Axillary lymph node dissection (ALND) has been associated with postoperative morbidities, including arm lymphedema, shoulder dysfunction, and paresthesia. Sentinel lymph node (SLN) biopsy emerged as a method to assess axillary nodal status and possibly obviate the need for ALND in patients with clinically node-negative (cN0) breast cancer. The majority of breast cancer patients are eligible for SLN biopsy only, so ALND can be avoided. However, there are subsets of patients in whom ALND cannot be eliminated. ALND is still needed in patients with three or more positive SLNs or those with gross extranodal or matted nodal disease. Moreover, ALND has conventionally been performed to establish local control in clinically node-positive (cN+) patients with a heavy axillary tumor burden. The sole method to avoid ALND is through neoadjuvant chemotherapy (NAC). Recently, various forms of conservative axillary surgery have been developed in order to minimize arm lymphedema without increasing axillary recurrence. In the era of effective multimodality therapy, conventional ALND may not be necessary in either cN0 or cN+ patients. Further studies with a longer follow-up period are needed to determine the safety of conservative axillary surgery.
腋窝淋巴结清扫术（ALND）与术后并发症相关，包括手臂淋巴水肿、肩关节功能障碍及感觉异常。前哨淋巴结（SLN）活检作为一种评估腋窝淋巴结状态的方法应运而生，可能使临床淋巴结阴性（cN0）乳腺癌患者免于接受ALND。大多数乳腺癌患者仅需进行SLN活检即可，从而避免ALND。然而，仍存在部分患者无法免除ALND。对于存在三个或以上阳性SLN，或伴有明显淋巴结外侵犯或融合性淋巴结病变的患者，仍需进行ALND。此外，传统上对于临床淋巴结阳性（cN+）且腋窝肿瘤负荷较大的患者，ALND被用于实现局部控制。避免ALND的唯一方法是新辅助化疗（NAC）。近年来，为在不增加腋窝复发风险的前提下最大限度减少手臂淋巴水肿，多种形式的保守性腋窝手术得以发展。在有效多模式治疗时代，无论是cN0还是cN+患者，传统ALND可能已非必需。需要更长期的随访研究来确定保守性腋窝手术的安全性。
肿瘤(癌症)患者之家