[Skip to Content]
Sign In
Individual Sign In
Create an Account
Institutional Sign In
OpenAthens Shibboleth
[Skip to Content Landing]
November 1991

Total Axillary Lymphadenectomy in the Management of Breast Cancer

Author Affiliations

From the Department of Surgery, Division of Oncology (Drs Senofsky, Moffat, Masri, Clark, Robinson, and Ketcham and Mr Sabates) and the Department of Biostatistics and Epidemiology (Mr Davis), Sylvester Comprehensive Cancer Center and University of Miami (Fla) School of Medicine.

Arch Surg. 1991;126(11):1336-1342. doi:10.1001/archsurg.1991.01410350026004

• The optimal extent of axillary dissection in patients with breast cancer remains unclear. We report 278 total axillary lymphadenectomies (levels I, II, and III and Rotter's [inter-pectoral] nodes) that were performed in 264 closely followed up private patients. There have been no axillary recurrences to date (mean follow-up, 50 months). If only level I and II nodes had been removed, the false-negative staging error would have been only 2.6%. However, 29 (31.5%) of 92 pathological node-positive axillae contained apical and/or Rotter's metastases. The incidence of complications was comparable with that reported for partial lymphadenectomy. Arm lymphedema developed in 6% of nonirradiated patients; postoperative radiotherapy and gross nodal disease were significant risk factors for lymphedema. Total axillary lymphadenectomy largely prevents axillary recurrence, eliminates the small staging error inherent in partial lymphadenectomy, and has acceptable morbidity, provided radiotherapy to the regional nodal areas is avoided.

(Arch Surg. 1991;126:1336-1342)

