stage (n, %)
    IIA
    IIB
    IIIA
    Estrogen receptor positivity (n, %)
    c-erbB2 protein positivity (n, %)
    Triple negative breast cancer (n, %)
    Adjuvant chemotherapy (n, %)
    Adjuvant radiotherapy on axilla (n, %)
    Adjuvant hormonal therapy (n, %)
    months)
    Local recurrence (n, %)
    Distant metastasis (n, %)
    oncological results. Many studies of AS have been reported but the definition of the procedure is still not clear. This problem may prevent accurate comparison of each study and the results may not be reliable. We tried to define AS in clinical and pathological terms through multidisciplinary team discussion and by comparing the oncological results with those of conventional ALND. Targeted AS involves removal of a bunch of ALNs including targeted LNs and SLNs. However, surgeons cannot distinguish how many LNs are actually contained in the specimen. Therefore, we focused upon the fact that the axillary vein, long thoracic nerve and thoracodorsal nerve are fully exposed in con-ventional ALND. We defined targeted AS clinically as removal of a bunch of LNs containing targeted LNs and SLNs but without full exposure of the axillary vein, long thoracic nerve and thoracodorsal nerve. Although we also provided a pathological definition of targeted AS, the extent of resection that is performed by surgeon is the most impor-tant factor in determining the name of surgical procedure. Therefore, whether additional treatment is required should be determined when the clinical definition of targeted AS has been established.
    SLNB should be performed even if the suspicious LN is targeted with charcoal injection, because the concordance rate between SLNs and targeted suspicious LNs is 
    92e97%.29e31 The incidence of complications is higher in cases of axillary recurrence, even if the isolated axillary recurrence rate is only 1% in breast cancer. Overall survival is not generally affected by axillary recurrence if appro-priate management is applied at the time of recurrence.32e34 In a recent study, the local recurrence rate was only 1.6% and there was no axillary recurrence. In the present study, there was no significant difference in oncological results between AS with and without axillary radiotherapy. However, these results were only based on 5-years follow-up data, so further follow-up should be conducted.
    There are several limitations in our study. First, the population was relatively small and all data were from only a single center. However, the reliability would be high because the operations were conducted by four different surgeons and the follow-up period was more than five years. Second, the definition of AS is still ambiguous to perform an accurate comparative study. However, we focused not only on the oncological outcomes of 5-year follow-up but also on forming a definition of targeted AS. Although there are several reports about targeted AS pro-cedures, clear definition is still lacking. As a result, the technical or oncological safety cannot be compared accu-rately. Because the anatomical structure of the axillary