Estadificación quirúrgica de la axila en la mujer con cáncer de mama durante el periodo 1999-2015análisis de su evolución técnica y estudio de su impacto en la supervivencia libre de enfermedad, supervivencia global y morbilidad postoperatoria

Resumen

Introdution. Axillary treatment in breast cancer has evolved over the past years from the systematic indication of axillary lymph node dissection (ALND) to sentinel lymph node biopsy (SLNB) and, more recently, to the suppression of ALND with metastasic sentinel lymph node. This study analyzes the evolution of axillary staging procedures and its impact on survival and lymphedema. Patients and Method. Retrospective study of surgical patients in three time periods defined by the introduction of sentinel lymph node biopsy and the ACOSOG Z0011 criteria. Results. The indication of ALND progressively decreased (from 100% to 30%) and futile ALND (from 60% to 10%), particularly in patients with conservative primary surgery. Tumor size and nodal involment are the most important prognostic factors for overall survival. Changes in lymph node staging methods did not modify survival. Axillary radiotherapy allowed a similar control of the disease in these patients that associated risk factors. ALND is the main risk factor for lymphedema. Conclusion. The modification of the criteria for an ALND reduces futile ALND, without compromising survival with lower morbidity. Axillary radiotherapy can be an alternative to ALND in those patients with risk factors and lymph node involment.