The topic discussed here is of great importance. As the arsenal of multimodal cancer treatment expands, oncologists face the unique challenge of how to manage enduring the adverse effects of the life-saving treatments they dispense. Lymphedema is one of the most common and well-known complications of breast cancer. Even as Halstead’s radical mastectomy devolved during the 20th century with emerging muscle- and skin-sparing techniques, and with recent movement away from complete axillary nodal dissection, BCRL still affects a surprisingly high proportion of patients.
The Z0011 study represented a tectonic shift away from complete axillary lymph node dissection by establishing criteria for definitive sentinel lymph node biopsy. The practice-changing study demonstrated that patients with small, clinically node-negative tumors who underwent breast-conserving surgery, sentinel node biopsy with up to two positive nodes on pathologic review, and adjuvant radiotherapy experienced similar locoregional recurrence and overall survival whether they also underwent complete axillary dissection. A first step in reducing BCRL requires clinicians to fully integrate evidence-based recommendations that limit axillary surgery when appropriate. Furthermore, as data emerge on the variable mortality risk across histologic subtypes and patient populations, researchers must continue refining selection criteria for axillary surgery.
Hence it is well said the prevention is never out of fashion.