Complete axillary lymph node dissection (cALND) was previously the standard of care for breast cancer (BC) patients with axillary node disease or macro-metastases found via sentinel lymph node biopsy (SLNB). However, due to significant morbidity, contemporary management now considers a more selective approach, influenced by studies like ACOSOG Z0011. This trial showed that cALND could be omitted without compromising local control or survival in patients with low axillary nodal disease burden undergoing breast-conserving therapy, radiotherapy, and systemic therapy. The relevance of this approach for women with low axillary nodal burden undergoing total mastectomy (TM) remained unclear. A PubMed search up to September 2023 identified 147 relevant studies, with 6 meeting the inclusion criteria, involving 4184 patients with BC and low-volume axillary disease (1–3 positive lymph nodes) undergoing TM. Postmastectomy radiotherapy receipt was similar in both groups. After a mean 7.2-year follow-up, both the pooled results and the meta-analysis revealed no significant differences in overall survival. The combined analysis of the published studies, including the subgroup analysis of the SINODAR-One trial, indicates no survival advantage for cALND over SLNB in T1–T2 breast cancer patients with 1–3 positive sentinel lymph nodes (pN1) undergoing mastectomy. This suggests that, following a multidisciplinary evaluation, cALND can be safely omitted. However, the impact of other patient, tumor, and treatment factors on survival requires consideration and therefore further prospective trials are needed for conclusive validation.
完全性腋窝淋巴结清扫术（cALND）曾是针对经前哨淋巴结活检（SLNB）发现腋窝淋巴结转移或存在宏转移的乳腺癌（BC）患者的标准治疗方案。然而，由于该术式并发症发生率较高，现代临床实践已转向更为个体化的治疗策略，这一转变受到ACOSOG Z0011等研究的影响。该试验表明，对于接受保乳治疗、放疗及全身治疗的腋窝淋巴结低负荷患者，省略cALND并不会影响局部控制或生存率。但对于接受全乳切除术（TM）的腋窝淋巴结低负荷患者，此策略的适用性尚不明确。截至2023年9月，通过PubMed检索共识别出147项相关研究，其中6项符合纳入标准，共涉及4184例接受TM且腋窝淋巴结低负荷（1-3枚阳性淋巴结）的乳腺癌患者。两组患者接受术后放疗的比例相近。经过平均7.2年的随访，汇总结果和荟萃分析均显示两组总生存率无显著差异。对已发表研究的综合分析（包括SINODAR-One试验的亚组分析）表明，对于接受乳房切除术且前哨淋巴结阳性数目为1-3枚（pN1）的T1-T2期乳腺癌患者，cALND相比SLNB并未带来生存获益。这表明经过多学科评估后，可安全地省略cALND。然而，其他患者因素、肿瘤特征及治疗因素对生存的影响仍需考量，因此需要进一步的前瞻性试验来提供确凿证据。
肿瘤(癌症)患者之家