Abstract
Axillary lymph node dissection (ALND) is the ‘gold standard’ surgical procedure for the management of metastatic axillary nodes in patients with invasive breast cancer. The procedure involves removal of all the lymph nodes below the inferior border of axillary vein along with fibro-fatty tissue from the axilla preserving important nerves and vessels. Following ALND, histological examination reveals the number of involved lymph node(s) along with findings of any perinodal spread of tumour which is considered a significant prognostic indicator according to the 8th Edition of American Joint Committee on Cancer—AJCC 8th edition. The risk of locoregional and systemic recurrence is determined by the number of positive nodes, the stage of the cancer and the extent of axillary dissection. With complete ALND, the axillary recurrence varies from 0.5 to 2.5% at 10 years. The extent of clearance of axillary tissue in ALND has clearly defined anatomical boundaries all around except for the ‘inferior limit’ of dissection. The surgical literature does not provide a clear guideline regarding the lower border of axillary dissection.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Yan M, Abdi MA, Falkson C (2018) Axillary management in breast cancer patients: a comprehensive review of the key trials. Clin Breast Cancer 18(6):e1251–e1259
Giuliano AE, Edge SB, Hortobagyi GN (2018) Eighth edition of the AJCC cancer staging manual: breast cancer. Ann Surg Oncol 25(7):1783–1785
Thompson AM (1999) Axillary node clearance for breast cancer. A F R Coll Surg Edinb 23:101–109
O’Rourke MGE, Layt CWL (1993) Angular vein of the axilla and the anatomy of the subscapular vein important in axillary node dissection. Aust NZ J Surg 63:396–398
Chan CY, Tan M (2003) Spatial relations of the angular vein, an important landmark in axillary node dissection. Br J Surg 90:948–949
Tan MP, Ung OA (2007) Surgical approach to the angular vein of the axilla: an ‘Inverted’ technique of axillary dissection. Breast J 13(2):220–222
Khonji NI, Edwards R, Sweetland HM, Monypenny IJ, Mansel RE, Webster DJ (2002) Incidence of node in completion mastectomy specimens following breast conservation and axillary clearance. Br J Surg 89(10):1294–1295
Chintamani (2010) Optimum axillary dissection in breast cancer—is angular vein a reliable spatial landmark? Indian J Surg Oncol 1(3):214–215
Chintamani (2014) Ten commandments of safe and optimum mastectomy for breast cancer. Indian J Surg 76(3):175–180
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of Interest
Kamal Kataria, Afrin Sultana, Chitresh Sharma, Piyush Ranjan, Anita Dhar, Anurag Srivastava.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Presentation or prior publication: None.
Rights and permissions
About this article
Cite this article
Sultana, A., Kataria, K., Sharma, C. et al. Extent of Axillary Dissection: How Far Down Should We Dissect?. Indian J Surg 84 (Suppl 3), 786–788 (2022). https://doi.org/10.1007/s12262-021-03235-w
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12262-021-03235-w