Forrest APM, Roberts MM, Cant ELM, et al.  Simple mastectomy and pectoral node biopsy: the Cardiff-St Mary's trial . World J Surg . 1977;1:320-323.Article
Kissin MW, Thompson EM, Price AB, Slavin G, Kark AE.  The inadequacy of axillary sampling in breast cancer . Lancet . 1982;2:1210-1212.Article
Steele RJC, Forrest APM, Gibson T, Stewart HJ, Chetty U.  The efficacy of lower axillary sampling in obtaining lymph node status in breast cancer: a controlled randomized trial . Br J Surg . 1985;72:368-369.Article
Benson EA, Thorogood J.  The effect of surgical technique on local recurrence rates following mastectomy . Eur J Surg Oncol . 1986;12:267-271.
Fisher B, Wolmark N, Bauer M, Redmond C, Gebhardt M.  The accuracy of clinical nodal staging and of limited axillary dissection as a determinant of histologic nodal status in carcinoma of the breast . Surg Gynecol Obstet . 1981;152:764-772.
Fisher B, Redmond C, Fisher ER, et al.  Ten-year results of a randomized clinical trial comparing radical mastectomy and total mastectomy with or without radiation . N Engl J Med . 1985;312:674-681.Article
Graversen HP, Blichert-Toft M, Andersen JA, et al.  Breast cancer: risk of axillary recurrence in node-negative patients following partial dissection of the axilla . Eur J Surg Oncol . 1988;14:407-412.
Delouche G, Bachelot F, Premont M. Kurtz JM.  Conservation treatment of early breast cancer: long term results and complications . Int J Radiat Oncol Biol Phys . 1987;13:29-34.Article
Siegel BM, Mayzel KA, Love SM.  Level I and II axillary dissection in the treatment of early-stage breast cancer: an analysis of 259 consecutive patients . Arch Surg . 1990;125:1144-1147.Article
Schwartz GF, D'Ugo DM, Rosenberg AL.  Extent of axillary dissection preceding irradiation for carcinoma of the breast . Arch Surg . 1986;121:1395-1398.Article
Attiyeh FF, Jensen M, Huvos AG, Fracchia A.  Axillary micro-metastasis in carcinoma of the breast . Surg Gynceol Obstet . 1977;144:839-842.
Pigott J, Nichols R, Maddox WA, Balch CM.  Metastases to the upper levels of the axillary nodes in carcinoma of the breast and its implications for nodal sampling procedures . Surg Gynecol Obstet . 1984;158:255-259.
Boova RS, Bonanni R, Rosato FE.  Patterns of axillary nodal involvement in breast cancer: predictability of level one dissection . Ann Surg . 1982;196:642-644.Article
Rosen PP, Lesser ML, Kinne DW, Beattie EJ.  Discontinuous or 'skip' metastases in breast carcinoma: analysis of 1228 axillary dissections . Ann Surg . 1983;197:276-283.Article
Smith JA, Gamez-Araujo JJ, Gallager HS, White EC, McBride CM.  Carcinoma of the breast: analysis of total lymph node involvement versus level of metastasis . Cancer . 1977;39:527-532.Article
Berg JW.  The significance of axillary node levels in the study of breast carcinoma . Cancer . 1955;4:776-778.Article
Veronesi U, Rilke F, Luini A, et al.  Distribution of axillary node metastases by level of invasion: an analysis of 539 cases . Cancer . 1987;313:683-687.
Veronesi U, Saccozzi R, Del Vecchio M, et al.  Comparing radical mastectomy with quadrantectomy, axillary dissection and radiotherapy in patients with small cancers of the breast . N Engl J Med . 1981;305:6-11.Article
Kissin MW, Querci della Rovere G, Easton D, Westbury G.  Risk of lymphedema following the treatment of breast cancer . Br J Surg . 1986;73:580-584.Article
Dewar JA, Sarrazin D, Benhamou E, et al.  Management of the axilla in conservatively treated breast cancer: 592 patients treated at Institut Gustave-Roussy . Int J Radiat Oncol Biol Phys . 1987;13:475-481.Article
Langlands AO, Prescott RJ, Hamilton T.  A clinical trial in the management of operable breast cancer . Br J Surg . 1980;67:170-174.Article
Carabell SC, Richter MP, Bryan JH, Blumberg AL, Click JH, Goodman RL.  Radiation therapy as an alternative to mastectomy for breast cancer: the role of axillary sampling . Int J Radiat Oncol Biol Phys . 1981;7:31-32.Article
Larson D, Weinstein M, Goldberg I, et al.  Edema of the arm as a function of the extent of axillary surgery in patients with stage I-II carcinoma of the breast treated with primary radiotherapy . Int J Radiat Oncol Biol Phys . 1986;12:1575-1582.Article
Beahrs OH, Henson DE, Hutter RVP, Myers MH, eds. Manual for Staging of Cancer. 3rd ed. Philadelphia, Pa: JB Lippincott; 1988:145-150.
Fisher ER, Palekar A, Rockette H, Redmond C, Fisher B.  Pathologic findings from the National Surgical Adjuvant Breast Project (protocol No. 4), V: significance of axillary nodal micro-and macrometastases . Cancer . 1978;42:2032-2038.Article
Huvos AG, Hutter RVP, Berg JW.  Significance of axillary macrometastases and micrometastases in mammary cancer . Ann Surg . 1971;173:44-46.Article
Fisher ER, Swamidoss S, Lee CH, Rockette H, Redmond C, Fisher B.  Detection and significance of occult axillary node metastases in patients with invasive breast cancer . Cancer . 1978;42:2025-2031.Article
Rosen PP, Saigo PE, Braun DW, Weathers E, Fracchia A, Kinne DW.  Axillary micro- and macrometastases in breast cancer . Ann Surg . 1981;194:585-591.Article
Recht A, Connolly JL, Schnitt SJ, et al.  Conservative surgery and radiation therapy for early breast cancer: results, controversies, and unsolved problems . Semin Oncol . 1986;13:434-449.
Davies GC, Millis RR, Hayward JL.  Assessment of axillary lymph node status . Ann Surg . 1980;192:148-151.Article
Fisher B, Slack NH.  Number of lymph nodes examined and the prognosis of breast carcinoma . Surg Gynecol Obstet . 1970;131:79-87.
Fisher B, Bauer M, Wickersham DL, Redmond CK, Fisher ER.  Relation of number of positive axillary lymph nodes to the prognosis of patients with primary breast cancer: an NSABP update . Cancer . 1983;52:1551-1557.Article
Cody HS, Egeli RA, Urban JA.  Rotter's node metastases: therapeutic and prognostic considerations in early breast cancer . Ann Surg . 1984;199:266-270.Article
Beadle GF, Silver B, Botnick L, Hellman S, Harris JR.  Cosmetic results following primary radiation therapy for early breast cancer . Cancer . 1984;54:2911-2918.Article
Salner AL, Botnick LE, Herzog AG, et al.  Reversible brachial plexopathy following primary radiation therapy for breast cancer . Cancer Treat Rep . 1981;65:797-801.
Match RM.  Radiation-induced brachial plexus paralysis . Arch Surg . 1975;110:384-386.Article
Bagley FH, Walsh JW, Cady B, Salzman FA, Oberfield RA, Pazianos AG.  Carcinomatous versus radiation-induced brachial plexus neuropathy in breast cancer . Cancer . 1978;41:2154-2157.Article
Fisher B, Slack NH, Cavanaugh PJ, Gardner B, Ravdin RG.  Postoperative radiotherapy in the treatment of breast cancer: results of the NSABP clinical trial . Ann Surg . 1970;172:711-732.Article
Fisher B, Montague E, Redmond C, et al.  Comparison of radical mastectomy with alternative treatments for primary breast cancer: a first report of results from a prospective randomized clinical trial . Cancer . 1977;39:2827-2839.Article
Fisher B, Wolmark N, Redmond C, et al.  Findings from NSABP B-04: comparison of radical mastectomy with alternative treatments, II: the clinical and biologic significance of medial-central breast cancers . Cancer . 1981;48:1863-1872.Article
Fisher B, Montague E, Redmond C, et al.  Findings from NSABP protocol No. 4: comparison of radical mastectomy with alternative treatments for primary breast cancer, I: radiation compliance and its relation to treatment outcome . Cancer . 1980;46:1-13.Article
Clark RM, Wilkinson RH, Miceli PN, MacDonald WD.  Breast cancer: experiences with conservation therapy . Am J Clin Oncol . 1987;10:461-468.Article
Rose CM, Botnick LE, Weinstein M, et al.  Axillary sampling in the definitive treatment of breast cancer by radiation therapy and lumpectomy . Int J Radiat Oncol Biol Phys . 1983;9:339-344.Article