Axillary lymph node dissection (ALND), although increasingly less necessary, is still required in specific breast cancer surgery scenarios, such as cases with a high axillary tumor burden. However, traditional practices are being reassessed due to the associated morbidity and impacts on recovery. This review explores five critical and controversial innovations in ALND: (1) same-day discharge, (2) omission of surgical drains, (3) application of fibrin sealants, (4) minimally invasive techniques, and (5) their collective influence on quality of life (QoL). Same-day discharge has proven to be safe and cost-effective, increasing patient satisfaction without raising complication rates. The omission of drains, while slightly increasing seroma volumes, is linked to shorter hospital stays and fewer complications. The use of fibrin sealants shows promising results in reducing the seroma volume and duration, expediting recovery, although their routine use remains under debate. Minimally invasive and endoscopic techniques reduce morbidity and improve cosmetic outcomes while maintaining oncological safety. Quality of life (QoL) is essential in the evaluation of breast cancer treatment and is evaluated using tools such as EORTC QLQ-C30, QLQ-BR23, and FACT-B, SF-36, which assess physical, emotional, and psychosocial recovery. Innovations in ALND seem to improve QoL by minimizing pain, increasing arm function, and reducing psychological stress, underscoring the importance of patient-centered strategies. Although axillary lymphadenectomy increases arm morbidity compared to sentinel node biopsy, its overall impact on quality of life appears limited, likely due to the overlapping effects of systemic therapies and breast surgery.
腋窝淋巴结清扫术（ALND）虽然在特定乳腺癌手术场景中（如腋窝肿瘤负荷较高的病例）仍属必要，但其应用范围已逐渐缩小。然而，由于该手术伴随的并发症及对康复过程的影响，传统操作方式正受到重新评估。本综述探讨了ALND中五项关键且具争议的创新技术：（1）当日出院，（2）免置手术引流管，（3）纤维蛋白密封剂的应用，（4）微创技术，以及（5）这些技术对生活质量的综合影响。当日出院模式已被证实安全且具有成本效益，在未增加并发症发生率的同时提升了患者满意度。免置引流管虽可能轻微增加血清肿体积，但与缩短住院时间、减少并发症相关。纤维蛋白密封剂的应用在减少血清肿体积与持续时间、加速康复方面展现出良好前景，但其常规使用仍存争议。微创及内窥镜技术在保证肿瘤学安全性的同时，可降低手术并发症并改善美容效果。生活质量是乳腺癌治疗评估的核心指标，通过EORTC QLQ-C30、QLQ-BR23、FACT-B及SF-36等工具对生理、情绪及社会心理康复进行系统评估。ALND的技术创新通过减轻疼痛、改善手臂功能、降低心理压力等途径提升生活质量，凸显了以患者为中心的治疗策略的重要性。尽管与前哨淋巴结活检相比，腋窝淋巴结清扫术会增加手臂相关并发症，但其对生活质量的总体影响似乎有限，这可能与全身性治疗和乳房手术产生的叠加效应有关。
Breaking Dogmas in Axillary Lymphadenectomy and Quality of Life
肿瘤(癌症)患者之家