• Sabine R de Wild, Lori M van Roozendaal, de WiltJohannes H WJHW0000-0001-6773-9668Department of Surgery, Radboud University Medical Centre, Nijmegen, the Netherlands., Thijs van Dalen, Jos A van der Hage, Frederieke H van Duijnhoven, Janine M Simons, Robert-Jan Schipper, Linda de Munck, van KuijkSander M JSMJ0000-0003-2796-729XDepartment of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre+, Maastricht, the Netherlands., Liesbeth J Boersma, Sabine C Linn, Marc B I Lobbes, PoortmansPhilip M PPMPDepartment of Radiation Oncology, Iridium Netwerk, Antwerp, Belgium.Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium., Tjan-HeijnenVivianne C GVCGDepartment of Medical Oncology, Maastricht University Medical Centre+, Maastricht, the Netherlands., Koen K B T van de Vijver, Jolanda de Vries, A Helen Westenberg, StrobbeLuc J ALJADepartment of Surgery, Canisius Wilhelmina Hospital, Nijmegen, the Netherlands., and Marjolein L Smidt.
• Maastricht University Medical Centre+, Department of Surgery, GROW School for Oncology and Reproduction, Maastricht, The Netherlands.
• Br J Surg. 2024 Apr 3; 111 (4).

BackgroundTrials have demonstrated the safety of omitting completion axillary lymph node dissection in patients with cT1-2 N0 breast cancer operated with breast-conserving surgery who have limited metastatic burden in the sentinel lymph node. The aim of this registry study was to provide insight into the oncological safety of omitting completion axillary treatment in patients operated with mastectomy who have limited-volume sentinel lymph node metastasis.MethodsWomen diagnosed in 2013-2014 with unilateral cT1-2 N0 breast cancer treated with mastectomy, with one to three sentinel lymph node metastases (pN1mi-pN1a), were identified from the Netherlands Cancer Registry, and classified by axillary treatment: no completion axillary treatment, completion axillary lymph node dissection, regional radiotherapy, or completion axillary lymph node dissection followed by regional radiotherapy. The primary endpoint was 5-year regional recurrence rate. Secondary endpoints included recurrence-free interval and overall survival, among others.ResultsIn total, 1090 patients were included (no completion axillary treatment, 219 (20.1%); completion axillary lymph node dissection, 437 (40.1%); regional radiotherapy, 327 (30.0%); completion axillary lymph node dissection and regional radiotherapy, 107 (9.8%)). Patients in the group without completion axillary treatment had more favourable tumour characteristics and were older. The overall 5-year regional recurrence rate was 1.3%, and did not differ significantly between the groups. The recurrence-free interval was also comparable among groups. The group of patients who did not undergo completion axillary treatment had statistically significantly worse 5-year overall survival, owing to a higher percentage of non-cancer deaths.ConclusionIn this registry study of patients with cT1-2 N0 breast cancer treated with mastectomy, with low-volume sentinel lymph node metastasis, the 5-year regional recurrence rate was low and comparable between patients with and without completion axillary treatment.© The Author(s) 2024. Published by Oxford University Press on behalf of BJS Foundation Ltd.

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