Developed by researchers at the Istituto Nazionale Tumori in Milan, the «selective axillary dissection» (or SAD) is destined to replace the up to now standard procedure with many advantages for the patients and their quality of life
Italian researchers have developed a new strategy for treat breast cancer effectivelyhowever sparing the patients one of the most frequent and annoying consequences: lymphedema, or swollen arm, which occurs in about a quarter of the women who have undergone the removal of axillary lymph nodes and in half of those subjected also to locoregional radiotherapy. The innovative surgical technique, studied by a team of experts from the IRCCS Foundation of the National Cancer Institute of Milan (Int), with the support of the Ministry of Health, is illustrated in the scientific journal Cancer
and is set to change the standard of care.
Numbers on the rise
Lymphedema is a chronic, progressive and debilitating diseasecauses pain and difficulty moving freely. And the cases are destined to increase together with the number of women operated on for breast cancer, in Italy and in the world. It is a disorder that not only significantly worsens the quality of life of those who suffer from it, with a deleterious impact also on the body image, but which it also interferes with social and work life, increasing direct (for patients) and indirect (for the healthcare system) costs. «In Italy almost 60,000 women are operated on for breast cancer every year and still today, despite early diagnoses and therapeutic progress, 15-25% of them have to undergo an axillary dissectionwith often disabling effects – he underlines Maximilian Gennaro, breast specialist at the Milanese institute and first author of the study —. The new intervention of selective axillary dissection however, it has a great advantage: it preserves the passage of the lymph and therefore replaces the “old” type of operation whenever surgical staging of the axillary lymph nodes is necessary”.
Why does lymphedema form
Those who perform only the sentinel lymph node biopsy have a very low risk of developing lymphedema, while the odds increase for those who have all lymph nodes removed, to a radiotherapy treatment on the armpit and for those who are overweight. «When the surgeon is forced to also remove the axillary lymph nodes, in addition to the breast cancer, he can slow down the circulation of the limb lymph, which accumulates in the tissues, thus giving rise to a lymphedema – explains Gennaro -. Lymphedema can form gradually over a few days or even several years after surgery. The most common symptoms are the swelling (of the whole arm or only some parts), the sense of fullness and heaviness of the affected arm, the difficulty in raising the limb, stiffening of the shoulder, reduced motor capacity or the flexibility of the hand or wrist. Prevention, physiotherapy and early treatment are decisive for regressing, attenuating and keeping the swelling of the limb under control”.
The benefits for the patients
A pilot study, also conducted in 2013 at the Milanese Int, had evaluated the feasibility of the so-called selective axillary dissection (or SAD) which preserves the lymphatic drainage of the arm. Then in 2021 another research confirmed the safety of this new method, documenting a low risk of axillary recurrence. Finally, the latest trial compared traditional axillary dissection with the selective one on 130 patients with breast cancer extending to the axillary lymph nodes and the results, recently reported on Cancer
indicate the effectiveness and great utility of SAD for women: «The lymph nodes that drain the arm are identified through the inoculation of a radiopharmaceutical and lymphoscintigraphy (a technique called Axillary Reverse Mapping) – clarifies the breast specialist -. The new surgical technique was feasible in 94% of cases and confirmed the expected benefits in the preservation of a collateral lymphatic drainage that can be efficiently adapted to the new functional demand, after the removal of the axillary lymph nodes. And selective preservation of an average of two specific axillary lymph nodes halves the incidence of arm edema detected one year after surgery (from 42% after complete axillary dissection to 21% after SAD): i.e. edema afterwards is not only less frequent, but also less severe».
New standard technique
As expected, in terms of survival, there were no appreciable differences between the two groups compared. So what changes for the patients? “The national guidelines considered SAD only for appropriately selected cases, but in fact this surgical technique was not accessible outside of specific clinical research protocols – concludes the expert -. Now, in the light of new evidence, this surgical technique can be used for a large number of patients who require dissection of the axillary lymph nodes in their therapeutic pathway. It is therefore no longer just a niche intervention, also in consideration of the fact that it is not a complex procedure, but has a very rapid learning curve and it is within the reach of all Breast Units. It does not require any special tools (except the probe already in use to perform the simple biopsy of the sentinel lymph node) and the time is comparable (10-15 minutes more in the learning phase) to that of traditional axillary dissection”.
January 12, 2023 (change January 12, 2023 | 3:18 pm)
© Time.News