A new surgical technique developed at the National Cancer Institute of Milan halves the risk of arm edema (lymphoedema), a complication that occurs in more than half of patients with breast cancer – up to one in four – for whom it is dissection of the axillary lymph nodes is still required. The result of the group of Massimiliano Gennaro, breast specialist at the Int, is published in ‘Cancer’.
The cases of breast cancer in which it is necessary to proceed with the dissection of the axillary lymph nodes are gradually decreasing, explain the IRCCS of via Venezian. However, for many patients with lymph node involvement, the procedure remains essential to define the prognosis and to guide adjuvant treatments. However, the dissection of the axillary lymph nodes is burdened by the risk of lymphedema, i.e. accumulation of fluid in the soft tissues of the affected arm. According to some epidemiological estimates, more than 60% of patients subjected to integrated treatments suffer from it, with a significant impact in terms of perceived discomfort, decreased quality of life and alteration of the body image; there is also no shortage of problems in social and professional life and an increase in health care costs. The risk of lymphedema can now be reduced with the innovative surgical technique of dissection defined as ‘selective’ (Sad – Selective axillary dissection) developed at the Complex Structure of General Surgery specializing in oncology 3 – Senology of the Int.
“Our goal was to verify whether a particular selective axillary dissection technique could translate into an advantage in terms of morbidity associated with the surgery, such as arm edema – says Gennaro, lead author of the article -. As a first step we published a pilot study, followed by a study dedicated to oncological safety: both gave favorable results”. Hence the idea of conducting a more in-depth analysis, to evaluate the effectiveness of the method with a randomized study involving 130 patients operated on for breast cancer, of which 65 treated with the conventional technique and 65 with the selective technique. “Also in this case the data that emerged were comforting: compared to the traditional technique – reads a note – the selective conservation of an average of two specific axillary lymph nodes has been shown to halve the incidence of arm edema detected at one year from surgical treatment (42% to 21%)”.
“This significant reduction – continues the note – was confirmed by a multimodal evaluation to which the enrolled patients were subjected, also documenting that, after the SAD, when the edema occurs, it appears in a less severe form”.
In Italy – the Int of Milan recalls – around 60 thousand women are operated on for breast cancer every year and even today, despite the diagnostic anticipation and therapeutic progress, 15-25% have to undergo an axillary dissection . The clinical evidence acquired from the study conducted, according to the authors “can change the treatment approach of these patients: the Aiom guidelines (Italian Association of Medical Oncology, ed.) considered Sad only for appropriately selected cases, but the results obtained show that this surgical technique can now be used by a large number of women who, in their therapeutic path, require the dissection of axillary lymph nodes”.
“This surgical technique therefore reduces the risk of arm edema by half: it is an important result for the progress of surgical therapies, an area in which it is rather rare to see a benefit of this magnitude – comments Gennaro – The result has already been welcomed in the niche of breast surgeons, so much so that selective dissection is explicitly mentioned in the latest Aiom guidelines for breast cancer, released in 2021, as a ‘possible future alternative to traditional axillary dissection’ due to ‘the growing evidence of efficacy and low risk of regional recurrences”. Now, however, it is a question of spreading it to a wider public, also involving patient associations, so that it becomes a new standard of treatment: for this reason we will take steps to adapt the Drg as well”.
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