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Inicio Cirugía Española (English Edition) Impact of lymphadenectomy on axillary recurrence and morbidity of the upper limb...
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Vol. 89. Núm. 5.
Páginas 307-316 (mayo 2011)
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Vol. 89. Núm. 5.
Páginas 307-316 (mayo 2011)
Acceso a texto completo
Impact of lymphadenectomy on axillary recurrence and morbidity of the upper limb in breast cancer patients with negative sentinel node. A prospective randomised study
Impacto de la linfadenectomía sobre la recurrencia axilar y la morbilidad del miembro superior en pacientes con cáncer de mama y ganglio centinela negativo. Estudio prospectivo aleatorizado
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José Luis Fougoa,
Autor para correspondencia
joseluisfougo@gmail.com

Corresponding author.
, Mário Dinis-Ribeirob,c, Cláudia Araújoa, Teresa Diasa, Paulo Reisa, Laurinda Giesteiraa, Fernando Castroa, Hernâni Silvaa
a Departamento de Oncología Quirúrgica, Instituto Português de Oncologia Francisco Gentil, Centro do Porto, Portugal
b Departamento de Gastroenterología, Instituto Português de Oncologia Francisco Gentil, Centro do Porto, Portugal
c CINTESIS, Departamento de Bioestadística e Informática Médica, Facultad de Medicina de Porto, Porto, Portugal
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Abstract
Introduction

To determine the impact of axillary lymphadenectomy on regional recurrence, the overall and disease free survival, and upper limb morbidity in patients with breast cancer and negative sentinel node (SN).

Patients and methods

A total of 176 patients with breast cancer and negative SN (pN0sn) were either randomised to lymphadenectomy (Group I) or to observation only (Group II). The triple technique was used to identify and remove the SN. Follow-up was carried out every 3 months for the first 3 years, and then every 6 months up to 5 years. Pain, numbness (paresthesia), limitations in shoulder mobility, and arm oedema were recorded.

Results

No axillary lymph node recurrence was detected in the patients of Group II after 60 months follow up. The overall and disease free survival was similar in both groups. The proportion of patients with morbidity and who had more than two complications was significantly higher in Group I.

Conclusions

Axillary lymphadenectomy may be avoided in patients with negative SN without compromising lymph node extension studies and the patient treatment results. Axillary lymphadenectomy is associated with a higher morbidity of the upper limb compared to SN biopsy.

Keywords:
Sentinel node
Breast cáncer
Prospective study
Lymph node staging
Morbidity
Lymphoedema
Survival
Resumen
Introducción

Determinar el impacto de la linfadenectomía axilar sobre la recurrencia regional, la supervivencia global y libre de enfermedad y la morbilidad del miembro superior en pacientes con cáncer de mama y ganglio centinela (GC) negativo.

Pacientes y métodos

Ciento sesenta y seis pacientes con cáncer de mama y GC negativo (pN0sn) fueron aleatorizados a linfadenectomía (Grupo I) o solo observación (Grupo II). Se utilizó una técnica triple para identificar y extirpar el GC. El seguimiento se realizó cada 3 meses durante los 3 primeros años y, posteriormente, cada 6 meses, hasta los 5 años. Se registraron el dolor, entumecimiento (parestesias), la limitación de movilidad del hombro y el edema del brazo.

Resultado

Tras un seguimiento mínimo de 60 meses, no se detectó recurrencia ganglionar axilar en los pacientes del Grupo II. La supervivencia global y la libre de enfermedad fueron similares en ambos grupos. La proporción de pacientes con morbilidad y los que tuvieron más de dos complicaciones fue significativamente mayor en el Grupo I.

Conclusiones

Se puede evitar la linfadenectomía axilar en pacientes con GC negativo sin comprometer el estudio de extensión ganglionar o los resultados del tratamiento. La linfadenectomía axilar se asocia a una más elevada morbilidad de la extremidad superior en comparación a la biopsia del GC.

Palabras clave:
Ganglio centinela
Cáncer de mama
Estudio prospectivo
Estadificación ganglionar
Morbilidad
Linfedema
Supervivencia
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This project has been presented partially at the 7th European Breast Cancer Conference (EBCC 7), Barcelona, Spain, March 2010.

Copyright © 2011. Asociación Española de Cirujanos
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