Opening Doors to Kinder Surgery
A recent international study led by experts from the Karolinska Institutet, and published in the prestigious ‘New England Journal of Medicine’, marks a milestone in the treatment of breast cancer, offering a less invasive and more effective approach for patients.
The spread of breast cancer to the lymph nodes in the armpit has been a considerable challenge for specialists. When tumors are limited to the breast and axillary lymph nodes, they are classified as a localized disease, with the primary goal of curing the patient.
The Dilemma of Surgery
One of the most complex dilemmas faced by breast cancer surgeons is how to proceed when patients have metastases in the armpit, detected during surgery.
Removal of numerous axillary lymph nodes, known as axillary dissection, carries the risk of developing lymphedema in the arm, a complication that can result in significant swelling and discomfort.
The Search for Safe Alternatives
In this context, Dr. Jana de Boniface, breast cancer surgeon and researcher at the Department of Molecular Medicine and Surgery at the Karolinska Institutet, highlights the need for less invasive procedures that minimize side effects for patients.
The study focused on patients without preoperative evidence of lymphatic dissemination. In these cases, selective removal of the sentinel lymph nodes, the first to receive lymphatic drainage from the breast, is generally chosen.
This technique was shown to be safe in previous trials, but the present study expanded the evidence, even for patients with larger metastases.
Revealing Results
The trial, which included nearly 2,800 patients from five countries, addressed the treatment of metastases larger than two millimeters in one or two sentinel lymph nodes.
After sentinel lymph node surgery, patients were randomly assigned to complete axillary dissection or to leave the axilla without further alterations.
The results revealed that although some patients had additional lymph node metastases, cancer recurrence was similar in both groups, suggesting that postoperative treatment was effective.
A Safer Alternative
Dr. de Boniface concludes that for patients with a maximum of two macrometastases in the sentinel lymph nodes, it is safe to avoid axillary dissection. Instead, radiation therapy is recommended, which reduces complications associated with the arm.
This approach has already been successfully implemented in clinical practice in Sweden, offering a safer and less invasive alternative for breast cancer patients.
